Features of the social and built environment that contribute to the well-being of people with dementia who live at home: A scoping review.

This scoping review summarizes findings from 23 qualitative articles on how social and built environments contribute to the well-being of people with dementia who live at home. Through thematic analysis, two themes were identified: i) connection to society and supportive relationships and ii) interaction with natural environments and public space. Features of the social and built environment contribute to well-being both positively and negatively. Future research should explore how these features intersect in an urban-rural context as a basis to inform the development of dementia-friendly initiatives. Moreover, involving people with dementia in the design of features of built environments, such as infrastructure, will result in more inclusive communities.


Introduction
As the population ages, more people with dementia will live at home and less will be cared for in institutional settings (Ansah et al., 2017;Macdonald and Cooper, 2007). Dementia is a syndrome connected with deterioration in memory, thinking, behavior and the ability to perform everyday activities (WHO, 2018). Alzheimer's disease is the most common type of dementia, accounting for approximately 80% of cases (Alzheimer's Association, 2019). The probability of developing all types of dementia increases with age from 1% at age 60 to 40% at age 85 (Bolla et al., 2000). However, the prevalence rate is likely under-friendly initiatives are being implemented to improve their quality of life. Communities, which consist of both social and built features, can become dementia-friendly by adapting practices, such as providing person-centered care, dementia awareness education and implementing environmental design principles. Such practices can enhance the quality of life for people with dementia (Hebert and Scales, 2017). To ensure that dementia-friendly communities empower and meet the needs of people with dementia, a best practice is to include the perceptions of individuals with dementia who live at home as a basis to develop effective programs and policy (Han et al., 2016;Morrisby et al., 2018;. To this end, community-led initiatives such as workshops or community forums, can identify the structural elements of a community which can be mobilized to create a dementia-friendly community (Courtney-Pratt et al., 2018). Such structural elements may include community cohesion and local health services.
The well-being of people with dementia can be positively influenced through environmental design (Day et al., 2000). There is extensive research on how design interventions in both long-term care and home environments, such as layout and access to outdoor and social spaces, impact the level of engagement and well-being of people with dementia (Chaudhury et al., 2018;Cohen-Mansfield et al., 2011;Motealleh et al., 2019;Soilemezi et al., 2019). However, the impact of dementia-friendly environmental design on the quality of life, improved functioning or well-being of people with dementia, has yet to be fully evaluated (Hebert and Scales, 2017;Shah et al., 2016). Further, there is critique that dementia-friendly initiatives tend to focus on attributes of the built environment, as opposed to the social environment, and guidelines used to measure the environment are based on institutional research and not applicable to community-settings (Førsund et al., 2018;Hebert and Scales, 2017;Lin and Lewis, 2015). Despite the crucial role that social and built environments play in dementia-friendly initiatives, there is a gap in the literature in understanding the impact of these features on well-being, from the perspectives of people living with dementia (Hebert and Scales, 2017). Therefore, the purpose of this scoping review is to summarize and identify gaps what is known about how people with dementia who live at home perceive the social and built environment, outside the home, and how features of these environments contribute to their well-being.

Methods
The scoping review method used for this article is based on the framework developed by Arksey and O'Malley (2005). This five-stage iterative approach is suited to mapping broad topics and a variety of study designs to clarify key concepts and identify gaps. This method is appropriate for dementia research where the research is wide-ranging and multi-disciplinary. A scoping review identifies gaps in the research with a range of study designs and beyond studies related to intervention effectiveness (Levac et al., 2010;Peters et al., 2015). To ensure the quality of this review, we referred to the methodological guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) (Appendix 1) (Tricco et al., 2018). A protocol for this review has not been registered.

Research question
The research question guiding this review is "How do people with dementia who live at home perceive the features of the social and built environment, outside the home, and how do these environments contribute to their well-being?" The articles selected for review had to meet the following inclusion criteria: i) people with dementia were the target population of the study; ii) the perceptions of people living with dementia were included; iii) described a social and/or built environment in a community setting; iv) peer-reviewed with no limits on the type of study (editorials and commentaries were excluded); v) published in English.
To ensure that the perceptions of the people with dementia were captured in an ethical manner, only peer-reviewed literature was considered. This is based on the assumption that all published research would have met ethical standards. Articles were excluded if the research was conducted in a medical or long-term care setting or if the focus was on people with a broader category of diseases, such as chronic conditions or mental health or disabilities.

