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Learn more: PMC Disclaimer | PMC Copyright Notice Gerontologist . 2026 Feb 17;66(5):gnag014. doi: 10.1093/geront/gnag014 Search in PMC Search in PubMed View in NLM Catalog Add to search Exploring the cognitive aspects of walking in the neighborhoods among people living with dementia Joey Oi Yee Wong Joey Oi Yee Wong , MHLP, RN 1 School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada Find articles by Joey Oi Yee Wong 1, ✉ , Habib Chaudhury Habib Chaudhury , PhD 2 Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada 3 Department of Housing and Interior Design, College of Human Ecology, Kyung Hee University, Seoul, South Korea Find articles by Habib Chaudhury 2, 3 , Kishore Seetharaman Kishore Seetharaman , MS, PhD 4 Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada Find articles by Kishore Seetharaman 4 , Cari Randa-Beaulieu Cari Randa-Beaulieu , MA 5 Alzheimer Society of B.C., Vancouver, British Columbia, Canada Find articles by Cari Randa-Beaulieu 5 , Lillian Hung Lillian Hung , PhD, RN 6 School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada Find articles by Lillian Hung 6 , Daizi Davies Daizi Davies , BSc 7 Department of Psychology and Neuroscience, City University of London, London, United Kingdom Find articles by Daizi Davies 7 , Lily Haopu Ren Lily Haopu Ren , MHLP 8 Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada Find articles by Lily Haopu Ren 8 Editor: Andrea Gilmore-Bykovskyi Author information Article notes Copyright and License information 1 School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada 2 Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada 3 Department of Housing and Interior Design, College of Human Ecology, Kyung Hee University, Seoul, South Korea 4 Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada 5 Alzheimer Society of B.C., Vancouver, British Columbia, Canada 6 School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada 7 Department of Psychology and Neuroscience, City University of London, London, United Kingdom 8 Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada ✉ Address correspondence to: Joey Oi Yee Wong, MHLP, RN. E-mail: [email protected] Roles Andrea Gilmore-Bykovskyi : PhD, RN , Decision Editor Received 2025 Aug 9; Accepted 2025 Dec 19; Collection date 2026 May. © The Author(s) 2026. Published by Oxford University Press on behalf of the Gerontological Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected]. PMC Copyright notice PMCID: PMC13078912 PMID: 41701151 Abstract Background and Objectives The population living with dementia has been growing globally. Supportive neighborhood environments are essential for maintaining their autonomy, independence, and social participation. This article explores the cognitive aspects (e.g., attention, task execution, recognition, spatial navigation) of the walking experiences of people living with dementia in neighborhoods, identifying attributes that support and hinder their ability to walk outside the home. Research Design and Methods This qualitative study presents findings based on 26 participants living with mild to moderate dementia in Metro Vancouver, Canada. Each participant (or dyad with care partner) took part in four sessions, encompassing a structured questionnaire, semi-structured sit-down and walk-along interviews with concurrent photo and video documentation. Reflexive thematic analysis was performed. Results Five themes were generated: (1) Comfort of Knowing supported decision making and reduced anxiety, (2) Planning and Coping Strategies mitigated stress, (3) Routines in walking routes and frequency, (4) Paying Attention to prevent injuries, and (5) Use of Technology for independence, motivation, and stimulation reduction. Discussion and Implications The findings underscore the significant role of familiarity and daily routines in supporting independence, the active role people living with dementia play in planning walking routes and coping with challenges, the potential environmental hazards requiring attention, and the emerging role of technology. These insights offer practical implications for policymakers, urban planners, and researchers to design dementia-inclusive neighborhoods, promote volunteer-accompanied walking programs, expand supportive housing options, and develop accessible technologies to enhance safety and autonomy for people living with dementia. Keywords: Cognitive impairment, Qualitative, Multi-methods, Walk-along interviews, Environment Globally, more than 57 million people are living with dementia ( World Health Organization, 2025 ). As of January 2025, it is estimated that 771,939 people in Canada are living with dementia, with more than 400 people developing dementia daily ( Alzheimer Society of Canada, 2025 ). By 2050, more than 1.7 million Canadians are predicted to be living with dementia ( Alzheimer Society of Canada, 2022 ). Sixty-one percent of Canadians living with dementia reside in the community at large ( Canadian Institute for Health Information, n.d. ). Many people living with dementia prefer staying in their communities over moving to age-segregated living arrangements ( Biglieri & Dean, 2024 ; Chippendale & Bear-Lehman, 2010 ). Supporting aging in place requires understanding how neighborhoods either enable or constrain the everyday mobility of people living with dementia, particularly walking, an activity critical for autonomy and well-being ( Wiles et al., 2011 ). Dementia-inclusive neighborhoods can support healthy aging ( Biglieri & Dean, 2024 ) and aim to bring a sense of belonging ( Chaudhury et al., 2021 ), which is known to be important to people living with dementia ( Huizenga et al., 2023 ). As cognitive abilities decline, neighborhood features, both physical and social, can help or hinder autonomy, independence, and social engagement ( Gan et al., 2022 ). The built environment and psychosocial aspects, such as support services of the neighborhood, are significant contributing factors to the quality of life for people living with dementia ( Gan et al., 2022 ). Wayfinding relates to “the process of determining and following a path or route between an origin and destination” ( Golledge, 1999 ). Wayfinding and navigation involve a range of motor, sensory, and cognitive processes to allow for the creation and maintenance of internal representations of the environment and mental maps ( Bock et al., 2024 ; Prevratil et al., 2023 ; Wolbers & Hegarty, 2010 ). Older adults have reported challenges in recalling known routes, identifying landmarks, and wayfinding