Skip to main content

Neighbourhoods and dementia in the health and social care context: a realist review of the literature and implications for UK policy development

  • John Keady (a1), Sarah Campbell (a1), Helen Barnes (a1), Richard Ward (a1), Xia Li (a2), Caroline Swarbrick (a1), Simon Burrow (a1) and Ruth Elvish (a1)...

The National Dementia Strategy in England has performed an essential role in transforming health and social care services and improving the commissioning architecture. However, to date, little attention has been paid to understanding the ways in which the outdoor and built environment impacts and intersects with the lives of people with dementia and their carers. One way of better understanding the outdoor and built environment is through a focus on the ‘neighbourhood’ as this is an area of public policy where attempts are being made across disciplines to unpack its meanings, significance and identity. This paper adopts a realist review method to detail the key findings and messages from the body of work that links the experience of living with dementia to the neighbourhood. Our findings from this review are assimilated and defined/presented under three headings, namely: outdoor spaces, built environment, and everyday technologies. These headings and our definitions are not discrete properties and there is some overlap in content. We found no research that sets out to enquire about how people with dementia might define their neighbourhood or that explores everyday neighbourhood practices for those living with the condition. Emerging concepts such as citizenship and, in the UK, the Coalition Government advancement of the ‘Big Society’, promote a vision of civic responsibilities and networked, dementia-capable communities, but evaluation of such initiatives are virtually absent from the literature. The review did uncover some interesting and innovative research methods that extend neighbourhood working, such as the ‘walking interview’. In order to develop a neighbourhood model for dementia, future research should examine the relationship and interaction between the neighbourhood as a social space and as a physical space alongside the active role of people with dementia as ‘place-makers’.

Corresponding author
Address for correspondence: John Keady, Professor of Older People's Mental Health Nursing, Dementia and Ageing Research Team, School of Nursing, Midwifery and Social Work, University of Manchester, University Place (Room 6.321), Oxford Road, Manchester M13 9PL, UK. Email:
Hide All
1Blackman, T, Mitchell, L, Burton, E, Jenks, M, Parsons, M, Raman, S, Williams, K. The accessibility of public spaces for people with dementia: a new priority for the ‘open city’. Disability Society 2003; 18: 357–71.
2Price, R, Keady, J. Systematic review: role of health promotion in vascular dementia. J Nursing Healthcare Chronic Illness 2010; 2: 88101.
3Ward, R, Campbell, S, Keady, J. Friends for Life: a local evaluation of the one year (2010–2011) peer support project for people with dementia in Salford. Manchester: The University of Manchester; 2011.
4Mayeux, R. The neighbourhood as the laboratory: Looking for answers by knocking on doors. Alzheimer Disease Assoc Disorders 2007; 21: 272–75.
5Gibson, G, Chalfont, G, Clarke, P, Torrington, J, Sixsmith, A. Housing and connection to nature for people with dementia: findings from the INDEPENDENT Project. J Housing Elderly 2007; 21: 5572.
6Gomez, LF, Parra, DC, Buchner, D, Brownson, RC, Sarmiento, OL, Pinzon, JD, Ardila, M, Moreno, J, Serrato, M, Lobelo, F. Built environment attributes and walking patterns among the elderly population in Bogotá. Am J Preventive Med 2010; 38: 592–99.
7Alzheimer's Society. Dementia UK: A report into the prevalence and cost of Dementia, prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at Kings College London for the Alzheimer's Society. London: Alzheimer's Society; 2007.
8National Audit Office. Improving Dementia Services in England – an Interim Report. London: The Stationery Office; 2010.
9Department of Health. Living Well with Dementia: A National Strategy. London: Department of Health; 2009.
10Luengo-Fernande, R, Leal, J, Gray, A. The economic burden of dementia and associated research funding in the United Kingdom. London: Alzheimer's Research Trust; 2010.
11Wimo, A, Prince, M. Alzheimer's Disease International World Alzheimer Report 2010: The Global Economic Impact of Dementia. Available at: (accessed 27 October 2011).
12Prince, M, Bryce, R, Ferri, C. World Alzheimer Report 2011: The benefits of early diagnosis and intervention. Available at: (accessed 27 October 2011).
13Banerjee, S.The use of antipsychotic medication for people with dementia: Time for action – A report for the Minister of State for Care Services. London: HMSO; 2009.
14Cabinet Office. Building the Big Society. Available at: (accessed 27 October 2011).
15Goodchild, C, Rippon, S. Dementia and the Big Society: Report from Think Tank 16th February 2011. London: Department of Health; 2011.
