‘We are developing our bubble’: role of the built environment in supporting physical and social activities in independent-living older adults during COVID-19

ABSTRACT

This study explores how the built environment can support and challenge a bubble strategy designed to protect older adults from virus transmission while at the same time allowing them maintain their physical and social activities during COVID-19. We conducted a case study of older adults in an independent-living building and the surrounding neighborhood in Edmonton, Alberta, Canada. Data were collected through building and neighborhood observations, and 11 semi-structured in-depth interviews with 6 building residents and 6 stakeholders. Data were analyzed through mapping and interpretative phenomenological analysis (IPA). Complex and nuanced relationships between human and nonhuman factors that supported and challenged the bubble are elaborated in three built environment categories. (1) ‘Building interiors’, where residents conduct routine activities and attend physical and social activities with neighbors, were central to the bubble. (2) ‘Neighborhood environments’ were extensions of the bubble that affected residents’ outdoor activities. (3) ‘Building edges’ were important for balancing residents’ needs for connecting to the world outside and protecting themselves from the virus. Communities should consider the bubble strategy combined with built environment supports to assist older adults in protecting themselves against virus transmission, and maintaining physical and social activities during the ongoing pandemic and future epidemics.

KEYWORDS:

• COVID-19
• case study
• built environment
• older adults
• physical activity
• social activities

This article is related to:

Research for city practice

Introduction

The ongoing COVID-19 pandemic has raised challenges in how built environments can support older adults’ health and wellbeing. COVID-19, an infectious disease caused by the coronavirus SARS-CoV-2, was declared a pandemic in March 2020 (WHO 2020). To reduce virus spread, local and national governments introduced physical distancing and stay-at-home measures to communities, and emphasized such measures for older adults who are particularly vulnerable to severe infection and mortality (Promislow and Anderson 2020). Independent-living buildings are congregate community-dwellings providing both private living spaces, like apartments, and common-activity spaces for older adults who do not require assistance with activities of daily living or skilled nursing care. Older adults living in independent-living buildings usually conduct daily activities in their home and neighborhood (Radwan et al. 2020). During the pandemic, home buildings can become even more dominant spaces for daily activities because many public/common spaces are closed or have limited attendance. Consequently, the planned and unplanned physical activity levels of adults decreased when these COVID-19 measures were in place (Cunningham and O’sullivan 2020). Further, prolonged isolation at home has created psychological distress in older adults (Kotwal et al. 2021).

Calls have been made for innovative strategies to assist older adults in overcoming COVID-19 relevant physical, social, and psychological difficulties (e.g. Brown et al. 2021). Strategies like technology use to improve older adults’ virtual communication with family and friends, and online exercise programs have been reported (Vargo et al. 2021). However, strategies incorporating changes to home and neighborhood environments are still lacking. Concepts like ‘social bubble’ or ‘support bubble’ have been proposed to manage virus transmission by controlling people’s contact with those outside the bubble (Gupta 2020, Leng et al. 2020). The bubble concept has been implemented in some residential communities in New Zealand, Germany, and the UK (e.g. Leng et al. 2020, Shortt et al. 2021) and long-term care facilities in Switzerland (e.g. Robalo Nunes et al. 2022). However, studies elaborating complex and nuanced relationships between people, social bubbles and the built environment have not been found in literature.

This study employed multiple qualitative methods (Denzin and Lincoln 2000) to conduct a case study of an independent-living apartment building and surrounding neighborhood to gain insights into how older adults adapt to a bubble and how the surrounding built environment impacts this adaptation. We asked: what are older adults’ lived experiences of a bubble established by the building operator during COVID-19? How does the bubble support or challenge residents’ physical activity and social activities, and how does the built environment support and/or challenge the bubble’s maintenance? How can this understanding inform the planning and design needs of future buildings and neighborhoods?

Built environments, virus spread prevention, and wellbeing maintenance

Bubbles are personal spaces constructed by individuals to limit in-person social interactions, activities and spaces (Low 2003). A COVID-19 bubble strategy intended to protect older adults’ physical, social, and psychological wellbeing and prevent virus transmission should balance maintaining activities for wellbeing such as physical activity and in-person social interactions with preventing viral spread.