in new environments ( Davis & Ohman, 2016 ). A decline in wayfinding and spatial cognition has been associated with aging, especially for people living with dementia or mild neurocognitive disorder ( Klencklen et al., 2012 ; Muffato & De Beni, 2020 ; Plácido et al., 2022 ). Supportive environmental cues can provide support with wayfinding ( Wang & Lu, 2022 ). For example, a review specified aspects such as clear signage, distinctive landmarks, and low noise environment can aid navigation ( Marquardt et al., 2014 ). Walking and physical activity can improve cognition in older adults and improve brain health ( Alzheimer Society of Canada, 2022 ; Kang et al., 2021 ; Sáez de Asteasu et al., 2017 ). Walking in natural environments has been associated with better mental well-being ( Duvall, 2011 ). Walking is not only a physical activity, but it also involves significant complex cognitive functions. The abilities of wayfinding and route planning are needed to partake in effective walking activities; changes in these cognitive abilities disrupt walking. For people living with dementia, the changes in cognitive functioning can lead to challenges in spatial navigation, generate feelings of anxiety, and increase the risk of disorientation and getting lost. Even with external support, their perception of the walks in the neighborhoods can impact their attitude and motivation toward walking. This perception can lead to a “negative cycle” where older adults fear walking due to negative past experiences, resulting in a further loss of mobility ( Canadian Institutes of Health Research, 2022 ). This study presented in this article is part of a larger project named “ Dementia-inclusive Spaces for Community Access, Participation, and Engagement (DemSCAPE),” which examined the walking experiences of people living with dementia in their neighborhoods ( Seetharaman et al., 2023 ). This article aims to focus on providing a deeper understanding of the cognitive aspects (e.g., attention, execution of tasks, recognition, spatial navigation) of their walking experiences in the neighborhood, and what factors may be fostering or limiting their mobility. Method Sampling and recruitment Participants were recruited by purposive sampling based on the inclusion criteria: (1) self-declared diagnosis of mild to moderate dementia or mild cognitive impairment (MCI), (2) current residence in the community in Metro Vancouver, and (3) a practice of walking outside regularly or occasionally. The research team approached the participants by (1) promotion flyers distributed to local older adult support groups, dementia support groups, programs at local senior centers and dementia support and advocacy organizations; (2) presentations at dementia support groups; and (3) screening by clinicians at the Centre for Brain Health at the University of British Columbia Hospital Clinic for Alzheimer Disease and Related Disorders (UBCH-CARD), Vancouver. The research team contacted participants identified at the Centre for Brain Health via phone calls. Other participants contacted the research team by email or phone number provided on the flyers and in presentations. The research team then screened these self-approached participants based on the inclusion criteria and followed up with phone calls to confirm recruitment. Twenty-six older adults living with dementia (individual and dyads) were recruited. Two thirds of the participants were White, while others were Asian. The participants were primarily male, with 15 males and 11 females. Most participants were aged 70 or above and with various diagnoses, including MCI, Alzheimer’s disease, vascular dementia, and Lewy Body dementia. Participants were at different stages of dementia, ranging from mild to moderate stages. See Table 1 for the demographic characteristics of the participants. Table 1. Demographic characteristics of participants. Participant Age (at the time of interviews) Gender (M: male, F: female) Race Dementia diagnosis and number of years since diagnosis Other health conditions Care partner involved in data collection (if applicable) City of residence and duration of residence in city (at the time of interviews) P01 84 M White Mild dementia NOS (Year unknown) Hard of hearing N/A Abbotsford (6 years) P02 73 F White Mild MCI (>10) – PC02; spouse Maple Ridge (10 years) P03 87 M White Mild dementia NOS (<1) – PC03; spouse Vancouver (32 years) P04 67 F White Mild atypical frontotemporal (>20) – N/A Richmond (22 years) P05 85 M Mixed race Moderate dementia NOS (year unknown) – PC05; daughter Richmond (5 years) P06 74 M Southeast Asian Mild dementia NOS (>5) – N/A Burnaby (45 years) P07 72 F East Asian Mild MCI (year unknown) – PC07; daughter Vancouver (40 years) P08 80 M White Mild–moderate Alzheimer’s disease (>10) – PC08; spouse Maple Ridge (19 years) P09 73 M White Mild Lewy body (1) Parkinson’s disease PC09; spouse Pitt Meadows (1 year) P10 71 F White Mild–moderate Alzheimer’s disease (10) Bipolar, glaucoma, nasal drip PC10; spouse Richmond (47 years) P11 82 M White Moderate vascular (year unknown) – PC11; spouse West Vancouver (5 years) P12 63 M East Asian Mild–moderate Fahr’s syndrome (8-9) Two stents placed PC20; spouse Burnaby (6 years) P13 80 M White Mild–moderate dementia—unknown type High blood pressure N/A North Vancouver (15 years) P14 87 M East Asian Mild–moderate vascular dementia (>5) High blood pressure, cholesterol, frequent urination PC14; spouse Vancouver (<1 year) P15 61 M East Asian MCI (10) Seizures PC15; spouse Vancouver (24 years) P16 80 F East Asian Mild MCI (15) Cardiac issues, motion sickness, dizziness PC16; spouse Vancouver (20 years) P17 76 F White Mild Alzheimer’s disease (Year unknown) – PC17; spouse Vancouver (21 years) P18 61 M White Mild neurocognitive disorder (1) HIV, depression N/A Vancouver (6 years) P19 77 F White Unknown (>5) – N/A Burnaby (10–15 years) P20 85 M White Mild–moderate Alzheimer’s disease (13) HIV, sciatica N/A Vancouver (22 years) P21 82 F White Mild dementia (5) High blood pressure, reflux, arthritis PC21; spouse North Vancouver (6 years) P22 74 F White Mild Alzheimer’s disease (1) Anxiety, osteoporosis, some joint pain PC22; spouse Tsawwassen (49 years) P23 78 M White Mild to moderate cognitive impairment related to Parkinson’s disease (5) Occasional back pain PC23; spouse North Vancouver (10 years) P24 65 F White Mild to moderate MCI (5) Blood-based autoimmune disorder, COPD, mobility issues N/A Vancouver (10 years) P25 70 M White Mild to moderate Lewy body (12) Seizures and stroke PC25; spouse Vancouver (11 years) P26 85 F Middle Eastern