16Pawson, R, Greenhalgh, P, Harvey, G, Walshe, K. Realist review – a new method of systematic review designed for complex policy interventions. J Health Services Res Policy 2005; 10 (suppl 1): 2134.
17Clegg, S. Evidence-based practice in educational research: a critical realist critique of systematic review. Br J Sociol Education 2005; 26: 415–28.
18O'Campo, P, Kirst, M, Schaefer-McDaniel, N, Firestone, M, Scott, A, McShane, K. Community-based services for homeless adults experiencing concurrent mental health and substance use disorders: a realist approach to synthesizing evidence. J Urban Health Bulletin NY Acad Med 2009; 86: 965–89.
19Blackman, T.Placing health: neighbourhood renewal, health improvement and complexity. Bristol: The Policy Press; 2006.
20Molyneux, P.This is somewhere I want to stay. The Voluntary Sector's contribution to place-shaping. York: Joseph Rowntree Foundation; 2007.
21Clark, A. From neighbourhood to network: a review of the significance of neighbourhood in studies of social relations. Geography Compass 2009; 3: 1559–78.
22Cumberlege, J.Neighbourhood nursing – a focus for care. Report Community Nursing Rev. London: HMSO; 1986.
23Reinhard, SC, Christopher, MA, Mason, DJ, McConnell, K, Rusca, P, Toughill, E. Promoting healthy communities through neighborhood nursing. Nursing Outlook 1996; 44: 223–28.
24Miller, D.The Comfort of Things. London: Polity Press; 2008.
25De Silva, MJ, McKenzie, K, Harpham, T, Huttly, SR. Social capital and mental illness: a systematic review. J Epidemiol Community Health 2005; 59: 619–27.
26Forrest, R, Kearns, A. Social cohesion, social capital and neighbourhood. Urban Studies 2001; 38: 2125–43.
27Gray, A. The social capital of older people. Ageing Society 2009; 29: 531.
28Ross, CE. Neighborhood disadvantage and adult depression. J Health Social Behavior 2000; 41: 177–87.
29Abbott, P, Sapsford, R. Living on the margins. Policy Studies 2005; 26: 2946.
30Kruger, DJ, Reischl, TM, Gee, GC. Neighborhood social conditions mediate the association between physical deterioration and mental health. Am J Community Psychol 2007; 40: 261–71.
31Ziersch, AM, Baum, FE, MacDougall, C, Putland, C. Neighbourhood life and social capital: the implications for health. Social Sci Med 2005; 60: 7186.
32Warr, D, Feldman, P, Tacticos, T, Kelaher, M. Sources of stress in impoverished neighbourhoods: insights into links between neighbourhood environments and health. Australian New Zealand J Public Health 2009; 33: 2533.
33Diez Roux, AV, Mair, C. Neighborhoods and health. Annals NY Acad Sci 2009; 1186: 125–45.
34Wen, M, Browning, CR, Cagney, KA. Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. Social Sci Med 2003; 57: 843–60.
35Warr, DJ. Social networks in a ‘discredited’ neighbourhood. J Sociol 2005; 41: 285308.
36Kitwood, T.Dementia Reconsidered: The Person Comes First. Buckingham: Open University Press; 1997.
37Kitwood, T. The experience of dementia. Aging Mental Health 1997; 1: 1322.
38Bartlett, R, O'Connor, D. From personhood to citizenship: broadening the lens for dementia practice and research. J Aging Studies 2007; 21: 107–18.
39Bartlett, R, O'Connor, D. Broadening the Dementia Debate: Towards social citizenship. Bristol: The Policy Press; 2010.
40Behuniak, SM. Toward a political model of dementia: power as compassionate care. J Aging Studies 2010; 24: 231–40.
41Department of Health. Healthy Lives, Healthy People: our strategy for public health in England. London: Department of Health; 2010.
42Faculty of Public Health. Working to improve the public's health: White paper response – Key points. London: Faculty of Public Health of the Royal Colleges of Physicians of the United Kingdom; 2011.
43Crane, M, Warnes, AM. The outcomes of re-housing older homeless people: a longitudinal study. Ageing Society 2007; 27: 891918.
44Scharf, T, Phillipson, C, Smith, AE, Kingston, P. Growing older in socially deprived areas. Social exclusion later in life. London: Help the Aged; 2008.
45Tribe, R, Lane, P, Heasum, S. Working towards promoting positive mental health and well-being for older people from BME communities. Working with Older People 2009; 13: 3540.
46World Health Organisation. Ottawa Charter for Health Promotion: First International Conference on Health Promotion. Ottawa: World Health Organisation; 1986.
47World Health Organisation. The Bangkok Charter for Health Promotion in a Globalised World. Copenhagen: World Health Organisation; 2005.