Search strategy and study selection
The literature search was conducted by one of the authors (DSP) using the following electronic databases: Scopus, PubMed, PsycINFO, and Web of Science. We searched for empirical, peer-reviewed articles published between January 2005 and May 2019. The search strategy was based on a combination of terms, using Boolean operators 'AND' and 'OR' (see Appendix 2). Additional searches were made by citation chaining. Citation alerts and Google Scholar alerts, based on the key words, were also used to update the search until March 2020.
The initial electronic database search identified 955 citations which were merged into a common Excel file. Duplicates were removed, resulting in 696 unique citations. The titles and abstracts were initially screened by the first author and further assessed by an additional author (LM) resulting in 11 articles which met the inclusion criteria. Additionally, 14 articles were identified through a citation chaining process and four more by citation alerts. A full text review of these 29 articles resulted in a shortlist of 23 articles. As recommended by Levac et al. (2010), the first five articles of the shortlist were further screened by the second author (SN) to confirm that the selected articles were consistent with the research question. Fig. 1 summarizes the search and selection process.

Data extraction and analysis
The first author assessed the selected articles and charted in Excel with information on: lead author, year, location, research aim, methodology, sample description and main findings.
We present the findings of this scoping review in two ways. First, a summary of the study characteristics of the articles according to the year of publication, research location, sample size and age range plus participant eligibility criteria. Second, we used a thematic approach, as detailed by Green and Thorogood (2004), to analyze the findings and results of the selected articles, which we then present in a narrative account. For the articles that concerned with a mix of research Table 1 Key concepts and definitions.

TERM DEFINITION
Dementiafriendly "A cohesive system of support that recognizes the experiences of the person with dementia and best provides assistance for the person to remain engaged in everyday life in a meaningful way" (Davis et al., 2009, p.187;p.187) Built environment The physical structures and elements of the human made environments in which we live, work, travel, and play. Such environments include houses, parks, streets, shopping centers, and transit stations (Frank and Engelke, 2005) Social environment Locally situated relationships and contact with family, friends and the general public (Odzakovic et al., 2019) Well-being The balance between resources and challenges that can be affected by life events. Well-being is stabilized when individuals have psychological, social and physical resources to offset challenges. (Dodge et al., 2012) participants (e.g., caregivers), only the data collected from those with dementia were included in the analysis. The first author carried out a thematic analysis with the use of Atlas.ti (8.4.24) software. An open coding scheme was used to generate codes which were further organized into themes and sub-themes. The second author also coded the first five articles to validate the themes and sub-themes. Differences were discussed and resolved among the authors.

Characteristics of the included articles
We identified twenty-three qualitative articles for inclusion in this review (Table 2). Although published between 2006 and 2020, more than half (n = 14) were published between 2016 and 2020. The majority of the articles were from the UK (n = 8) and Sweden (n = 7). Four publications were based on the "Neighborhoods: Our people, our places" project, a longitudinal and comparative study in two sites in the UK and one in Sweden (#7, #16, #17, #22). The majority of the included articles used semi-structured interviews, walking interviews and focus groups. The sample size ranged from six to 67 participants. Their age of ranged between 48 years and 95 years, with the majority of the participants being between 60 years and 89 years old. Eight articles included participants under the age of 60 and two articles included participants over 90. All studies involved people with dementia, the eligibility criteria however, related to the type of diagnosis varied. The majority of the studies had inclusion criteria pertaining to a diagnosis of dementia. Impaired cognition was assessed with clinical tools such as the Mini-Mental State Examination (MMSE) in six of the studies (#2, #6, #10, #13, #14, #15). Other studies had less stringent eligibility criteria and included those experiencing memory problems related to an illness (#20) or participants who chose not to, or were unable to, reveal the type of dementia that they had (#7, #16, #17, #22). Recruiting participants based on experiencing memory issues is an inclusive approach to dementia research: the results reflect a range of experiences related to dementia-related symptoms, not necessarily a formal diagnosis (Hellström et al., 2007;Michalowsky et al., 2016;Novek and Wilkinson, 2017;Sturge et al., 2020).