Unknown (year unknown) – PC26; daughter Vancouver (27 years) Open in a new tab Note. COPD = chronic obstructive pulmonary disease; HIV = human immunodeficiency virus; MCI = mild cognitive impairment; NOS = not otherwise specified. Setting Data collection was conducted in Metro Vancouver, British Columbia, Canada. There were four data collection sessions. Besides the third session, data collection was performed in person at a local space (e.g., participants’ homes, local cafés close to their homes, or at the authors’ institution) or virtually on the Zoom web conference platform, depending on the participants’ preference. The third session was conducted outdoors in the participant’s neighborhood. The four data collection sessions will be described in detail in the following section. Data collection Data were collected from June 2022 to November 2022. Each participant took part in four individual or dyad interviews with their care partners depending on the preference of the person living with dementia. Each interview lasted 60 to 90 minutes and were approximately a week apart. The study adopted multiple data collection methods (see Figure 1 ), which were conducted sequentially to allow follow-up and in-depth exploration of participants’ patterns and experiences of walking in their neighborhoods from diverse perspectives. The research assistants who were trained in conducting qualitative interviews had briefing of the interview guides and the use of equipment—related to audio recording for all sessions and walk-along interviews, before the data collection started. Figure 1. Open in a new tab Data collection activities. In the first sit-down interview , two research assistants used a structured questionnaire named ‘Participation in Activities and Places Outside Home (ACT-OUT)’ ( Margot-Cattin et al., 2019 ) to explore and identify the participants’ weekly routines and patterns (when, where, and how) participating in their neighborhoods over time. This survey needed to be conducted in-person to be effective in collecting responses from people living with dementia. Findings of that survey data are not part of the current paper. The first in-person session is also instrumental to build trust and rapport with the participant for subsequent semi-structured interview sessions. In the second sit-down interview , two research assistants conducted a semi-structured interview to examine participants’ attitudes, experiences, perceptions, and preferences for walking in their neighborhoods. Participants also chose and described a walking route in their neighborhood for the third data collection session, a walk-along interview adapted from the go-along interview ( Carpiano, 2009 ). Three research assistants conducted the walk-along interviews . One research assistant walked with the participants in their neighborhoods and asked questions about participants’ perceptions and experiences of the walks. Participants wore either a hat-mounted or chest-mounted GoPro camera with their consent (see Figure 2 ). This camera captured the full walking environment from the vantage point of the participant, and the video data will be presented in a separate paper. If the participant was not comfortable or willing to put the camera on themselves, the research assistant walking beside the participant would hold the camera to video-record and focus on features of the neighborhood environment that the participant spoke about during the walk. The second research assistant walked a few steps behind the participant, taking notes and pictures of environmental features that the participant described or pointed out. The third research assistant walked a few meters behind the participant to video-record the walk-along interview with another camera. Figure 2. Open in a new tab A research assistant with a hat-mounted video camera. In the follow-up sit-down interview , the research assistant preselected clips from the walk-along interview video data for further discussions with the participants based on the video-elicitation method ( Li & Ho, 2019 ; Odzakovic et al., 2020 ) using a set of questions developed based on the identified clips. This session provided the participants the opportunity to “revisit” the site of the walk-along and elaborate on the observations and information they shared during the walk-along interview. For interviews with dyads, some care partners provided additional information on what the participants living with dementia shared during the interviews. See Table 2 for sample interview questions. Seetharaman et al. (2023) and Chaudhury et al. (2025) present a more detailed description of the data collection and interview questions. Table 2. Sample interview questions for the second and third data collection sessions. Data collection session Sample interview questions Second sit-down interview Which places in your neighborhood are you familiar with? Do you walk outside alone? Walk-along interview What problems do you experience while you walk here? How do you decide which way to go? Open in a new tab Data analysis This article analyzes the data collected from our second to fourth data collection sessions. Interview transcripts for these three sessions were generated from the audio recordings using Otter.ai transcription software and cleaned for comprehensibility and legibility by four research assistants. There were three transcripts and one video for each participant/dyad’s data. In total, there were 78 transcripts and 26 videos for the data analysis. Our team used reflexive thematic analysis (TA) to analyze the data collected from the second to fourth interviews ( Braun & Clarke, 2022 ). The team used the NVivo software to support the data analysis process. We followed the six steps of TA ( Braun & Clarke, 2022 ): (1) Four research assistants were assigned a data set and familiarized themselves with the transcripts by reading and re-reading them, along with the video data from the walk-along interview. (2) The four research assistants identified meaningful data segments of their assigned data set and generated initial codes. (3) These research assistants shared the initial codes and discussed and generated initial themes. (4) The research team, including the research assistants and the supervising researchers, reviewed the coded extracts and full dataset with the preliminary themes, collapsed some initial themes, and split some broader themes into new themes. (5) The research team refined and finalized our themes, and (6) the team drafted and edited the findings. See Table 3 for examples of the coding process including extracts of