Lynch (1964) has categorized urban areas into five key functional elements: ‘Paths’ through which people move around the city, ‘nodes’ where people rest and gather, ‘landmarks’ orienting people through external focus points, ‘edges’ separating two functional spaces, and ‘districts’ containing the above elements in an area and make it identifiable. Parks, sidewalks and greenways are nodes and paths where older adults routinely get exercise, walk dogs, and socialize together (Gardner 2011, Gibson 2018, Chang 2020). Local businesses like cafés and bakeries and park benches are additional nodes for older adults to socialize with friends, neighbors, and business owners/employees (Gardner 2011, Alidoust et al. 2019). Within independent-living building spaces, nodes include common dining and activity areas providing older adults with opportunities to socialize (Shippee 2012). Edges can be considered liminal spaces or boundaries connecting indoor building spaces, outdoor areas and neighborhood streets, comprising both visual and physical connections; (Alidoust et al. 2019). These spaces are important for older adults. For example, older adults who plant gardens on their front yard talk with neighbors walking on the street (Gardner 2011). Through the use of built environment spaces, older adults set up a sense of belonging and identity within a local district (Gardner 2011). Furthermore, the five functional elements interact dynamically with one another to create a ‘human habitat’ (Lynch 1964, Steiner 2002) where paths, nodes, landmarks, and edges make up districts and together they make up the built environment supporting or challenging the bubble of our independent-living community.

During COVID-19, the five categories of functional elements may become less distinct. Some cities and independent-living building operators have adapted their built environments to accommodate people’s practice of physical distancing. For example, sidewalks used only as paths previously have sometimes become nodes for community residents for gathering activities. Traffic lanes have been observed in some cities to change from being merely paths for vehicles to being demarcated shared-use paths and nodes for non-vehicular activities such as running, biking, and meeting neighbors (Mehta 2020). These adaptations at some level help with the maintenance of physical activity and social activities and the prevention of virus transmission when expected body distances are between 120-360 cm (4-12 feet) (Hall and Hall 1966). Relationships that are maintained through closer body distances, including intimate relationships (less than 45 cm or 1.5 feet) and personal relationships with family and friends (45 to 120 cm or 1.5 to 4 feet) (Hall and Hall 1966), however, are not addressed by these built environment measures. For example, people continue to have difficulty hugging family members during COVID-19 (Mehta 2020).

During the pandemic, not only has the five functional elements become more obscured and interchangeable, but the issue of density in cities has also become more complex. Density plays a key role in supporting the proximity of nodes, types of paths and size of districts. Density of populations in an area supports a larger mix of nodes and multiple types of paths possible to those nodes. This in turn assists in ensuring amenities (e.g. recreation and retail) can be accessed nearby by older adults (Schneider et al. 2014), supporting healthy aging and aging in place in both COVID and non-COVID times (e.g. Lehning 2012, Bigonnesse and Chaudhury 2020). There is complexity in considering issues of density during the COVID pandemic. Studies have shown large metropolitan areas with dense populations have higher COVID-19 infection and death rates compared to less dense areas (e.g. Hamidi et al. 2020). As COVID-19 research progresses, however, factors like quality of built environment spaces (e.g. indoor air quality) have also been found to impact viral spread in communities (McFarlane 2021). This study will add to the current discourse by exploring the relationship between a social bubble strategy and the built environment, in particular the built environment’s role in supporting or challenging the social bubble created for viral spread prevention while helping older adults maintain physical activity and social activities.

Methodology and methods

This study takes a nested research methodology that is integrated in case study research (Yin 2018) and multiple qualitative methods (Denzin and Lincoln 2000). Case study research is relative to specific times, places, and activities (Merriam and Tisdell 2016, Yin 2018). Multiple qualitative methods allowed us to investigate the integrated aspects of a built environment by documenting the various elements that make up this environment as habitat. This methodology (and subsequent methods) help to capture the complexity and nuanced details of urban environments including connections and boundaries among paths, nodes, landmarks, and edges that make up a district. Similar methods are also being used for a large research project of our team (Stearns et al. 2021). Ethics approval for this study was granted by the University of Alberta’s research ethics board and anonymity is kept by using fictitious names rather than real names for the building and participants, allowing for more frank and critical evaluation. Details not critical in the research and that are potential identifiers of participants also have not been collected (e.g. individual ethnicity, health condition[s], specific building floor other than ground floor vs above ground floor). Due to COVID-19 restrictions, all interviews were conducted virtually; indoor environment observations not already conducted prior to COVID-19 did not occur, but outdoor observations were allowed.

