Flying solo: A review of the literature on wayfinding for older adults experiencing visual or cognitive decline

Applied Ergonomics 58 (2017) 327e333

Contents lists available at ScienceDirect

Applied Ergonomics journal homepage: www.elsevier.com/locate/apergo

Review article

Flying solo: A review of the literature on wayfinding for older adults experiencing visual or cognitive decline Sheila J. Bosch a, *, Arsalan Gharaveis b a b

University of Florida, Department of Interior Design, College of Design, Construction and Planning, 348 ARCH, PO Box 115705, Gainesville, FL, 32611, USA Texas A&M University, Langford Architecture Building, 3137 TAMU, College Station, TX, 77843-3137, USA

a r t i c l e i n f o

a b s t r a c t

Article history: Received 2 June 2015 Received in revised form 16 July 2016 Accepted 18 July 2016

Accessible tourism is a growing market within the travel industry, but little research has focused on travel barriers for older adults who may be experiencing visual and cognitive decline as part of the normal aging process, illness, or other disabling conditions. Travel barriers, such as difficulty finding one's way throughout an airport, may adversely affect older adults' travel experience, thereby reducing their desire to travel. This review of the literature investigates wayfinding strategies to ensure that older passengers who have planned to travel independently can do so with dignity. These include facility planning and design strategies (e.g., layout, signage) and technological solutions. Although technological approaches, such as smart phone apps, appear to offer the most promising new solutions for enhancing airport navigation, more traditional approaches, such as designing facilities with an intuitive building layout, are still heavily relied upon in the aviation industry. While there are many design guidelines for enhancing wayfinding for older adults, many are not based on scientific investigation. © 2016 Published by Elsevier Ltd.

Keywords: Wayfinding Airport design Older adults

Contents 1. 2.

3. 4. 5.

6. 7. 8.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 Finding one's way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 2.1. Wayfinding overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 2.2. Aging and wayfinding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 2.2.1. Visual decline and wayfinding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 2.2.2. Cognitive decline and wayfinding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 5.1. Facility planning and design strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 5.1.1. Environmental cues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 5.1.2. Floor plan typology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 5.2. Technology solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330 Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332

* Corresponding author. E-mail address: [email protected]fl.edu (S.J. Bosch). http://dx.doi.org/10.1016/j.apergo.2016.07.010 0003-6870/© 2016 Published by Elsevier Ltd.

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“The ability to find one's way, known as wayfinding, is essential for maintaining independence in the world” eDavis & Weisbeck, 2015.

1. Introduction Accessible tourism is a growing market within the travel industry, as well as an interesting area of academic investigation. Defined as a form of tourism that enables people with access needs (e.g., visual, cognitive, hearing, mobility) to travel independently, with dignity, through the benefits of universal design (Michopoulou et al., 2015), accessible tourism is one approach for increasing travel activity. However, we have a limited understanding of the travel barriers experienced by older adults, who represent an increasing portion of the global population and often have access needs. People 65 and older frequently experience challenges due to sensory or cognitive decline. As we age, we often experience physical (Gazova et al., 2013) and cognitive limitations (Yamamoto and DeGirolamo, 2012) due to the normal aging process or the incidence of illness, resulting in worsening eyesight, reduced mobility and/or declining cognitive function that may affect our ability to travel independently. One important factor influencing our travel independence is our ability to navigate from one place to another. 2. Finding one's way 2.1. Wayfinding overview As humans, we revel in our independence. Whether wishing to travel from the bedroom to the bathroom or from Iceland to Peru, a lack of confidence in one's own navigational capabilities may decrease a person's eagerness to travel. Air travel typically requires the ability to navigate large, busy airports and often results in frustration and confusion for older adults with access needs. Airports can promote accessible tourism by utilizing effective wayfinding systems that address the special needs of older air travelers. Although wayfinding is a complex concept, in general, it is the process of accessing a building, navigating through it to a given destination using the best route, and then retracing the process to leave the building (Castell, 2012; Wiener et al., 2009; Brush and Calkins, 2008). Finding a target during a wayfinding task involves movement choices at a series of decision points (Frankenstein et al., 2012). Wayfinding is related to the ability of individuals to explore the environment, as well as learn and remember a route, with the purpose of relocating from one place to another in a large-scale space (Kitchin, 1994). Good wayfinding requires information processing and decision making, whether in a familiar or an unfamiliar environment (Arthur and Passini, 1992). Excellent airport wayfinding systems will likely result in lower anxiety and confusion, and possibly in an increased desire by older adults to travel by air. The primary goal of wayfinding design is to clearly provide essential information for people that will enhance their ability to navigate within a building's environment (Passini, 1984). 2.2. Aging and wayfinding Research on older travelers and how best to meet their wayfinding needs is a relatively new field of investigation. Older travelers are prone to conditions such as Alzheimer's disease, cardiovascular diseases, osteoporosis, diabetes, and other ailments that can adversely affect one's ability to navigate (Lee et al., 2012),