Perceptions of people with dementia
The thematic analysis resulted in two main themes and several subthemes relating to the influence of the social and built environment on well-being. Table 3 provides an overview of the results from the thematic analysis.
Theme 1. Connection to society and supportive relationships

Friends and family
Seventeen papers in this review describe the supportive role of friends and family (#1, #2, #3, #6, #7, #8, #10, #11, #13, #12, #14, #15, #16, #17, #21, #22, #23). Spending quality time with friends and family is important for people with dementia (#21) and some rely on this type of support to motivate them to get out of the house (#3, #23) or to drive them to places (#8). Some people with dementia report losing friends or having less contact with family after receiving a dementia diagnosis while others state that relations with friends, family and neighbors continued after the diagnosis (#8, #16, #21). According to Clark et al. (2020) (#7), it is less about the size of a person's social network but more about the quality and capacity to provide support that matters. Also related to the quality of relationships, some articles highlight the importance of being needed and trusted by others (#14, #23) plus the importance of reciprocal relationships (#7, #22).

Formalized activities and professional support
Some participants, achieve social inclusion by being involved in an active social network or attending formalized activities at senior centers (#21, #23) and cultural centers (#11, #17) or peer-support activities (#20). Others find social situations awkward and, in turn, avoid them (#8, #9), or avoid activities that are too overwhelming due to crowds and noise (#20). Healthcare professionals can also play a key role in the lives of people living with dementia at home by providing support and information, and promoting autonomy and a sense of friendship (#2, #8, #11, #21).

Social interaction in the neighborhood
Interactions with people in a neighborhood can provide a sense of security and belonging for people with dementia who live at home  (#22). Fifteen articles mention neighbors as actors in the lives of people with dementia (#1, #6, #7, #8, #10, #11, #12, #13, #14, #16, #17, #18, #20, #22, #23). The role that neighbors played in the lives of people with dementia varies. For some, neighbors played an active role, such as by keeping a watchful eye or providing emotional support (#7, #16, #22) while others experience people in the community as unfriendly (#23) and are cautious of their neighbors and have limited encounters with them (#12, #17). In several articles, participants described going out for a walk as a common way to stay fit and also to engage with people in their neighborhood (#1, #10, #12, #14). Some people purposely walk or sit on a bench in a public space for a chance encounter to chat with a stranger (#10, #12, #17) while others rely on strangers to help them navigate their way back home (#1, #3, #15). 'Familiar strangers' (#7; p. 13) are people within the neighborhood with whom people with dementia have regular encounters. However, they may not necessarily know the names or details of these strangers. Having regular interaction with these "familiar strangers" and familiar faces provides a sense of belonging for people with dementia (#3, #10, #22). As shown in the preceding, some people are wary of strangers while for others, strangers provide chance encounters and over time they may become more familiar which can possibly lead to friendship.
Going to places such as museums (#6), pubs and cafes (#16, #17) and libraries (#8) provides connection to the outside world. Shops are locations that are the most visited by people with dementia who live at home (#2, #9, #13). Participants describe visiting shops, sometimes on a daily basis, which gives them a connection to society and also opportunities for social interaction with staff (#7, #22). For instance, in the Blackman et al. (2007) (#2) study, participants preferred shopping areas that were bright and spacious shopping areas with plenty of seats but with not too many people. People with dementia can also feel vulnerable in shops when making payments, where it may be unclear how to pay, they forget their pin number or miscount money at the till (#1, #4, #14, #18). These situations can make people with dementia feel like they are revealing their health condition is being exposed to strangers against their will, which can make them feel unsafe and vulnerable: they fear that others may steal from them or see their pin code written somewhere, a strategy they use to cope with their condition (#4, #18).