quotes. During the data analysis process and the team discussion sessions, team members critically reflected on the impact of their positionality, backgrounds, and assumptions on how they interpreted the data. Table 3. Coding examples. Themes Sample categories Sample codes Sample quotes Routines Route Going the same route prevents getting lost The need for variety within “routines” “I’ve been in the park, probably two, three dozen times. I know, in my mind where I am. I’d say that there’s no chance of getting lost.” (P09) “You need variety when you walk… So there are different ways of going for walks in here, but we have our routines.” (P10) Time Prefers morning Weather “I have more energy in the morning. The afternoon I like to read and maybe have the odd nap.” (P01) “No, I won’t take the other route even with a weather change.” (P06) Open in a new tab Rigor Data triangulation using different data collection methods, such as semi-structured interviews, surveys, walk-along interviews and video elicitation, enhances the study rigor ( Patton, 1999 ). To ensure analytic triangulation, the research team performed independent coding, discussed strategies to overcome issues encountered during data collection and analysis in team meetings, and documented the steps in data collection using reflexive notes. Research team The research team included a researcher specializing in environmental gerontology and a researcher from nursing, both with multiple years of research experience working with people living with dementia in diverse settings, including people living with dementia in the community. The researchers supervised and mentored four graduate students and an undergraduate student on the team, all of whom brought insights from their diverse backgrounds, including gerontology, nursing, art therapy, psychology, and neuroscience. We collaborated with an older person living with dementia (i.e., patient partner) in our research team to support the study design and data collection preparation phase. He supported the video camera testing and shared his lived experiences and insights regarding the data collection methods, such as the walk-along interviews and the interview questions. Ethical considerations This study received ethics (H21-03552) through the Research Ethics BC Network from the institutional research ethics boards at Simon Fraser University and the University of British Columbia. The study adopted a process consent approach where informed consent (i.e., written consent and ongoing verbal consent) was obtained from participants and/or care partners at the beginning of all interview sessions ( Dewing, 2007 ; Hellström et al., 2007 ; Pesonen et al., 2011 ; Thoft et al., 2021 ). Informed assent was obtained from people living with dementia who could not provide their consent to express their willingness to participate in the study verbally ( Dewing, 2007 ). Their assent was supplemented by informed consent from their care partners. Participation in the project was voluntary, and participants could withdraw from the project at any time. Care partners of some participants were involved in data collection to support participants with engaging in study activities and procedures. Participants were given an honorarium as a token of appreciation. Our patient partner living with dementia supported the research design to ensure the data collection process was inclusive and ethical for the study participants. Other considerations included asking clear and concise questions, offering breaks as needed, and providing reminders before interview appointments and during interviews to recall information. The research team took measures to create a safe space and provide support when participants appeared confused or walked in a direction deviating from the route to get to their chosen destination during the walk-along interview ( Seetharaman et al., 2023 ). Results All 26 older adults living with dementia (individual and dyads) participants completed all interviews. The data analysis generated five themes related to cognitive aspects of walking in the neighborhood for people living with dementia. The themes are (1) Comfort of Knowing, (2) Planning and Coping Strategies, (3) Routines, (4) Paying Attention, and (5) Use of Technology. Comfort of knowing Several participants emphasized the importance of familiarity with their surroundings when walking in their neighborhoods, finding it a source of stability and comfort. Environmental comprehension or understanding of the meaning of a place is a fundamental and necessary step for our participants’ movement in the neighborhood. Participants’ recognition of environmental features, such as streets, shops, and natural elements, is supported through their past associations and familiarity. Many participants expressed that familiarity contributed to reduced anxiety. In an unfamiliar environment, the lack of environmental comprehension could result in disorientation, which brings our participants anxiety and uncertainty, raising concerns about one’s ability to make decisions regarding mobility in the community. A participant shared how an unfamiliar environment generates anxiety, whereas a familiar environment provided a comforting understanding of the path ahead and assurance about where to seek assistance if needed: I’m imagining walking in Vancouver, where I’m unfamiliar, and therefore I’m uncomfortable, and I am anxious about what I am doing. Am I doing the correct thing? And worrying what’s around the corner. Where here, I know pretty well what’s around the corner and where to go for help. (P02, follow-up sit-down interview) This participant’s reflections point out not only how environmental familiarity contributed to their confidence about what to expect when they walked in the neighborhood, but also the knowledge of support from others if needed. The support could potentially be from a person at a familiar coffee shop, convenience store, or library, which reflects the connection of social support with familiar places, that is, social comfort linked with familiar places. One participant associated the importance of familiarity with aging, which suggests a broader significance of the predictability of neighborhood places for older adults: “Old people do not like any change. Familiarity is very important to us” (P26, follow-up sit-down interview). This preference also relates to areas where the participants have spent much time. Familiarity with the environment also aided in wayfinding, as many participants expressed an inherent feeling of knowing the way. This was often expressed