and older age has been linked to a decline in spatial cognition (Klencklen et al., 2012). Whether due to normal or pathological aging, our spatial learning and memory decline over the years (Yamamoto and DeGirolamo, 2012). After about age 60, spatial navigation decrement becomes apparent and accelerates after age 70 (Gazova et al., 2013). Older adults tend to learn new routes more slowly, navigate less efficiently, and make more wayfinding errors than younger adults (Newman and Kaszniak, 2000). Older adults have a lower accuracy of spatial navigation (Bates and Wolbers, 2014), and they tend to adopt different navigation strategies than younger adults (Wiener et al., 2013), perhaps due to degeneration of the hippocampus, which is believed to play a significant role in allocentric (i.e., cognitive map or place strategy) spatial processing (Rodgers et al., 2012). Two notable conditions affecting older adults' wayfinding capacity include deteriorating vision and cognitive abilities. 2.2.1. Visual decline and wayfinding The normal aging process causes a number of changes in vision that may affect wayfinding. These include reduced visual acuity, a narrowing of the visual field, reduction of contrast sensitivity, increased prevalence of cataracts, blurred vision, and increased
n et al., 2014). Older adults are less able to discriminate glare (Nyle between colors that are similar, experience a reduction in the size of their pupils, need higher light illumination, and have more
n et al., 2014). trouble reading information at a close distance (Nyle Approximately 10% of adults age 85 and up are legally blind and more than 20% experience low vision (Brabyn et al., 2000). The likelihood of developing macular degeneration and other conditions that cause visual decline increases as we age. There is much work to be done to ensure that older travelers with visual decline can easily access the information they need to navigate airports safely and efficiently by themselves. 2.2.2. Cognitive decline and wayfinding Older age is the single greatest risk factor for developing cognitive impairment, which affects more than 16 million people in the United States (Centers for Disease Control, 2011), with more than 5 million suffering from Alzheimer's disease, the most commonly occurring form of cognitive impairment. Cognitive impairment is associated with difficulties remembering things, learning new information, making day-to-day decisions, and navigating built environments. Cognitive aging affects wayfinding in older adults, both in terms of orientation and navigation (Bates and Wolbers, 2014). In fact, navigational impairment is often one of the earliest symptoms of dementia and may contribute to diagnosis of the disease (Moffat et al., 2001). Some studies have investigated the underlying causes of wayfinding problems associated with Alzheimer's-type dementia  et al., 2014; Marquardt, 2011; Yamamoto and DeGirolamo, (Caffo 2012). Researchers demonstrated that persons with Alzheimer's were unable to plan a solution to a fairly complex wayfinding problem, which caused them to function in a more “incremental and sequential fashion” (p. 687) from one decision point to the next (Passini et al., 2000). And, they had difficulty distinguishing relevant information from irrelevant information to assist in navigation. Persons with advancing dementia are more dependent upon a compensating environment than those without dementia (Marquardt and Schmieg, 2009). 3. Objective With age-induced spatial navigation decline, heightened by visual and/or cognitive decrements, it is important for airports to develop comprehensive, supportive wayfinding programs to

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promote travel independence. The planning and design of airports and the use of specific technologies can have positive impacts on the ability of older adults to find their way around. The purpose of this literature review is to identify suitable wayfinding strategies for use in airports to enhance the air travel experiences of older adults who have diminished visual and/or cognitive abilities. It is recognized that persons with advanced stages of dementia or other debilitating cognitive disorders should not travel by air without a companion. This study is not intended to provide a comprehensive review of the literature, but rather to identify practical, evidencebased wayfinding solutions for implementation by airport designers and operators. The research question specifically addressed is, “What facility planning and design strategies and technological solutions may enhance older adults' ability to navigate airports safely and independently to improve their travel experience?” 4. Methods A literature review was conducted in accordance with the PICO method for formulating a research question and developing a search strategy (Table 1). An initial search of the literature was conducted using several databases, including PsycInfo, PubMed, GoogleScholar, and SAGE Journals. A variety of key word combinations were utilized, and articles were selected for further review if the publication addressed elements of the physical environment (including technology) AND wayfinding AND older adults OR persons with visual or cognitive challenges. For example, in PsycINFO, this search string was used: (DE “Geriatrics” OR “Older adult*” OR senior* OR elder* OR “senior citizen*”) AND (DE “Wayfinding” OR Wayfinding OR “way finding” OR navigat*) Note: DE ¼ Subjects. Review of the acquired articles' reference lists and hand-searching identified additional potentially relevant articles. Inclusion and exclusion criteria:  Articles were limited to those published in full-text, in English, between 1985 and 2016.  The title and abstract of the articles were included or excluded from further analysis based on their relevance for informing wayfinding strategies for older adults.  Studies that included subjects that were not older adults were included if the facility planning and design strategies or technologies investigated were reasonably applicable to older adults with diminished vision or cognitive ability.  Peer-reviewed publications were included in the analysis, but some nonpeer-reviewed articles provided background and context. More than 200 potentially relevant articles were identified initially and their full texts were obtained, but only 12 of those provided evidence-based wayfinding solutions relevant for older adults with diminished visual or cognitive abilities. 5. Results 5.1. Facility planning and design strategies Older adults tend to rely heavily on other persons to help them plan their route to a new destination (Marquez et al., 2015), yet the environment itself is also important. When people search for a destination in an unfamiliar environment, they are more reliant upon external information (i.e., in the world) than on internal information (i.e., in their head) (Vilar et al., 2014). Therefore, distinguishing characteristics, such as color or landmarks that draw attention to important points, may support older travelers in