Disclosure and public awareness
Several papers describe the importance of disclosure and public awareness. In five articles, participants described a sense of comfort after telling others, on their own terms, about their dementia diagnosis (#1, #9, #14, #18, #22). Some feel that disclosing their diagnosis to strangers is a way to make them aware that that dementia is in the community (#7, #22). In the study by Smith et al. (2016) (#20) study, a participant describes how customer service improved after disclosing their diagnosis to a shopkeeper. Others have mixed feelings about disclosing their dementia diagnosis, commenting that they feel embarrassed about it and that telling people about their dementia poses a risk of not being allowed to continue living at home or that disclosure leads them feeling socially excluded, exposed or threatened (#3, #8, #9, #18). Smith et al. (2016) (#20) report another participant who felt that if his former workplace had been educated about dementia, and had implemented support strategies, he could have remained in employment. The importance of public dementia education programs is highlighted in four articles (#7, #17, #20, #23).

Engagement with natural environments
For people living at home with dementia, having access to natural environments is important for their emotional and spiritual well-being (#11) and it provides a sense of freedom, independence and being a part of society (#6, #12, #20, #21). Features in the built environment which provide access to natural areas such as parks and walkways can encourage people living with dementia to get outside (#10, #11, #13, #15, #16, #17). Housing features, such as windows, balconies and doorways, present a connection to the outdoor environment in addition to opportunities to observe, and engage with the social environment (#7, #9, #12 #16, #17, #22). Regardless of whether a person with dementia is walking outside or sitting in on their balcony, access to nature (e.g., fresh air, the beach, sunlight, flowers, plants and animals) is described as essential for overall well-being by several articles (#1, #2, #9, #10, #11, #12, #13, #15, #16, #17, #19, #20, #22).

Access to public space
A number of articles find that public spaces are more accessible to people with dementia when they themselves are familiar with such spaces (#3, #6, #8, #10, #13, #15, #20) and when activities meet their needs or provide opportunities for participation (#6, #8, #16, #21, #23). Engaging in public space, such as using public transportation, can provide a sense of independence although these activities can be intimidating and stressful when users transition from one location to another and when they face difficulties (e.g., crowded and bustling places) (#5, #6, #9, #13, #18, #23). Eight articles describe people engaging in morning activities (#3, #4, #6, #7, #14, #16, #17, #20) such as going for a walk (#3, #17), shopping (#6) or going to a cafe (#16). However, with regard to late afternoon or evening activities, people are less likely to go out alone and more likely to rely on others (#1, #6, #22). Some people reported feeling out of place and anxious in public spaces (#3, #8, #23) where they fear being targeted in a crime (#1, #4, #20). Others experience difficulty finding their way home (#12, #15). In other situations, the family may be anxious about where the person with dementia is, which in turn may affect the confidence of a person with dementia (#1, #10, #3).

Public space features a) Streets and traffic
Ten articles describe streets and traffic as features of the a built environment that people with dementia have trouble navigating (#1, #2, #5, #6, #12, #13, #17, #18, #19, #20). Some of the issues with streets include knowing which way to look when attempting to cross the road, navigating complicated street networks, identifying where a street begins or ends or navigating areas several connecting streets (e.g., a four-way junction or cul-de-sacs) (#5, #13, #18). Busy traffic, crowds of pedestrians, cars parked on the pavement, the poor condition of streets and sidewalks and poorly lit streets influence how well a person with dementia navigates public space (#2, #5, #12, #19). People with dementia typically prefer areas where traffic is limited and pedestrian crossings are clearly marked, timed and controlled with traffic lights (#2, #4, #17, #19, #20). In the Brorsson et al. (2016) (#5) study, people with dementia follow the flow of pedestrian traffic as a coping strategy to feel secure when crossing a street.

b) Noise
Noise in public space can be a positive or negative sensory experience. For people with dementia, the sound of children playing, birds singing, or listening to the sea can be a positive experience (#15). In addition, noise can be a helpful audible cue at a pedestrian crossing (#13) or listening for railway or highway sounds to help navigate their way home (#15). In other articles, noise from the traffic, pop music or screaming children is a negative factor that can cause stress (#4, #13) The absence of sound, for instance when places become less populated, can cause a sense of insecurity (#16).