as “ mental maps ,” which allowed participants to visualize their route and journey beyond the comfort of knowing where one is at a given time. This “ mental map ” or cognitive map can be relied upon to avoid disorientation and accidents. The perception of familiarity helped some participants reduce the need for signage, as orientation was derived from the individual’s sense of familiarity, routine, and memory. One participant noted how the “ mental map ” supported him to locate where the park was and walk to multiple places in the neighborhood from the park with confidence. A participant mentioned, [Have] your own mental map and then you can decide whether you want to go back into the park or now you’re on a sidewalk. Now you know exactly where you are. You can cross the road and go to one of the gas stations, or you can go up to the library… It’s just all within probably less than two blocks. (P09, follow-up sit-down interview) Planning and coping strategies Planning the walking route is a coping strategy implemented by participants to mitigate stress and anxiety during their walks in the neighborhood. It may result in some of their preference to stay with familiar route options. Also, their route planning prioritized known amenities on the path to reduce stress and discomfort regarding finding suitable support and facilities. Notably, planning their walks in the neighborhood with a preference to be near washrooms is a priority for some participants. One participant indicated that he chose a route around the park closer to his home when planning his walks: I think for [park’s name] is too far away for me. That’s why I only walk around [another park’s name] which is near my home. When I need to go to toilet I can rush home, that’s why it is more convenient for me. (P15, follow-up sit-down interview) Negative emotions, such as fear and anxiety, can be reduced by planning to avoid certain areas in the neighborhood. One participant mentioned, “I don’t walk down [Street Name] anymore … [I feel] scared” (P02, second sit-down interview). Although not all participants voiced the cause of why certain areas triggered feelings of anxiety, they mentioned the importance of feeling safe and secure. Participants stated that they planned their walk during the daytime as it made them feel more secure and less at risk of becoming victims of crime. A participant expressed, “[I prefer walking outside during] daytime… I don’t want to look like a victim or a target. So that’s more likely to be at night rather than at the daytime” (P13, second sit-down interview). The fear of being a victim of a crime may also depend on the sense of security one feels in their neighborhood. This example demonstrates that feelings of security are important in allowing people living with dementia to continue walking in their neighborhood. Some participants shared their plans for unaccompanied or accompanied walks in the neighborhood. A participant shared the preference for having someone with him for safety since a fall experience: “These days any walking I do is being accompanied by someone, which is most often [CP03], or other people that come and help us, as some sort of an eye … I don’t walk—I don’t go for a walk by myself” (P03, second sit-down interview). On the other hand, a few participants preferred unaccompanied walks and less crowded routes. A participant noted the perceived barriers of group walks: “I walk alone. I don’t walk with anybody… there’re too many hassles. Like some people are late and some people walk slow. I can’t walk fast. And then some people want to stop and look at stuff” (P01, second sit-down interview). These experiences reflect the diversity of preferences based on personal choices and circumstances. Instead of focusing on one or the other strategy for enhancing cognitive support, they point out the necessity for a multifaceted approach in social supports and arrangements, and physical environmental aspects. Routines The importance and practice of routines in the walks was a common theme for the participants of this study. The routine was related to the time of day and the chosen routes for the walks. Several participants expressed preference for walking in the morning compared with other times of the day, often due to their higher energy levels and a dislike toward walking in lower lighting conditions. One said, “I have more energy in the morning. The afternoon I like to read and maybe have the odd nap” (P01, second sit-down interview). Multiple participants also demonstrated feeling confident and connected to their everyday routines and experiencing feelings of unease when routines change, mainly the fear of getting lost. Repetition of walking on the same routes also allows for more effective recognition and wayfinding for the participants. One noted, “I’ve been in the park, probably two, three dozen times. I know, in my mind where I am. I’d say that there’s no chance of getting lost” (P09, second sit-down interview). The confidence in the routine walking routes and directions can also be noticed by the care partner walking with the participant. One care partner stated that the participant had difficulty remembering other aspects but could remember the route to the care home they visited twice a week. People living with dementia were also able to point out when they were going in the wrong or different direction on their walk: “If I take her or we go in an unfamiliar route, she will notice she would ask me, ‘Where are we going? This is not the way.’ Most of the times that what she says” (CP26, second sit-down interview). Even with variations in the weather, most participants preferred to stick to their familiar walking routine. A participant firmly expressed: No, I won’t take the other route even with a weather change. Because this [the street for his routine walks] is the shortest route for me, so if I do the main route, which is [street name], that’s much further and a lot busier; traffic- and pedestrian-wise they’re a lot busier. (P06, second sit-down interview) One participant referred to living in a colder climate in the past, feeling confident about continuing to walk in colder weather and maintaining their regular route. However, some noted that the change to colder seasons hinders their ability to continue with their routines and the precautions of warmer clothing and appropriate footwear are needed. A participant shared, “Yeah, I wish I walk the same [in winter]. I would just, if it doesn’t get that cold, I can just dress for the weather, wear rubber boots with a good ground grip” (P01, follow-up