329

Table 1 The PICO method was used to frame the search strategy. P

Patients, population or problem

I

Intervention(s)

C O

Comparison of Interventions Outcome to Measure or Achieve

Older adults age 65þ; persons with reduced vision or cognitive abilities Facility planning and design; Technology NA Wayfinding

navigating an airport that may be new to them. Passini et al. (1995) demonstrated that older persons were often unable to develop an overall plan for a wayfinding task and relied extensively on visible architectural information. There are two distinct types of architectural information that may be used to improve wayfindingdenvironmental cues (e.g., signage, furniture, color, lighting) and floor plan typology (Marquardt, 2011). 5.1.1. Environmental cues Marquez et al. (2015) emphasized that signage must be consistently available, legible, and systematic to support wayfinding. Although not recommended as a primary wayfinding support strategy, signage is an important means of communicating wayfinding information to those who have at least some level of sight. Signage should be placed within the field of vision of older adults, who tend to look down at the floor while navigating (Namazi and Johnson, 1991). Persons with dementia may no longer be able to read, and some researchers have suggested using pictograms on signage to convey directional information, rather than text (Marquez et al., 2015). Color is an environmental cue that has been shown to help people navigate an unfamiliar environment by helping them structure areas within the space (Jansen-Osmann and Wiedenbauer, 2004). Interior color coding of buildings has been associated with fewer wayfinding errors and improved spatial acquisition among adults exposed to large-scale, unfamiliar environments (Evans et al., 1980). Color can be used as a reference point to differentiate certain types of spaces from others, which is important for improving wayfinding in a newly encountered building interior (Baskaya et al., 2004). There is good evidence that colorful cues and color coding different rooms improves wayfinding among older adults in residential facilities (Davis and Therrien, 2012; Mazzei et al., 2014), but it may not be appropriate to generalize these findings to novel environments, such as airports, that may be unfamiliar to older travelers. Hidayetoglu et al. (2012) indicated that participants perceived cool-colored spaces to be more easily navigable than warm or neutral-colored spaces. Lighting that is sufficiently bright for older adults is important for helping them see and interpret their environments. There is evidence that ambient light should be at least 500 lx, and light supplying as much as 2000 lx is suggested for areas where activities occur (Marquardt, 2011). With respect to the general impact of lighting, it is believed that with appropriate and specifically bright lighting, the wayfinding process will be more successful (Gharaveis et al., 2016; Hidayetoglu et al., 2012; Vilar et al., 2012). Hidayetoglu et al. (2012) demonstrated that bright lighting is perceived to be more navigable than low or medium brightness levels. Gharaveis et al. (2016) found daylighting to be an important environmental factor supporting older adults' activities, including navigating through buildings. 5.1.2. Floor plan typology A user's initial wayfinding behavior is affected more by the visual configuration of the space, or floor plan typology, than by

