Exploring the awareness of changes in outdoor mobility and the influence of the neighbourhood environment among people living with dementia in British Columbia, Canada

• Exploring people’s awareness of age and disease related changes (AADRC) offers unique insights into how people living with dementia form experiential knowledge. • The transition into living with dementia is marked by changing mobility-related needs and priorities, and adapting to changing walking abilities to maintain out-of-home activity. • People living with dementia become increasingly aware of physical and social risk factors in the neighbourhood environment and adapt their outdoor walking routines to mitigate the effects of these risk factors. • Understanding how the neighbourhood built environment influences AADRC is useful to anchor dementia-inclusive urban design and planning (UDP) initiatives in the goals, values, preferences, and experiences of people living with dementia. • A dementia-inclusive neighbourhood environment 1) supports the desires, motivations, and needs of people living with dementia to be mobile in the community, 2) recognizes their vulnerabilities and agency, and promotes mutual caring practices, 3) minimizes the prevalence and impact of factors triggering their fears and anxieties, and 4) seeks their counsel in developing measures to augment inclusivity. Fostering an inclusive neighbourhood environment is a critical part of the social responsibility to support people living with dementia to participate in community activities and maintain autonomy, identity, health, and wellbeing. Dementia scholars and advocates have emphasized the need to understand how people living with dementia interact with and adapt to the neighbourhood environment. This understanding will inform dementia-inclusive policy and practice to create enabling physical and social environments. The present study explores the experiential knowledge of people living with dementia gained through their awareness of age and disease-related changes, perceptions of the neighbourhood environment, and adaptive processes to maintain outdoor walking. Sequential semi-structured sit-down and video-documented go-along interviews were conducted with 14 people living with mild to moderate dementia in Metro Vancouver, British Columbia. Thematic analysis produced two themes: 1) Awareness of needing to adapt to changing abilities to walk in the neighbourhood, and 2) Heightened awareness of risk factors and influence of neighbourhood environment on outdoor mobility adaptations. Recognizing people’s awareness and adaptive responses, and cultivating relational understandings of the agency and capacities of people living with dementia are integral to creating inclusive neighbourhood environments that enhance the capabilities for participation in the community.