sit-down interview). Interestingly, one participant expressed a desire for “variety” while sticking with routines of going to the same location: “We need variety. You need variety when you walk… So there are different ways of going for walks in here, but we have our routines. And we’re used to sticking to our routines” (P10, follow-up sit-down interview). Although this participant had predictable routes of going to destinations in the neighborhood, they appreciated the variety in what can be observed and/or interacted with in the physical and social environments during their journeys. The need for variety may also help people living with dementia stay cognitively engaged in their walk and keep them engaged on their trips. Paying attention Paying attention during their walks to ensure their safety and avoid falls is important for people living with dementia. A few participants mentioned that hazards such as uneven sidewalks, cracks, and potholes could cause accidents if they lose focus. One of them said, “I look at the sidewalk for levels, because sometimes sidewalks have broken concrete or … sidewalks that have ‘up-level’ because of the roots of trees” (P06, second sit-down interview). Narrow sidewalks also require more attention than wide sidewalks. Although falls and accidents create a sense of anxiety, these experiences can also be seen as learning experiences. One participant shared, “I’ve had a number of falls [while walking outside] in the last few years. And I had never fallen prior to the last few years. So, it’s just taught me the hard way to pay attention to things” (P02, follow-up sit-down interview). The physical functioning of participants living with dementia might impact which environmental features need their attention during the walk. Help from a care partner could be useful for some participants to know which aspects along their walks required more attention. Participants also reported difficulties with walking downhill upon noticing an increase in their walking speed: “It’s actually easier to walk when it’s uphill. It’s easier to do than downhill. Because downhill you have to be more careful that you don’t speed up.” (P03, walk-along interview). Being aware of the slope of the walking path allows participants to be consciously aware of and control their speed and reduce the risk of injury. Some participants noted how they paid attention to safety hazards and adjusted their walking path. Attention to the environment was an ongoing activity throughout the walk-along interviews, with variations in the levels based on environmental conditions and participants’ cognitive status. One participant noted how they adjusted their path based on lighting conditions and construction: “When no light, it’s unsafe. If construction, I will move to the other side.” (P05, second sit-down interview). Use of technology Implementing technology in walking activities was reported to have several benefits for people living with dementia. Participants stated that using technology to track and record steps allowed for a sense of achievement. Tracking steps could be a source of motivation for people living with dementia to go on walks. Technology can contribute to peace of mind for participants’ care partners and an increased sense of independence for people living with dementia. Global positioning systems (GPS) tracking applications allow some care partners to instantly know a person’s walking location and activity from a distance. This can allow for more autonomy and agency for people living with dementia, as they can continue walking without relying on the direct presence of a care partner. A participant’s daughter expressed: It’s just the Lifeline with GPS [app] with wandering. We love it. And that’s one of the reasons why we can let him be independent… We don’t have to worry so much and say, Dad, stay home or not go out for a walk , because that’s not what I want him to do. But with this, it helps because we can go find him. (CP05, follow-up sit-down interview) GPS applications can also help people living with dementia navigate their neighborhood on their own. These applications allow people living with dementia to check their planned route before leaving home and during the walks, which can be particularly beneficial when they are unfamiliar with the route. One participant said, “I’m so dependent on—if it’s not a place that I know, I’m just very dependent on Google Maps. Yeah. I’m having to check that” (P18, second sit-down interview). However, one participant living with dementia stated that some individuals with dementia may not be “ computer savvy ,” making the technological aids inaccessible. She suggested, “They probably do have a wayfinder system… probably it needs to be in black and white, so that people like me and others [who are not computer savvy] can clearly understand” (P02, follow-up sit-down interview). Some participants also mentioned the sense of safety from using suitable technology. For example, the ability to have contact with their care partner with the help of phones was favored by many participants and offered as a sense of security. One participant shared: I also have to take the phone because that’s my “contact CP02” … If I can’t get it going, and I need to either find my way someplace, or get to [CP02], and I can’t do it, I will— I’m not afraid to go and ask somebody, “ Could you please phone my husband? ” and I give them my phone. (P02, walk-along interview) A few participants noted reduction of anxiety with the use of wearable technology like headphones. The use of headphones helped manage sensory overstimulation, for example, noise from construction sites and traffic, and helped people living with dementia stay focused on the walk. One participant explained how the headphones supported his walks: Yes, it’s [P06’s headphone has noise cancellation] … that’s why I always put on my mp3 player and my headphones so that it sort of cuts the noise factor. But as you can hear, as you’ve heard, it is very distracting… for a person with dementia, noise is a very big issue … even medium noise could be very annoying or very distracting. (P06, follow-up sit-down interview) The examples showed that having options to deal with loud noise and crowded spaces makes participants’ walks more pleasant and allows them to continue walking in situations that may have been overstimulating, which would otherwise cause them to stop walking early. Discussion This study aimed to explore the lived experiences of persons living with dementia and their care partners to understand the cognitive aspects of walking in