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visible signage (Carpman et al., 1985) and other environmental cues. Passini et al. (2000) found that if the architectural composition of the environment is monotonous and repetitive, wayfinding is more difficult for patients with Alzheimer's disease. Other studies support the importance of layout complexity for navigation (O'Neill, 1991; Slone et al., 2015). Devlin (2014) identified plan configuration and manifest cues as significant factors affecting wayfinding success that should be used to inform design decisions. Elevators were identified as a prominent source of wayfinding challenges, as were obstructions in the corridors, which should be avoided. To assist persons with dementia and enhance wayfinding, an environment should be clearly articulated and differentiated, providing reference points that are distinctive and that can be remembered or recognized. Environmental wayfinding strategies for older adults work best when they occur in combination and address multiple senses (Marquardt, 2011). Many environments, even those designed specifically for older adults, are ineffective at supporting travel independence (Davis et al., 2008). Design guidelines for improving wayfinding are abundant, yet there have been relatively few empirical studies investigating the effect of specific planning and design strategies on the wayfinding behavior of older adults. Most readily available information is based on best practice recommendations rather than scientific evidence. 5.2. Technology solutions There have been many advances in the area of technology-based wayfinding aids for older adults with reduced vision or cognitive capabilities. Through the years, several different types of systems have been tested for improving indoor wayfinding for persons with limited vision or blindness, such as light beacons (e.g., Talking Signs), radio frequency (RF) beacons, radio frequency identification (RFID), and retroreflective digital signs. Tian, Yang, Yi, and Arditi (2013) developed an algorithm in order to facilitate the wayfinding process for the visually impaired population, which defines environmental cues, edges, and corners. To address visual disability, common methods of relaying information include speech (synthesized or recorded), simple audio (beeping rate/Geiger counter approach), spatialized sound that appears to come from a landmark's direction, listening for the maximum volume, and tactual displays (Coughlan and Manduchi, 2009). Using these approaches, auditory cues may be received as sounds are emitted from specific landmarks or points of decision, which might be difficult to hear in a busy airport. Cues may also be received through a device worn by an individual, which often supports the use of headphones so the sounds do not annoy or disturb others. Smart phones have become popular devices for enhancing wayfinding for persons with low vision or blindness because they are relatively small, portable, and inexpensive. Although not yet published in the peer-reviewed literature, the authors are aware that some airports are pilot testing Bluetooth, smart phone-based systems using iBeacons that deliver real-time information to travelers as they walk by certain points where the iBeacons are deployed. Using an iOS device (e.g., iPhone or iPad), travelers receive information from a series of location-aware beacons (i.e., transmitters) to help them find gates, ATMs, restrooms, power outlets, and information desks without additional assistance. Smart phones will likely be the chosen technology for providing wayfinding assistance in the near future (Dias et al., 2015), with assistive robots perhaps gaining prominence in the longer term. For persons with a cognitive disability, advanced technologies hold great promise in supporting travel independence. Virtual environments (VEs) offer a way to provide exploration and learning

about environments with fewer constraints than real-world environments, and knowledge gained in VEs has been shown to successfully translate into equivalent real-life places (Mengue-Topio et al., 2011). Other advances include assistive devices, such as the smart walker, developed by the Devices for Assisted Living (DALi) project, which is funded by the European Commission. The walker is enhanced with rather inconspicuous devices that enable it to sense the environment and choose the best path across a space to be navigated, and it boasts “mechanical, visual, acoustic and haptic guidance devices (to guide the person along the path)” (Palopoli et al., 2015, p. 1). Chang et al. (2010) built and evaluated a passive RFID wayfinding support system for persons who are cognitively disabled. RFID tags were placed at key points of decision, such as intersections. The system was comprised of RFID tags and readers, a personal digital assistant (PDA), and a routing engine. In addition, the system was capable of providing “unique-to-the-user” (p. 1) prompts to assist in navigation. Although the sample size was small (n ¼ 6), researchers demonstrated that passive RFIDs were effective in triggering navigation prompts (i.e., path guidance images). Still, their successful use in context-aware wayfinding tasks will likely depend on the type and level of disability, route complexity, training received, and distractions the user may encounter along the path. When communicating directions to persons with limited cognitive ability, there is no one-size-fits-all preferred format for receiving information (e.g., audio, photographic), so it might be most important that a navigation system be customizable by the user (Liu et al., 2008). Some research has indicated that photobased information using landmarks may be more effective for older adults than typical paper-based navigation aids (Goodman et al., 2005). But, strategies utilizing video-based prompts to enhance wayfinding have been shown to be even more effective than picture-based prompts (Chang and Wang, 2010). Emerging technologies will likely offer travelers with cognitive disabilities the option to customize the way in which they receive wayfinding support, according to their own unique needs and abilities. 6. Conclusions It has become apparent during this review of the literature that while there is a fair amount of literature regarding the physiological reasons as to why older adults often experience wayfinding difficulties, there is limited peer-reviewed research that investigates either technology-based solutions or facility planning and design strategies to improve navigation. Strategies to enhance wayfinding identified in this review are listed in Table 2. Planning and design strategies identified include lowering signage to enhance reading by older adults who tend to look downward as they walk, providing signage that is consistently available, systematic and legible, using signage with pictures, reducing visual clutter, and providing sufficiently bright lighting. Technology solutions include RFID-based systems, talking signs, systems combining GPS and GIS, camera-based devices, verbal landmarks, smart walkers, and training people to navigate virtual environments prior to entering the “real” environment. The use of virtual environments in wayfinding research seems to be gaining in popularity among researchers, as several wayfinding studies conducted in virtual environments were identified. 7. Discussion Perhaps the most promising solutions for improving older adults' ability to find their way are technology-based, although the

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331

Table 2 Strategies to promote wayfinding for visually or cognitively impaired older adults. Strategy