Research setting

Ravineside (fictitious name) is an apartment building for independent-living residents, not exclusive to, but targeted at individual or coupled older adults in Edmonton, Alberta, Canada. The four-story building operated by a private-sector developer has 45 one-bedroom apartments, 6 two-bedroom apartments, a guest suite, and common spaces including a lobby, ground-floor activity room, kitchen, small second-floor gym (closed during COVID-19), 2 stairwells at either end of the building, and an elevator (Figure 1). Each apartment has a living room, full kitchen, laundry space, and patio/balcony, and bedroom(s) and bathroom(s). At the time of interviews, 48 building residents lived in 36 one-bedroom and 6 two-bedroom apartments. The building is located in a mature, primarily mixed-income residential neighborhood with a population of 3,176 living in 1,531 residences (mostly single-family houses) and a land area of 1.13 km². The building is adjacent to affordable townhouses owned by the same developer/operator. The building, however, is a market-rate independent-living building and not an affordable housing development. The building is near nodes and landmarks including a small grocery store, bakery, diner, pub, pharmacy, barbershop, daycare, school, and community hall. Paths are made up of city sidewalks and multi-use green trails. One major landmark nearby is a park with a ravine. Sidewalks surround ~2.5 of the building’s 4 sides and connect to the building entrance and parking in the front. Land for future buildings onsite is currently covered by grass during warmer weather and snow in winter. The socio-demographics of the residents who reside in this neighbourhood are typical of the Edmonton region. Specifically, 14% of the population is 65 years or older (compared to 12% in Edmonton), 28% has a household income <$50,000 (compared to 26% in Edmonton), 26% has a bachelor’s degree or higher (compared to 27% in Edmonton), and 88% are a non-visible minority (compared to 63% in Edmonton; Statistics Canada 2017).

Figure 1. Building ground floor layout.

Data generation

Data collection methods included building and neighborhood observations, and in-depth interviews with building residents and stakeholders. Photographs (647 pieces), notes and sketches (72 pages), and interview transcripts (11 interviews; 753 minutes of audio recordings) were collected. Interviews were conducted during COVID-19 (August – September 2020) and building and neighborhood observations were completed before and during COVID-19; observations of indoor spaces were only collected prior to COVID-19. (September 2019 – September 2020). The use of multiple methods provided opportunities to understand the built environment in unique and deep ways, and triangulate and cross-reference among the data types. The holistic multiple-method approach allowed us to examine human habitats to better understand connections, disconnections, and boundaries within a district. Building and neighborhood observations were conducted under the guidance of architectural multisensory data collection (Grittner and Burns 2020) which is considered a ‘mapping’ of the built spatial environment. This method was chosen because it incorporates spatial and social factors into the mapping process, which reflects both the spatial quality and people’s multisensory experience of the spaces. Architectural multisensorial data collection was used to document the researcher’s observations of built environment attributes and people’s behaviors in building and neighborhood indoor and outdoor spaces, during the day and night, and in different seasons.

Sketch walks, spatial visualization, and photography (Grittner and Burns 2020) were employed: sketch walks – the researcher walked in different building and neighborhood spaces to record and interpret built environment attributes such as configurations, textures, materials, colors, temperature, lighting, sounds, noise, and odors and people’s behaviors in these spaces through field notes and sketches; spatial visualization – the researcher conducted functional analyses to document the functional spaces and spatial configurations of the building and surrounding neighborhood through drawings and field notes; photography – the researcher took photos to document the visual qualities of the building and neighborhood. Eleven semi-structured in-depth interviews were conducted with building residents (n = 6 comprising 4 individuals and 1 couple) and stakeholders (n = 6). There were 5 interviews with building residents (Table 1 with fictitious names included). The researcher emailed an information letter with a statement of consent and a recruitment poster to the building operator who helped distribute hard copies to all building residents. Interested residents contacted the researcher by phone or email to set up interviews, which meant they remained anonymous to the building operator and other parties throughout the process. Among the 8 stakeholders invited by the researcher for individual interviews, 6 stakeholders accepted, including the building manager, building cook, community bakery owner, farmers’ market bus owner, and 2 residents from the surrounding community. All interviews were conducted via phone or Zoom calls. To gather verbal consent, the researcher read the consent statement to participants at the beginning of their interview, and participants verbally agreed to participate.