the neighborhood. Based on data collected in sit-down and walk-along interviews, five themes were identified. We would argue that some of the themes are highly relevant for people living with dementia, such as the emphasized importance of familiarity of the neighborhood environment, intentional planning, and coping strategies for walking in the neighborhood, the salience of maintaining temporal and spatial routines, and the heightened importance of paying attention while walking. It is worthwhile to note that our participants were not only people living with dementia but also had the intersecting identity of being older adults. Some of these overlap with older adults without dementia ( Močnik et al., 2022 ; Wennberg et al., 2018 ) and those with physical disabilities ( Perry et al., 2021 ; Prescott et al., 2020 ). However, the data from our study show that these themes are particularly salient for the participants, as they relate to challenges of walking in the neighborhoods due to cognitive decline. Our paper emphasizes the experiences and needs of older adults are heightened by the experiences of living with dementia. With limited empirical evidence on this particular topic, this study makes an important contribution in building the evidence base in the Canadian context. Our findings highlighted that familiarity of the neighborhood environment and the adoption of routines were helpful as they aided in wayfinding and provided emotional comfort. The significance of familiar surroundings in the neighborhoods aligned with previous studies exploring environments for people living with dementia ( Gan et al., 2022 ). How familiarity of the environment supports wayfinding is congruent with Wang and Lu’s (2022) study of the built environment providing cues to aid wayfinding. Mental maps mentioned by our participants echoed previous literature in its support in navigation ( Bock et al., 2024 ; Prevratil et al., 2023 ; Wolbers & Hegarty, 2010 ). As the inherent cognitive resource for effective spatial navigation, mental maps help people living with dementia to be less dependent on written information or technological assistance to find their way to destinations in the community. Our findings contribute to understanding how people living with dementia perceive adverse events such as falls and how they might cope with these past negative experiences and make decisions regarding walking outdoors in their neighborhoods after these events. These negative walking experiences would still require participants to be more attentive and might lead to anxiety during their neighborhood walks. Contrary to the literature’s mention of going out less due to fear of falling ( Canadian Institutes of Health Research, 2022 ), most people living with dementia in our study viewed experiences like falls in a constructive way. Our participants treated these episodes as a learning experience and coped with their own mitigation strategies (e.g., route planning, having a walking companion) to avoid similar incidents in the future. Our findings also echoed a recent study regarding the association between marital status and fall worry ( Zhou et al., 2023 ). Participants mentioned how they coped with these adverse incidents with the support of their spouses. This study highlights how people living with mild to moderate dementia actively plan their route and incorporate coping strategies. Echoing a previous study ( Silverman, 2019 ), the active engagement in planning routes and routines demonstrates how people living with dementia sustain their autonomy and identity through walks. Policymakers and professionals, such as city planners, urban designers and transportation engineers, can play an important role in supporting more route options for people living with dementia to plan their walks in the neighborhood. They should acknowledge features and aspects of the neighborhood that contribute to comfortable, supportive, and safe walking routes for people living with dementia and the physical and social environmental features that create anxiety, confusion, and a sense of insecurity. Positive features shared by our participants include the availability of specific amenities, such as accessible public washrooms, and well-lit and even walking paths. Although not specific to older adults living with dementia, studies on intergenerational public spaces highlighted the role of clean and accessible public washrooms in supporting and prolonging older adults’ outdoor physical activities ( Moran et al., 2014 ; Hartt & Vincent, 2024 ). Urban planners and community organizations can partner with the law enforcement department to learn about the crime-related concerns of people living with dementia. This collaboration can help develop relevant strategies and community education programs to foster a sense of safety for people living with dementia, reassure them to walk comfortably and plan walking routes in their neighborhoods. Our participants also shared strategies for combatting the environmental changes and maintaining their walks such as wearing appropriate clothing and shoes in diverse weather conditions. Their sharing also suggested that their past experiences played a role in their ability to handle changes in routines and preferences during walks. Besides individual coping strategies, future research can examine organizational or system-level strategies to support routine walks for people living with dementia in diverse weather conditions. For example, city planners can build covered and nonslippery paths and indoor spaces for walking and ensure the availability of transportation to access these walking areas. There are examples of infrastructure promoting older adults’ mobility in cities, such as Singapore, where sheltered walkways and nonslippery paving tiles help mitigate walking in unfavorable weather conditions ( Močnik et al., 2022 ). When designing indoor walking spaces (e.g., underground spaces and shopping malls), designers need to consider the potential of overstimulation for people living with dementia due to confined spaces with various stimuli ( Zacharias & Wang, 2021 ). A few participants in our study appreciated accompanied walks to continue their walking routines and maintain social connections with their neighbors. Accompanied walking programs for people living with dementia, supported by trained volunteers, are known to help relieve caregiver stress ( Kohler et al., 2021 ). Besides providing respite for care partners, these accompanied walks also have the potential to support people living with dementia to explore a variety of walking