Visual

Cognitive

Reference

Use cues that are colorful (as opposed to black and white) and familiar (not abstract) Place signage lower so that older adults, who tend to look down, can see them Avoid visual clutter to facilitate comprehension of visual information Provide sufficiently bright lighting Wayfinding strategies should be combined to address multiple senses Signage must be legible, systematic, and consistently available The use of pictures on signs may help persons with cognitive limitations navigate the environment Technology Solutions

X X X X X X

X

Davis and Therrien, 2012 Namazi and Johnson, 1991 Passini et al., 1995 Marquardt, 2011 Marquardt, 2011 Marquez et al., 2015 Castell, 2012,a

Light beacons Radio frequency (RF) beacons Photo or video-based information regarding landmarks RFID Retroreflective digital signs Virtual environments prior to navigating in “real” environments Verbal landmarks Global positioning system coupled with geographical information systems Camera-based portable device for wayfinding Talking signs Smart walkers Optical character recognition (OCR) e Algorithm

X X X X X

X X X X

Facility Planning & Design Strategies

a

X X X X X X

X X X X

X X X X X X

Coughlan and Manduchi, 2009,a Coughlan and Manduchi, 2009,a Goodman et al., 2005; Chang and Wang, 2010a Coughlan and Manduchi, 2009,a; Chang et al., 2010,a Coughlan and Manduchi, 2009,a Rose et al., 2002,a Bentzen and Mitchell, 1995,a Coughlan and Manduchi, 2009,a Coughlan and Manduchi, 2009,a Bentzen and Mitchell, 1995,a Palopoli et al., 2015 Tian et al., 2013

These studies were not conducted exclusively on older adults and may not have had older adults in the sample.

most popular currently-deployed technologies were not found in the peer-reviewed literature. For example, there has been growth in the development of Bluetooth-based iBeacons, as deployed in the Dallas Fort Worth and the San Francisco International Airports, to help blind and visually impaired passengers navigate the airports independently. Other early adopters of similar systems include retail establishments, theaters, museums, Heathrow Airport in London, and even Major League Baseball, which installed iBeacons in 28 of its ball parks. There are some barriers for the comprehensive use of technological devices to enhance wayfinding. Older adults with vision and memory disabilities “were less likely to use technology compared with those without these disabilities” (Gell et al., 2013, p.7). But, it is important to remember that there are different generations within the older population, including the “younger seniors”. Other challenges with relying on technologies include economic barriers to acquiring technology, and educational and ergonomic issues related to using technology that may affect this population (Satariano et al., 2014). One of the greatest challenges with technology itself is the suboptimal capabilities of current localization techniques, which can likely be overcome through the use of sensors and crowdsourcing that have universal appeal to persons with and without sensory or cognitive disabilities (Dias et al., 2015). As smart phones and tablets proliferate the market, even among older adults, there are perhaps more ways than ever before to ensure that older travelers with diminished vision and cognitive ability travel safely, independently, and confidently to their intended destinations. Other wearable devices, such as Google Glass, may allow users to access crowdsourced photo-based descriptions. Watches that vibrate can provide important alerts regarding decision points and navigation errors, and when linked with smart phones can provide an easy-to-use interface for entering commands. While it is likely that these and other emerging technologies will be published in peer-reviewed publications in the near-term, these are outside the scope of this review. Although technology is becoming increasingly important, more traditional approaches to wayfinding, such as designing facilities with an intuitive building layout, are still heavily relied upon in the

aviation industry. With any new airport construction or renovation project, the needs of older persons with disabling conditions must be considered, and the design team should include at least one person who is familiar with designing for their needs. Capital construction projects provide rich opportunities to design an airport so that it is easy to navigate and is highly accessible to older travelers, supporting their independence. Of course, there are many ways to improve wayfinding, even when construction is not planned. From updating signage to the incorporation of new technologies, there are many opportunities to create traveler-centered environments. With the growth of accessible tourism, those who operate airports and airlines increasingly recognize that improving the travel experience for older adults may improve not only their image, but also their bottom line. 8. Limitations This review of the literature regarding wayfinding strategies to improve the air travel experience of older adults with visual and/or cognitive decline is limited by resource constraints. A more comprehensive, systematic approach to the literature review might have uncovered additional relevant studies that evaluate specific wayfinding strategiesdeither facility planning and design or technology solutions. Additionally, there are other types of wayfinding support strategies, such as assigning a member of the airport staff to assist older travelers, not captured in this specific review. One of the greatest limitations of this study is that because it included peer-reviewed literature only in the analysis, the most current and perhaps the most promising technological wayfinding solutions, such as iBeacons, were not part of this review. Acknowledgements This literature review was conducted as part of a larger project funded by the Transportation Research Board, Airport Cooperative Research Program, “Enhancing Airport Wayfinding for the Elderly and Persons with Disabilities” (ACRP 07-13). Many thanks to Jim Harding, Gresham, Smith and Partners, Laurel van Horn, Open Doors Organization, and other team members, including Aurora