c) Landmarks
Ten articles describe situations when people with dementia lose their way (#1, #3, #6, #8, #10, #13, #14, #18, #19, #22). To manage these "time-consuming misadventures" (#14: p. 47) some participants state that they are no longer tempted to roam and prefer to carry out activities in familiar spaces, such as the neighborhoods where they live (#6). Dominant features of a landscape, such as church steeples and buildings, are used for orientation. Smaller features, such as signage, street furniture and post boxes, are useful establishing their location. Other features, such as looped walking paths, can be reassuring where such paths bring people back to where they started (#15). Relying on landmarks as a means to find their way is a common coping strategy for people with dementia (#1, #2, #3, #5, #6, #13, #15, #18, #19).

d) Signage
Signage, a public space feature that people with dementia rely on, is discussed in eight articles (#2, #3, #6, #10, #13, #19, #20, #23). Some participants describe situations where signs, maps and bus timetables are difficult to interpret. In some cases, they are able to read the signs; however, they are unable to understand the purpose of the sign or locate their position on a map (#6, #18). In other situations, such as road works, participants described situations where they are unable to discern whether a sign was in place to control car traffic or pedestrians. These participants suggest clear signage to help people navigate the site properly (#2, #20). To ensure that signage is useful for people with dementia, Blackman et al. (2007) (#2) suggest that the design features should be clearly explained with simple text (e.g., bus station) rather than with photographs and symbols.

Changes in landscapes, design and technology
Changes in the built environment can negatively influence how people navigate and enjoy outdoor spaces. When a distinct landmark is removed or a landscape is modified, for example the reconstruction of a well-known site (#6, #12), this may cause confusion for some people with dementia (#8, #15). Confusion can also occur when the function of buildings change (e.g., office space being reconstructed as housing) (#17), when modern buildings are developed without a clear function or without indications such as the location of entrances (#2, #13). In addition, housing developments with uniform and similar structures can make it difficult for people with dementia to identify landmarks (#1, #13). When moving to a new home, the unfamiliar surrounding environment can be unfamiliar which in turn can cause a person with dementia to become disoriented in time and place (#3).
There is a trend toward larger grocery stores carrying a variety of products. According to Brorsson et al. (2018) (#4), people with dementia prefer small stores with spacious, organized layouts. In their study, participants described feeling overwhelmed by an overload of products on the shelves and are confused by some of the modern glass features in grocery stores. For example, they found themselves trying to pick vegetables from a mirror in the vegetable stand or walking into glass doors at the entrance.
Technology can be useful for people with dementia when they interact with public space. Devices such as cell phones and tracking technology can provide a sense of security (#1, #3, #15). However, people with dementia may perceive some technology in public spaces negatively (#1). For instance, when walking in public space some people cannot hear approaching electric cars and scooters (#5). When machines replace staff in grocery stores and libraries, these machines take away an often welcomed social encounter (#6). In such circumstances, people with dementia can be stressed by the different stages of a process (e.g., scanning, bagging, payment). Sometimes the technology in place is not intuitive, making it difficult to use (#4, #6).

Neighborhoods, the intersection of the social and built environment
The intersection between the social and built environment is emphasized in four articles that explore the supportive role neighborhoods play in the day-to-day lives of people affected by dementia (#7, #16, #17, #22). Neighborhoods can have several supportive built environmental features that facilitate the mobility of people with dementia such as well-maintained streets and sidewalks, clear signage, and traffic control measures. Further, the social environment in neighborhoods can be enhanced with opportunities for interaction, activity centers, green spaces and shops. Other features of a neighborhood that impact well-being can be difficult to contextualize, such as a feeling of safety and security. For instance, a quiet neighborhood atmosphere can cause a person with dementia to feel insecure and affect their well-being (#16).