routes while feeling a sense of safety. For example, regular walking groups for people living with dementia could serve as a supportive strategy that neighborhood and community organizations may implement. Future research can explore the impacts, facilitators, and barriers to implementing and sustaining these community-based volunteer-accompanied walking programs. Our participants shared how various technologies, such as GPS, wayfinding applications, wearable technologies supporting step counting, and noise-cancellation headphones, could allow them to maintain independence in their walks and enhance their walking experiences. The findings suggest that these technologies can also support participants in having a tangible goal (e.g., aiming for a certain number of steps) adds to the purpose and motivation to walking and allows tracking of walking habits. Participants and care partners focused more on how technology was beneficial in supporting the autonomy, values and preferences of people living with dementia, including a sense of safety and comfort, providing orientation cues and a sense of achievement during their walks. The use of GPS applications can potentially support people living with dementia to safely access and explore more places. These applications can also reduce their reliance on care partners in help with navigation and reassurance that they can be found, in the event they get lost or disoriented ( Doyle et al., 2024 ). Supporting people living with dementia with appropriate technologies can potentially extend the time they can continue going out on their own and maintaining independence. The participants did not raise ethical concerns about using these technologies that are discussed in the literature, such as infringement on privacy and human rights ( Cooper et al., 2021 ). A care partner suggested extra considerations when designing these technologies for people living with dementia. Dementia-inclusive technology may also be needed to allow individuals to feel comfortable using the technology and implementing it into walking routines. There should be further research and partnerships between people living with dementia, researchers, and technology developers to ensure the technologies supporting outdoor walks are more tailored, affordable, and accessible to people living with dementia. For example, the wayfinding apps can include features, such as locations of public washrooms, properly lighted and sheltered walkways to support route planning by people living with dementia. Training is necessary to build confidence and increase the comfort level of people living with dementia and their care partners in using these technologies to support walking routines and enhance their quality of life. Strengths and limitations A key strength of this study is to engage a person with lived experiences in the research team to ensure the data collection process was inclusive to people living with dementia. The study adopted multiple data collection methods to support the participants living with dementia to share their perspectives. The walk-along method centered the direct voices of people living with dementia and captured in-the-moment experiences of people living with dementia in our findings. By doing this, this article advocates for an understanding of the value of their experiences grounded in real life scenarios of walking in the outdoor environment. We also used video-elicited methods to support the recall of experiences by people with dementia in the follow-up sit-down interviews. All participants resided in urban and suburban areas in a Western context. The findings may not fully apply in remote, rural, and other regions in the world. Moreover, the study did not explore how diverse cultural backgrounds, different stages and types of dementia, and socioeconomic status might impact the cognitive aspects of participants’ walking experiences in their neighborhoods. We included walk-along interviews as one of our data collection methods which required participants to be able to walk outside their homes. This might potentially exclude the perspectives of individuals who wished to walk, but were unable due to significant mobility limitations. Conclusion This study contributes to advancing our understanding of the cognitive aspects (e.g., attention, execution of tasks, recognition, spatial navigation) of walking in the neighborhood among people living with dementia. The findings underscore how familiarity with the neighborhood environment can support independence, the active role people living with dementia play in planning their walks and coping with challenges, the importance of routine, the components of walks in the neighborhoods that require attention, and the emerging role of technology. The study offers conceptual and pragmatic insights for policymakers, urban planners, and researchers to explore the provision of dementia-inclusive walking spaces, housing options in neighborhoods, volunteer-accompanied walking programs, and wayfinding technology that supports safe walks. Understanding the cognitive aspects of the walking experiences of people living with dementia can support the creation of effective and meaningful dementia-inclusive neighborhoods and encourage people living with dementia to continue engaging in walks and social participation in their communities. Acknowledgments We would like to acknowledge all older adults living with dementia and care partners in providing their insights on the research. We would also like to acknowledge our colleague Janissa Altona for her valuable contributions to the editing of this manuscript. Contributor Information Joey Oi Yee Wong, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. Habib Chaudhury, Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada; Department of Housing and Interior Design, College of Human Ecology, Kyung Hee University, Seoul, South Korea. Kishore Seetharaman, Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada. Cari Randa-Beaulieu, Alzheimer Society of B.C., Vancouver, British Columbia, Canada. Lillian Hung, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. Daizi Davies, Department of Psychology and Neuroscience, City University of London, London, United Kingdom. Lily Haopu Ren, Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada. Funding This work was supported by the Public Health Agency of Canada (Dementia Strategic Fund: Awareness Raising Initiatives), the Alzheimer Society of Canada (Alzheimer Society Research Program), and the Alzheimer Society of B.C. 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