Table 1. Attributes of resident interview participants.

Pseudonym*	Sex	Age	Live alone/with family	Suite Type	Suite Floor	Length of living in the building	Own a car	Use of an assisted device
Pearl	Female	86-90	Alone	One-bedroom	Ground Floor	>2 years	No	Cane
Meggie and David	Female and male	76-80 81-85	Couple	Two-bedroom	Ground Floor	>2 years	Yes	Walker (David)
Jenny	Female	76-80	Alone	One-bedroom	Higher Floor	<1 year	Yes	No
Sherry	Female	76-80	Alone	One-bedroom	Higher Floor	<1 year	Yes	Cane
Molly	Female	81-85	Alone	One-bedroom	Ground Floor	<1 year	Yes	No

*Real names have not been used to protect the identity and confidentiality of participants.

Each interview lasted 1-1.5 hours. Interview guides covered questions about people’s experiences of physical activity and social activities (building residents and community residents) and work experiences relevant to the building residents (other stakeholders) before and during COVID-19. The virtual interviews (1 Zoom and 10 phone interviews) were audio recorded and transcribed verbatim for analyses.

Data analyses

Data analyses included mapping of the architectural multisensory data (Grittner and Burns 2020) and using interpretative phenomenological analysis (IPA) (Smith et al. 2009, Larkin and Thompson 2011). Mapping was employed to analyze sketches, photos, and notes collected through building and neighborhood observations. To connect the built environments and people’s behaviors, the researchers’ understanding of these two aspects are created within a series of maps (see Figure 2) as part of data analyses (Grittner and Burns 2020). Sketches, photos, and notes collected in the specific functional space were combined to create maps that visualized the information being gathered. While creating the maps, attention was given to documenting and examining the fine details of the built environment.

Figure 2. A mapping sample.

To complement and triangulate the information gained through mapping, IPA was used to contextualize insights about people’s lived experience and explore how particular participants established meanings of their world by interacting with surrounding material objects and spaces that matter to them (Larkin and Thompson 2011). IPA’s four-step method for analyzing interview transcripts (Smith et al. 2009) was employed. First, the researcher read and re-read all transcripts several times to gain a general sense of the data. Second, specific data were read in detail to develop descriptive comments (e.g. meeting family/friends on building patios), linguistic comments (e.g. bubble edge), and conceptual interpretations (e.g. how building patios became bubble edges to balance residents’ needs for family/friend connections and virus transmission prevention). Third, the researcher moved back and forth among data to investigate emergent themes facilitating (e.g. balconies/patios for connecting with visitors, nature, and surrounding communities) or challenging (e.g. no close physical contact with family members) residents’ physical and social activities. Finally, IPA was combined with mapping to further interpret the data and establish themes around similar functional spaces (e.g. balconies/patios). In this way, IPA was the start of our data analysis. It involved comparing, connecting, and interpreting the data through the residents’ lived experience into three built environment categories driven by the data, including building interiors, building edges, and neighborhoods. By combining IPA and mapping – including different functional spatial environments from the maps and people’s experiences within these spaces from the interviews – this became an integrated data analysis process that went beyond IPA’s purely descriptive mandate into a more interpretive one. This in-depth data analysis procedure enabled us to better elaborate how the residents in Ravineside created and maintained their bubble and the supports and challenges posed by the built environment.

Research rigor

Strategies for research rigor include: using multiple methods of data collection and multiple data analysis processes to enhance data triangulation (Lincoln and Guba 1985); carefully considering the number of interviews to ensure in-depth analysis for an IPA case study (Smith et al. 2009); filing the data analysis process for other researchers’ independent audit (Smith et al. 2009); conducting reflective and reflexive notes throughout the research process to enhance the researcher’s self-awareness of personal bias, experiences, and perceptions (Hale et al. 2008). The researchers acknowledge that reflection-inaction is a big part of designing and researching processes (see Schon 1984) and that the researcher’s personal values affects the research process through reflexivity (Attia and Edge 2017).