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Engineers, IBM, the University of South Florida and the Georgia Institute of Technology. The ACRP did not direct the study design nor participate in the collection, analysis, or interpretation of data, or the writing of this literature review. References Arthur, P., Passini, R., 1992. Wayfinding: People, Signs, and Architecture. McGrawHill Books, New York. € Baskaya, A., Wilson, C., Ozcan, Y.Z., 2004. Wayfinding in an unfamiliar environment: different spatial settings of two polyclinics. Environ. Behav. 36 (6), 839e867. http://dx.doi.org/10.1177/0013916504265445. Bates, S.L., Wolbers, T., 2014. How cognitive aging affects multisensory integration of navigational cues. Neurobiol. Aging 35 (12), 2761e2769. http://dx.doi.org/ 10.1016/j.neurobiolaging.2014.04.003. Bentzen, B.L., Mitchell, P.A., 1995. Audible signage as a wayfinding aid: verbal landmark versus talking signs. J. Vis. Impair. Blind. 89 (6), 494. € m-Portnoy, G., Lott, L.A., Schneck, M.E., 2000. Visual imBrabyn, J.A., Haegerstro pairments in elderly people under everyday viewing conditions. J. Vis. Impair. Blind. (JVIB) 94 (12). Brush, J.A., Calkins, M.P., 2008. Cognitive impairment, wayfinding, and the longterm care environment. Perspect. Gerontol. 13 (2), 65e73. http://dx.doi.org/ 10.1044/gero13.2.65. , A.O., Hoogeveen, F., Groenendaal, M., Perilli, V.A., Damen, M., Stasolla, F., Caffo Bosco, A., 2014. Comparing two different orientation strategies for promoting indoor traveling in people with Alzheimer's disease. Res. Dev. Disabil. 35 (2), 572e580. http://dx.doi.org/10.1016/j.ridd.2013.12.003. Carpman, J.R., Grant, M.A., Simmons, D.A., 1985. Hospital design and wayfinding: a video simulation study. Environ. Behav. 17 (3), 296e314. http://dx.doi.org/ 10.1177/0013916585173002. Castell, L., 2012. Adapting building design to access by individuals with intellectual disability. Australas. J. Constr. Econ. Build. (AJCEB) 8 (1). Retrieved from. http:// epress.lib.uts.edu.au/journals/index.php/AJCEB/article/view/2994/3177. Centers for Disease Control, 2011. Cognitive Impairment: a Call for Action, Now. Retrieved from. https://www.cdc.gov/aging/pdf/cognitive_impairment/ cogimp_poilicy_final.pdf. Chang, Y.J., Peng, S.M., Wang, T.Y., Chen, S.F., Chen, Y.R., Chen, H.C., 2010. Autonomous indoor wayfinding for individuals with cognitive impairments. J. Neuroeng. Rehabil. 7 (1), 45. http://dx.doi.org/10.1186/1743-0003-7-45. Chang, Y.J., Wang, T.Y., 2010. Comparing picture and video prompting in autonomous indoor wayfinding for individuals with cognitive impairments. Pers. Ubiquitous Comput. 14 (8), 737e747. http://dx.doi.org/10.1007/s00779-0100285-9. Coughlan, J., Manduchi, R., 2009. Functional assessment of a camera phone-based wayfinding system operated by blind and visually impaired users. Int. J. Artif. Intell. Tools 18 (3), 379e397. Davis, R.L., Therrien, B.A., 2012. Cue color and familiarity in place learning for older adults. Res. Gerontol. Nurs. 5 (2), 138e148. http://dx.doi.org/10.3928/ 19404921-20111004-01. Davis, R.L., Therrien, B.A., West, B.T., 2008. Cue conditions and wayfinding in older and younger women. Res. Gerontol. Nurs. 1 (4), 252e263. http://dx.doi.org/ 10.3928/19404921-20081001-06. Davis, R.L., Weisbeck, C., 2015. Search strategies used by older adults in a virtual reality place learning task. Gerontology 55 (Suppl. 1), S118eS127. http:// dx.doi.org/10.1093/geront/gnv020. Devlin, A.S., 2014. Wayfinding in healthcare facilities: contributions from environmental psychology. Behav. Sci. 4 (4), 423e436. http://dx.doi.org/10.3390/ bs4040423. Dias, M.B., Steinfeld, A., Dias, M.B., 2015. Future directions in indoor navigation technology for blind travelers. In: Karimi, Hassan A. (Ed.), Indoor Wayfinding and Navigation. CRC Press, Boca Raton, FL, pp. 203e226. Evans, G.W., Fellows, J., Zorn, M., Doty, K., 1980. Cognitive mapping and architecture. J. Appl. Psychol. 65 (4), 474e478. € lscher, C., 2012. The language of landFrankenstein, J., Brüssow, S., Ruzzoli, F., Ho marks: the role of background knowledge in indoor wayfinding. Cogn. Process. 13 (Suppl. 1), 165e170. http://dx.doi.org/10.1007/s10339-012-0482-8.
, J., Rubinova, E., Mokrisova, I., Hyncicova, E., Andel, R., Hort, J., 2013. Gazova, I., Laczo Spatial navigation in young versus older adults. Front. Aging Neurosci. 5 http:// dx.doi.org/10.3389/fnagi.2013.00094. Gell, N.M., Rosenberg, D.E., Demiris, G., LaCroix, A.Z., Patel, K.V., 2013. Patterns of technology use among older adults with and without disabilities. Gerontology. http://dx.doi.org/10.1093/geront/gnt166. Gharaveis, A., Shepley, M.M., Gaines, K., 2016. The role of daylighting in skilled nursing short-term rehabilitation facilities. Health Environ. Res. Des. J. (HERD) 9 (2), 105e118. http://dx.doi.org/10.1177/1937586715607835. Goodman, J., Brewster, S.A., Gray, P., 2005. How can we best use landmarks to support older people in navigation? Behav. Inf. Technol. 24 (1), 3e20. http:// dx.doi.org/10.1080/01449290512331319021. Hidayetoglu, M.L., Yildirim, K., Akalin, A., 2012. The effects of color and light on indoor wayfinding and the evaluation of the perceived environment. J. Environ. Psychol. 32 (1), 50e58. http://dx.doi.org/10.1016/j.jenvp.2011.09.001.