48World Health Organisation. A discussion document on the concepts and principles of health promotion. Health Promotion International 1986; 1: 7376.
49Eriksson, M, Lindstrom, B. A salutogenic interpretation of the Ottawa Charter. Health Promotion International 2008; 23: 190–99.
50Mitchell, L, Burton, E, Raman, S, Blackman, T, Jenks, M, Williams, K. Making the outside world dementia-friendly: design issues and considerations. Environment and Planning B: Planning and Design 2003; 30: 605–32.
51Burton, E, Mitchell, L. Inclusive Urban Design: streets for life. London: Elsevier; 2006. (E-book available at:; accessed 27 October 2011).
52Sheehan, B, Burton, E, Mitchell, E. Outdoor wayfinding in dementia. Dementia: Int J Social Res Practice 2006; 5: 271–81.
53Brittain, KR, Corner, L, Robinson, L, Bond, J. Ageing in place and technologies of place: The lived experience of people with dementia in changing social, physical and technological environments. Sociology Health Illness 2010; 32: 272–87.
54Joseph Rowntree Foundation. The Older People's Inquiry: ‘That little bit of help’. York: Joseph Rowntree Foundation; 2005.
55Sugiyama, T, Ward Thompson, C. Outdoor environments, activity and the well-being of older people: conceptualising environmental support. Environment Planning 2007; 39: 1943–60.
56Duggan, S, Blackman, T, Martyr, A, Van Schaik, P. The impact of early dementia on outdoor life: A ‘shrinking world’? Dementia: Int J Social Res Practice 2008; 7: 191204.
57Blackman, T, Van Schaik, P, Martyr, A. Outdoor environments for people with dementia: an exploratory study using virtual reality. Ageing Society 2007; 27: 811–25.
58Brorsson, A, Öhman, A, Lundberg, S, Nygård, L. Accessibility in public space as perceived by people with Alzheimer's disease. Dementia: Int J Social Res Practice 2011; 10: 587–602.
59Mitchell, L, Burton, E. Neighbourhoods for life: designing dementia-friendly outdoor environments. Quality Ageing: Policy, Practice Res 2006; 7: 2633.
60Mitchell, L. Neighbourhoods for life: the outdoor environment. J Dementia Care 2007; 15: 3637.
61Mitchell, L, Burton, E. Designing dementia-friendly neighbourhoods: helping people with dementia to get out and about. J Integrated Care 2010; 18: 1219.
62Yevchak, AM, Loeb, SJ, Fick, DM. Promoting cognitive health and vitality: a review of clinical implications. Geriatric Nursing 2008; 29: 302–10.
63Clare, L. Awareness in people with severe dementia: review and integration. Aging & Mental Health 2010; 14: 2032.
64Day, R. Theorizing growing and being older: connecting physical health, well-being and public health. Local environments and older people's health: dimensions from a comparative qualitative study in Scotland. Health Place 2008; 14: 299312.
65Blackstock, KL, Innes, A, Cox, B, Smith, A, Mason, A. Living with dementia in rural and remote Scotland: diverse experiences of people with dementia and their carers. J Rural Studies 2006; 22: 161–76.
66Berke, EM, Gottlieb, LM, Moudon, AV, Larson, EB. Protective association between neighborhood walkability and depression in older men. J Am Geriatrics Soc 2007; 55: 526–33.
67Cheston, R, Bender, M. Understanding Dementia: The Man with the Worried Eyes. London: Jessica Kingsley; 2009.
68Van Schaik, P, Martyr, A, Blackman, T, Robinson, J. Involving persons with dementia in the evaluation of outdoor environments. CyberPsychology Behaviour 2008; 11: 415–24.
69Mitchell, L, Burton, E, Raman, S. Dementia-friendly cities: designing intelligible neighbourhoods for life. J Urban Design 2004; 9: 89101.
70Sheller, M, Urry, J. The new mobilities paradigm. Environ Planning A 2006; 38: 207–26.
71Hall, T. Footwork: moving and knowing in local space(s). Qualitative Res 2009; 9: 571–85.
72Emmel, N, Lark, A. The methods used in Connected Lives: investigating networks, neighbourhoods and communities. London: ESRC National Centre for Research Method; 2009.
73Carpiano, R. Come take a walk with me: The ‘Go-Along’ interview as a novel method for studying the implications of place for health and well-being. Health Place 2009; 15: 263–72.
74Chalfont, G.Design for Nature in Dementia Care. London: Jessica Kingsley; 2007.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Reviews in Clinical Gerontology
  • ISSN: 0959-2598
  • EISSN: 1469-9036
  • URL: /core/journals/reviews-in-clinical-gerontology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed