As the population ages, the likelihood of diseases such as dementia increases. That means we need to rethink how we design and build cities for the future. A look up close from Lisbon.
LISBON — For Maria Manuela Maia, there are routes in Lisbon that are hard to forget, like the one that connects her home to the parish. But there are others where memory fails her. “Manuela is more or less autonomous,” says Orlando, her husband. “But the problem is when you change streets. Then she no longer knows where our house is.”
That's when she gets lost. And when she meets other elderly, homeless or lonely people, she talks to them. "Need something? You can come to my house and I'll help,” she says, trying to help them. Her husband, Orlando, calms her down: “That gentleman doesn't need anything, don't worry, let's go. Let's walk,” he says, guiding her through the streets.
Maria Manuela and Orlando met more than 50 years ago when Orlando was serving with the troops in Angola. “I corresponded with 22 girls,” he says. Of these 22, I would only choose one: Maria Manuela.
After so many years, the battlefield is now a different one: Alzheimer’s, the most common form of dementia, which leads to a progressive deterioration of cognitive functions. One of them is memory.
Manuela's forgetfulness is not limited to the map of Lisbon. There are times when, looking at her husband who is holding her hand, she asks him: “Who are you?"
Maria Manuela was diagnosed with Alzheimer's when she was about 60 years old. It started slowly, so her husband didn't realize it right away.
Alzheimer's disease takes a steady path, one the Alzheimer Portugal association knows all too well as it fights daily to demystify dementia in the community.
Space and accessibility
In Portugal, INE data indicate that between 2018 and 2080, the number of elderly people will increase from 2.2 to 3 million. According to Pordata, around 128,000 elderly people lived in Lisbon in 2021, 23.5% of the city's population. As you age, the likelihood of developing dementia increases, although cases are increasingly occurring earlier (from around the age of 30).
According to data from the Alzheimer's Association, the probability is 5% for people between 65 and 74 years old; 13% for people between 75 and 84; and 33% for people aged over 85. According to a study published this year, by 2050 it is estimated that there will be around 350,000 people with dementia in Portugal.
At the day care center where Maria Manuela spends her time, the aim is for users to live as part of the community. “The diagnosis of dementia is not a matter of all or nothing; it is a gradual loss of capacities,” says Marisa Mendes, a social worker at the association. “With stimulation and pharmacological intervention, it is possible to put a brake on the disease. And of course, early on, there is autonomy: they take care of their own hygiene and feed themselves…”
But it is not always easy to promote inclusion. On the one hand, there is stigma and ignorance. On the other hand, there is the planning of spaces and accessibility.
Risks of falling
In the 1990s, the world began to wake up to the problem of dementia, with Japan creating the first “communities friendly to people with dementia”.
The idea would eventually reach Europe: England, Wales and Belgium were some of the countries that responded first, training their shopkeepers to deal with people with dementia. And in 2017, London even announced its goal of becoming “the capital of friendly cities for people with dementia”.
In Portugal, efforts were also made. In 2018 the campaign “Friends in Dementia” was launched, an initiative of the Alzheimer Portugal association, with the aim of creating local communities friendly to people with dementia.
But the results were not what they expected with low numbers signing up.
But the problem goes beyond all this. For Marisa Mendes, the big problem is security. “When we go out with users, we have some difficulty in terms of accessibility, and, as some have limited mobility, there is a risk of falling.”
Elderly woman exiting a café in Lisbon, Portugal
According to the World Health Organization, age-friendly cities should include:
- green spaces;
- pedestrian pathways;
- careful and wide walks;
- suitable treadmills;
- separate bike lanes for cyclists;
- nearby services;
- buildings with elevators;
- ramps, handrails, stairs, etc.;
- rest zones;
- public bathrooms.
These are elements that are not always found in the city. Portuguese sidewalks are often in poor condition and susceptible to causing accidents, or the escalators of some metro stops have been inactive for a long time.
Therefore, organizing activities beyond the care center doors is always complicated. Going to museums needs an initial visit.
In 2004, a study published in the Journal of Urban Design looked at the best urban planning solutions for cities “friendly to people with dementia”. It took as a starting point walks with elderly people with and without dementia. The main conclusion: “the exterior must be familiar, legible, distinctive, accessible, comfortable and safe.”
Inside the Lisbon metro
Helping those who forget
Recently, in Dronten, a Dutch city, the issue of urban planning has gone even further. Here, a route adapted for people with dementia was built, connecting a home for users with Alzheimer's to a shopping center.
Without many signs but with clear indications, the sidewalks on this route are all the same and the benches are the same color (green) to be more easily recognizable. In addition, a bike lane was built separately to avoid confusion.
These are adjustments that are not only useful for people with dementia, but for the general population: more space, more benches to rest, more safety for pedestrians.
In Lisbon, nothing seems to be planned yet. For now, Maria Manuela still gets lost on her daily walks: to the supermarket, to her daughters' houses, to the doctor. It is her husband who helps her to find herself again. But one day, perhaps, the streets of Lisbon will also remember those who forget.