Jansen-Osmann, P., Wiedenbauer, G., 2004. Wayfinding performance in and the spatial knowledge of a color-coded building for adults and children. Spatial Cognition Comput. 4 (4), 337e358. http://dx.doi.org/10.1207/ s15427633scc0404_3. Kitchin, R.M., 1994. Cognitive maps: what are they and why study them? J. Environ. Psychol. 14 (1), 1e19. http://dx.doi.org/10.1016/S0272-4944(05)80194-X.
s, O., Dufour, A., 2012. What do we know about aging and Klencklen, G., Despre spatial cognition? Reviews and perspectives. Ageing Res. Rev. 11 (1), 123e135. http://dx.doi.org/10.1016/j.arr.2011.10.001. Lee, B.K., Agarwal, S., Kim, H.J., 2012. Influences of travel constraints on the people with disabilities' intention to travel: an application of Seligman's helplessness theory. Tour. Manag. 33 (3), 569e579. http://dx.doi.org/10.1016/ j.tourman.2011.06.011. Liu, A.L., Hile, H., Kautz, H., Borriello, G., Brown, P.A., Harniss, M., Johnson, K., 2008. Indoor wayfinding: developing a functional interface for individuals with cognitive impairments. Disabil. Rehabil. Assistive Technol. 3 (1e2), 69e81. http://dx.doi.org/10.1080/17483100701500173. Marquardt, G., 2011. Wayfinding for people with dementia: a review of the role of architectural design. Health Environ. Res. Des. (HERD) 4 (2), 75e90. http:// dx.doi.org/10.1177/193758671100400207. Marquardt, G., Schmieg, P., 2009. Dementia-friendly architecture: environments that facilitate wayfinding in nursing homes. Am. J. Alzheimer's Dis. Other Dement. 24 (4), 333e340. http://dx.doi.org/10.1177/1533317509334959. Marquez, D.X., Hunter, R.H., Griffith, M.H., Bryant, L.L., Janicek, S.J., Atherly, A.J., 2015. Older adult strategies for community wayfinding. J. Appl. Gerontol. http:// dx.doi.org/10.1177/0733464815581481. April 13, 2015. Mazzei, F., Gillan, R., Cloutier, D., 2014. Exploring the influence of environment on the spatial behavior of older adults in a purpose-built acute care dementia unit. Am. J. Alzheimer's Dis. Other Dement. 29 (4), 311e319. http://dx.doi.org/ 10.1177/1533317513517033. Mengue-Topio, H., Courbois, Y., Farran, E.K., Sockeel, P., 2011. Route learning and shortcut performance in adults with intellectual disability: a study with virtual environments. Res. Dev. Disabil. 32 (1), 345e352. http://dx.doi.org/10.1016/ j.ridd.2010.10.014. Michopoulou, E., Darcy, S., Ambrose, I., Buhalis, D., 2015. Accessible tourism futures: the world we dream to live in and the opportunities we hope to have. J. Tour. Futur. 1 (3), 179e188. http://dx.doi.org/10.1108/JTF-08-2015-0043. Moffat, S.D., Zonderman, A.B., Resnick, S.M., 2001. Age differences in spatial memory in a virtual environment navigation task. Neurobiol. Aging 22 (5), 787e796. http://dx.doi.org/10.1016/S0197-4580(01)00251-2. Namazi, K.H., Johnson, B.D., 1991. Physical environmental cues to reduce the problems of incontinence in Alzheimer's disease units. Am. J. Alzheimer's Dis. Other Dement. 6 (6), 22e28. http://dx.doi.org/10.1177/153331759100600605. Newman, M.C., Kaszniak, A.W., 2000. Spatial memory and aging: performance on a human analog of the Morris water maze. Aging, Neuropsychol. Cognition 7 (2), 86e93. http://dx.doi.org/10.1076/1382-5585(200006)7:2;1-U;FT086.