Discussion
This scoping review summarizes research findings on how people with dementia perceive features of social and built environment and how interaction with these features contribute to the well-being of people with dementia who live at home. From our review of 23 qualitative articles, we identified two themes i) connection to society and supportive relationships and ii) interaction with natural environments and public space. Despite challenges associated with dementia, access to social and built environments contributes positively to the well-being of people with dementia who live at home (#10, #16). However, when individuals experience stress and challenges within these environments, these interactions can negatively impact well-being. These observations resonate with the definition of well-being: when there is a balance between resources and challenges, positive functioning and psychological health improves (Clare et al., 2019;Clarke et al., 2020;Dodge et al., 2012). As we have outlined in the results, there is no "one size fits all" solution to the question of which features of the social and built environment contribute to well-being. Some individuals may experience environmental features such as children playing, as positive but not all experience the same features similarly.
This scoping review builds upon (Keady et al., 2012), who summarizes earlier literature and identified similar themes related to outdoor space, built environment and everyday technologies that promote the independence of people who live with dementia in the neighborhood. Our review expands on Keady et al.'s (2012) through a scoping review methodological framework and an updated search of the literature, with a focus on literature that reflects the perception of a person with dementia. Our review also highlights the importance of the intersection between social and built environments. This is significant because this intersection has been found to impact older adults' well-being in general (Kabisch et al., 2017;Ottoni et al., 2016). For instance, features of the built environment such as shops, well-maintained streets and sidewalks, clear signage and traffic control measures can encourage independence and provide social interaction opportunities for people with dementia. However, built environmental features can also impact a person's sense of coherence, which can restrict mobility and directly influence social relations, health and well-being (Antonovsky, 1993;Biglieri, 2018;Evans, 2003;Hanson et al., 2013;Koster et al., 2006;Mouratidis, 2018). It is also essential to explore the intersection between the social and built environment in urban and rural settings. Individuals living in a rural environment may have fewer opportunities to interact with an accessible built environment (e.g., limited infrastructure that may be poorly maintained). However, connecting with the social environment may be easier in a rural area than an urban area because of the presence of strong networks of friends and families who can provide support services (Blackstock et al., 2006;Keating and Phillips, 2008;Wiersma and Denton, 2016). Also, individuals who live in rural environments tend to be surrounded by abundant nature. However, access to nature may be compromised without human-made features such as maintained pathways, which are more common in urbanized areas. Further research is needed to explore the urban-rural context related to social and built environment and how they impact the well-being of people with dementia. One way to enhance dementia-friendly plans in both urban and rural settings is to consider the social environment and its impact on the social health of people with dementia. The concept of social health highlights the capabilities of a person with dementia and emphasizes the importance of social opportunities and engagement for better health and well-being, and this concept has been operationalized for people with dementia. Social health, in relation to dementia, has three dimensions which include i) fulfilling one's potential (e.g., through work, volunteer jobs), ii) managing one's life with some degree of independence (e.g., taking a walk alone) and iii) participating in social activities (e.g., meaningful activities and social interactions) (Dröes et al., 2017;Vernooij-Dassen and Jeon, 2016). Our review emphasizes the importance of public education and dementia-awareness for a better understanding of people living with dementia. Greater awareness can improve interactions with public space, mitigate stigma and enhance the social environment.