Research findings: ‘we are developing our own bubble’

As a response to COVID-19, a bubble was established by the building operator to protect Ravineside residents from virus transmission, and to assist in the maintenance of physical activity and social activities for wellbeing. To address the COVID-19 pandemic, the Chief Medical Officer of Health in Alberta’s Ministry of Health ordered restriction measures for facilities housing vulnerable residents who required advanced care (CMOH 2020). As a building for independent-living residents, Ravineside was not required to implement these measures. Nevertheless, the building operator implemented similar protocols to protect residents, who were predominantly older than 65 years of age.

The bubble emerged as Ravineside residents followed the building’s COVID-19 protocols. Examples of protocols implemented include: restrictions on unnecessary indoor visits and services from outsiders, visitors only being allowed on building patios or outdoor spaces, and restrictions on residents from visiting specific spaces. According to building staff, most residents chose to follow protocols, except for a small number who chose or had to visit protocol-restricted spaces, such as the nearby ravine or hospitals, or because they had just moved into the building and were required to self-isolate from other residents for 2 weeks. These latter residents became bubble-excluded and were not allowed to use the building’s common recreational spaces or join group activities. These bubble-excluded residents were required to wear masks when in building common circulation spaces. To join/re-join the bubble, they were required to self-isolate in their apartments for 2 weeks first.

There had been no reports of COVID-19 cases at Ravineside at the time the interviews. The bubble created a sense of safety and protection for residents, and enhanced their psychological wellbeing. As Sherry indicated:

We are developing our own bubble. And we were pretty safe as long as we don’t bring too many outside people into our bubble. I feel protected here. They are looking after my safety. I would not want to be living on my own and going through this pandemic.

The bubble established by the building operator and maintained by the Ravineside residents shows how socio-spatial relations were altered, navigated and adapted as a result of COVID-19. Built environmental spaces including districts, nodes, paths, landmarks, and edges in the building and its surrounding neighborhood were selected by the residents based on their need to maintain everyday physical activity and social connections. The five categories of functional elements in the bubble became less distinct, and some built environment spaces had multiple functional meanings to the residents. As a district, the bubble was established and maintained, or challenged, through residents’ everyday interactions with available nodes, paths, landmarks, and edges located in the building’s three categories of interiors, building edges, and neighborhood environments. These spatial categories constructed a hierarchical spatial relation from the center to the extension and through the connections for the bubble.

Building as central to the bubble

The Ravineside building was a landmark of the virus-safe bubble that contained nodes where residents completed all indoor physical activity and social activities. As a landmark, the building oriented and dominated residents’ outdoor physical and social behaviors in the neighborhood. Nodes within the building included the individual apartments and common activity room, and paths including the elevator, stairwells and hallways. The design quality of these nodes and paths impacted residents’ activities.

Apartment units with full-functional spaces are core nodes of the bubble that supported residents’ daily activities and helped reduce opportunities for virus transmission. Maggie and David described their daily lives using their apartment space: each person had their own bedroom and Maggie had an exercise mat in her bedroom for daily exercise; in the living room, they had their own seats with lamps located by the window where they read; between the dining table and sitting area, David had enough space to swing his arms from side to side; they sometimes had hot drinks on their apartment patio adorned with potted plants; Maggie’s spacious kitchen afforded daily activities including cooking meals, baking, and washing dishes. Ravineside’s independent-living apartment design also allowed residents who visited protocol-restricted spaces to self-isolate in their unit for two weeks.

The common activity room on the building ground floor was another node for residents to conduct congregate physical and social activities such as DVD-led exercise classes, card games, coffee, and meals. According to building staff, since COVID-19, the building began offering diverse options for residents: some residents cancelled dining room meals or requested meals be served in their apartments, while some continued eating in the activity room with the purpose of socialization. Residents considered themselves part of a safe bubble, which psychologically comforted them to practice shorter physical distancing though they still avoided sitting too close to one another. As Sherry noted:

That’s probably four feet from each other. We’re not elbow to elbow anymore. But we feel comfortable. The ones that are going down there to eat are the people that are obeying the rules by not going out shopping, nor going into dangerous places.