n, P., Favero, F., Glimne, S., Tea €r Fahnehjelm, K., Eklund, J., 2014. Vision, light and Nyle aging: a literature overview on older-age workers. Work J. Prev. Assess. Rehabil. 47 (3), 399e412. http://dx.doi.org/10.3233/WOR-141832. O'Neill, M.J., 1991. Effects of signage and floor plan configuration on wayfinding accuracy. Environ. Behav. 23 (5), 553e574. http://dx.doi.org/10.1177/ 0013916591235002. Palopoli, L., Argyros, A., Birchbauer, J., Colombo, A., Fontanelli, D., Legay, A., Sedwards, S., 2015. Navigation assistance and guidance of older adults across complex public spaces: the DALi approach. Intell. Serv. Robot. 8 (2), 77e92. http://dx.doi.org/10.1007/s11370-015-0169-y. Passini, R., 1984. Spatial representations, a wayfinding perspective. J. Environ. Psychol. 4 (2), 153e164.
treault, M.-H., 2000. Wayfinding in a nursing Passini, R., Pigot, H., Rainville, C., Te home for advanced dementia of the Alzheimer's type. Environ. Behav. 32 (5), 684e710. http://dx.doi.org/10.1177/00139160021972748. Passini, R., Rainville, C., Marchand, N., Joanette, Y., 1995. Wayfinding in dementia of the Alzheimer type: planning abilities. J. Clin. Exp. Neuropsychol. 17 (6), 820e832. http://dx.doi.org/10.1080/01688639508402431. Rodgers, M.K., Sindone, J.A., Moffat, S.D., 2012. Effects of age on navigation strategy. Neurobiol. Aging 33 (1), 202.e15e202.e22. http://dx.doi.org/10.1016/ j.neurobiolaging.2010.07.021. Rose, F.D., Brooks, B.M., Attree, E.A., 2002. An exploratory investigation into the usability and usefulness of training people with learning disabilities in a virtual environment. Disabil. Rehabil. 24 (11/12), 627e633. Satariano, W.A., Scharlach, A.E., Lindeman, D., 2014. Aging, place, and technology: toward improving access and wellness in older populations. J. Aging Health 26 (8), 1373e1389. http://dx.doi.org/10.1177/0898264314543470. Slone, E., Burles, F., Robinson, K., Levy, R.M., Iaria, G., 2015. Floor plan connectivity influences wayfinding performance in virtual environments. Environ. Behav. 47 (9), 1024e1053. http://dx.doi.org/10.1177/0013916514533189. Tian, Y., Yang, X., Yi, C., Arditi, A., 2013. Toward a computer vision-based wayfinding aid for blind persons to access unfamiliar indoor environments. Mach. Vis. Appl. 24 (3), 521e535. http://dx.doi.org/10.1007/s00138-012-0431-7. Vilar, E., Rebelo, F., Noriega, P., 2014. Indoor human wayfinding performance using vertical and horizontal signage in virtual reality. Hum. Factors Ergon. Manuf. Serv. Ind. 24 (6), 601e615. http://dx.doi.org/10.1002/hfm.20503. Vilar, E., Teixeira, L., Rebelo, F., Noriega, P., Teles, J., 2012. Using environmental affordances to direct people natural movement indoors. Work 41, 1149e1156. http://dx.doi.org/10.3233/WOR-2012-0295-1149.

S.J. Bosch, A. Gharaveis / Applied Ergonomics 58 (2017) 327e333 €lscher, C., 2009. Taxonomy of human wayfinding Wiener, J.M., Büchner, S.J., Ho tasks: a knowledge-based approach. Spatial Cognition Comput. 9 (2), 152e165. http://dx.doi.org/10.1080/13875860902906496. Wiener, J.M., de Condappa, O., Harris, M.A., Wolbers, T., 2013. Maladaptive bias for extrahippocampal navigation strategies in aging humans. J. Neurosci. 33 (14),

333

6012e6017. http://dx.doi.org/10.1523/JNEUROSCI.0717-12.2013. Yamamoto, N., DeGirolamo, G.J., 2012. Differential effects of aging on spatial learning through exploratory navigation and map reading. Front. Aging Neurosci. 4 http://dx.doi.org/10.3389/fnagi.2012.00014.