Design, policy and practice implications
Using technology in public space can be a challenge for people with dementia. According to Lindqvist et al. (2018) who found that technology can support or hinder the everyday lives of people living with cognitive impairments. Further, people with mild cognitive impairment (MCI) experience more problems using everyday technology than people without the impairment (Nygård, 2008). As businesses "advance" and increase automation to decrease the number of hired staff, this can be detrimental to a person with dementia. Understanding the experiences of people with dementia have when they use technology in public spaces, such as stores and banks, can inform dementia-friendly initiatives as well as care plans developed by professionals, such as occupational therapists (Gaber et al., 2019). It is becoming common practice to engage people with dementia during co-designing and in the development of assistive information technology (IT), housing environments and serious gaming (Anderiesen, 2017;Rodgers, 2018;Span et al., 2013;Tsekleves et al., 2020;van Hoof et al., 2015). Co-design techniques and training strategies can be further developed to explore the needs and abilities of people with dementia in the use of technology in public space. For instance, consulting with people with dementia in the design process of developing technology for customer interaction could ensure that the technology becomes intuitive for all customers.
Our review demonstrates that changes in landscape and public space design can cause disorientation for people with dementia, which has implications for planners and policy-makers who play a role in enhancing the well-being of people with dementia by linking the social and built environments (Biglieri, 2018;Ottoni et al., 2016).To ensure that the built environment is developed to accommodate the needs of people with dementia, planners should consult with local dementia groups to advise on redevelopment strategies, infrastructure and city planning (Mitchell and Burton, 2010). In addition, policy regulation and planning guidelines can reflect dementia-friendly environmental design and encourage architects to build and design in a manner that is 'dementia-friendly' (Biglieri, 2018). For example, guidelines for community plans could encourage the development of housing estates with unique design features that facilitate wayfinding or the provision of outdoor furniture as a required feature. Public art and heritage structures are valuable yet straightforward built environment features that people with dementia identify as distinct and meaningful landmarks (Seetharaman et al., 2020). Planners can also develop dementia-friendly, crime prevention initiatives that reflect principles of crime prevention through environmental design (CPTED) principles (Cozens and Love, 2015) to ensure that built environments provide a sense of safety in a community.
Although this review is specific to the experiences of people with dementia, some of these experiences, such as the value of social inclusion or difficulties navigating traffic, relate to the experiences of older people in general, which highlights the need to develop age-friendly environments that reflect the diverse needs of the older population and that enhance the 'agency' of particular groups (Buffel et al., 2012;Wiles et al., 2012). In addition, it is important to note that dementia does not just occur with older persons, and that the needs of those with dementia may differ based on their life course and progression of the disease. As highlighted by Bartlett and Brannelly (2019) (#1), people with dementia in their 50s and 60s tend to have insight into things that they can no longer do safely on their own while participants over the age of 70 are more aware that their overall health can fade at any time. Therefore, dementia-friendly initiatives should reflect the needs of a wider age range, not just older adults. As highlighted in this review, some people with dementia disclose their diagnosis to strangers, but it is essential to note that this is on their own terms. Policies should not segregate people with dementia by insisting that they are a certain age or that they disclose their illnesses to access services (e.g., dementia-specific villages and memory cafes) (Rahman and Swaffer, 2018). The ideal way to achieve this balance is to explore the diverse lived experiences of people with dementia as a basis for policy development.

Strengths and limitations
A key strength of this scoping review is the focus on literature that includes the perspective of people living with dementia instead of research informed by other people's experiences (e.g., caregivers). The scoping review framework has resulted in a systematic overview of the literature on dementia which describes how people function and interact with the social and built environment in a community setting. There are some limitations of this review. First, related to the nature of a scoping review, it is likely that not all publications were identified where the search strategy is not exhaustive, nor has the quality of the articles been assessed. Second, we focused on English, peer-reviewed literature which omits other studies which could provide a different perspective from people with dementia. Also, most of the research included in this review was conducted in affluent countries, which may limit the transferability of the findings to low and middle income countries. Where the social and built environment are dependent on a number of socio-political factors, we therefore suggest the need for further research other countries. Third, it should be noted that more than half the total number of articles were identified using search methods outside the electronic database search methods. This could be related to the search criteria not including terms such as 'outdoor life' or 'places' which are common terms in the literature. In addition, qualitative studies tend to have small samples which usually consist of people who are willing to share their experiences with a researcher, are active service users (Morrisby et al., 2018) or have the resources to participate (#21). Therefore, the evidence in this review provides insight into the experiences of people with access to outdoor environments, not those with dementia who are restricted to staying indoors. Further, the perception of those with dementia may be dependent on their caregivers. Decreasing cognitive functioning and deteriorating perceptions can pose a barrier and deter participation in research.

Conclusion
As more people with dementia live at home, communities will need to adapt their social and built environment to become more dementiafriendly. Understanding these environments, based on the diverse, lived experiences and perceptions of people with dementia who live at home, yields valuable insight into the features of the external social and built environments that positively and negatively affect well-being. Highlighting the ability and functioning of people with dementia provides a better understanding of their well-being. We suggest further research to explore how these environmental features impact well-being and intersect in an urban-rural context as a basis to inform the development of dementia-friendly communities. Moreover, engaging people with dementia in planning initiatives, designing environments and technology development will result in supportive social and built environments that can improve the lives of people with dementia and foster in more inclusive communities.

Declaration of competing interest
None declared.