The COVID-19 protocols in the meantime challenged some residents’ activities and communications with family members. According to building staff, one resident used to have her husband, who lived in a long-term care facility, join her for dinner in the building. Because of the building’s visitor restrictions, she was no longer able to see him in-person, and she continuously worried about him and became less engaged in the building’s congregate activities. As the building staff noted:

She was concerned and said: ‘we’ve been married for 50 years already, and this is the first time we’ve been separated for a long time’. That’s really hard for her, especially she feels worried because many long-term care facilities got COVID cases, and she’s worried what’s going to happen to her husband. She doesn’t even go to the lounge (common activity room) as much. She just prefers to stay in her suite.

According to the residents and building staff, the elevator was the main path used by residents to travel between floors. During COVID-19, building protocols restricted two residents at maximum within the bubble to take the elevator together. Many residents spent a long time waiting for the elevator rather than using stairs for moving between floors, as noted by building staff. While some residents had mobility difficulties like walking with canes or using walkers, long distances between emergency stairwells and residents’ destinations such as the building’s main entrance and common activity room, and stairwell design quality, were thought by some residents to hinder stairwell use. For two residents who frequently used stairwells both before and during COVID-19, Jenny used the one near her apartment; Maggie only used the one with a less steep stair slope for physical activity.

Buildings’ edges as a connection between the outside world and the bubble

Edges are spaces along the building that distinguish the interior and exterior spaces. Edges along the building – including patios and balconies, the main entrance, and sidewalks on the site – became spaces where residents inside the bubble connected with the world outside the bubble. During COVID-19, residents maintained family and social connections mainly via phone calls, video programs, and texts. For in-person visits to the building, residents could only see visitors on the common activity room’s attached patio (if they lived on higher floors) or on their suite patios (if they lived on the ground floor). Visitors entered those patios directly from outside (Figure 3). Before COVID-19, residents could see visitors in their apartment and the building common indoor spaces. The patios and balconies were edges that also performed as boundaries that connected the inside and outside spaces, and connected people together.

Figure 3. Building sidewalks connected to farmers’ market bus (top-left); Farmers’ market bus interior (top-right); Building patios and balconies (bottom-left); Furniture and plants on one patio 388 (bottom-right).

When the COVID-19 restrictions were in place, the activity room’s patio and individual apartment private patios/balconies became nodes for all the residents at Ravineside. For instance, the protocol allowed residents living on higher floors to book the activity room patio for 45 minutes at a time to interact with their visitors. On private patios/balconies, residents reorganized chairs so that they were two or more meters apart for physical distancing (Figure 3). Residents like Maggie and David hosted patio visits with their son, a friend who dropped off home baking, and another friend who biked to the building. For all visits, residents had to be at least two meters apart from visitors, wear masks, and not serve food or drinks. This posed challenges for some residents. However, many of them followed protocols to protect themselves from virus transmission. As Pearl pointed:

I miss being able to hug my daughter and my son-in-law and my grandkids. A little piece of my heart falls off every time they come but I can’t hug them. I know a lot of people here are in the same boat. Certainly, for people like me, that’s been tough. But it’s better than being sick, that’s the only thing I can bring it all up to. I don’t want to be ill, because my age group is the age group that dies.

Interestingly, private balconies and patios were simultaneously nodes and bubble edges where residents connected with nature and surrounding communities. Residents like Molly took care of potted plants and enjoyed chatting with residents living in the nearby townhouses:

I really like the fact that this complex has all of the townhouses outside so I can see people out on the grass and kids playing. There are other dogs and it’s much more of a neighborhood. The families in the townhouses are close by and they often come up and talk to me.

The patio and balcony spaces also became edges between residents’ apartments (a building sub-node presented above) and places where residents conduct social activities with each other. Pearl visited a 97-year-old friend on the same floor several times daily. She cooked lunch for them both to eat together on her friend’s patio. Because of the patio, Pearl and her building friend maintained in-person connections without needing to meet in each other’s apartment indoor spaces.

Most balconies and patios were side-by-side and protruded from the building (Figure 3), enabling residents’ engagement in unscheduled communications with neighbors without visual barriers. Sherry, living on a higher floor, liked chatting with neighbors next door or on different floors when they were all on their balconies/patios; their plants and flowers served as common discussion points during conversations which was noted to relieve loneliness during COVID-19:

I have a balcony and I use it quite a bit in the summertime. [During COVID-19], if someone’s out, someone next door or two doors down will wave and admire their flowers and things like that. People get very inventive with their little gardens on their balconies.

The building’s main entrance was another node and edge where residents picked up goods delivered from places outside the bubble. Residents in the bubble were restricted from shopping in-person in any public spaces at the time of interviews. At the building entrance, residents picked up groceries ordered online or shopped by family members or building staff, goods delivered by the local bakery, and medicines delivered by the local pharmacy.

A farmers’ market bus stopped on the building edge for one hour each Tuesday to sell local produce and foods. The bus was observed to be connected with the building through the building sidewalks (Figure 3). Residents wore masks and waited in the building’s common area until building staff invited two people at a time to get on the bus to purchase foods. The farmers’ market bus became popular; some residents wished to have this service continue after COVID-19 because, besides buying food, residents socialized with the owner. This was echoed by the owner who noted:

They really like social engagement … They’d be telling me about their grandkids or their daughters or sons. [They told me] how they used to go out here and there, how they spoke to their grandkids on the phone or something like that.

Neighborhood as extension of the bubble

During COVID-19, these neighborhood spaces extended the bubble from building spaces to neighborhood environments and contained paths and landmarks that impacted residents’ ability to maintain physical activity and social activities.

Neighborhood sidewalks were found to be the main path supporting the bubble extension, connecting residents to each other, as well as to enjoyable physically active social activities (e.g. walking with companions from the building to observe appealing residential front gardens in the neighbourhood). In Ravineside’s neighborhood, the sidewalks allowed residents’ to practice physical distancing with pedestrians outside the bubble. The City did not implement additional physical distancing interventions like closing a traffic lane to accommodate pedestrians in this neighborhood, though most sidewalks in this neighborhood were observed to be narrower than two meters (Figure 4). Residents indicated not encountering significant issues with physical distancing from other pedestrians outside the bubble because of the low frequency of people walking on the sidewalks; if so, the other pedestrians usually walked onto grass or road areas to wait for the older adults to pass.

Figure 4. Neighborhood sidewalks in summer during COVID-19 (top-left) and winter before COVID-19 (top-right); Green trails during COVID-19 (bottom-left); Local amenities during COVID-19 (bottom-right).

Trees and appealing residential front gardens with flowers were reported as important features for promoting residents’ walking activity. They became landmarks to attract and facilitate residents’ accessibility. As Maggie noted: We enjoy looking at the gardens. We look at other people’s gardens and discuss flowers.

Attractive greenery and flowers became a subject Pearl would discuss with other residents in the building activity room during coffee time daily. Pearl carried a small camera to take pictures of the gardens and showed the pictures to other residents during the afternoon’s coffee time:

I have hundreds of pictures, literally, of flowers and gnomes. People have them in their yard, and I take pictures of them … From 3:00 to 4:00, there’s coffee on a semi-formal basis. I take my camera if I’ve done pictures for the day, I just pass my camera around to everybody.

Having a walking companion was essential for many residents living alone to extend the bubble into the neighborhood context and maintain physical activity because they did not want to walk alone. At the time of interviews, a maximum of two residents in the bubble, whether or not they lived in the same apartment, were allowed to consistently walk together outdoors. Many Ravineside residents chose to include themselves in the building’s bubble and as such could maintain the outdoor walking activity with companions. As Pearl noted: I have a friend here who I walk with every day. We try to do a mile and a half. And we pretty much always accomplish that.

The ravine on the building’s northside was a landmark that attracted residents. However, during COVID-19, the path of green trails through which people access the ravine became building protocol-restricted. The trails with two-way designs were observed to often be crowded with multiple users, including children, pets, and bicycles simultaneously, causing physical distancing difficulties, even though these trails were wider than two meters (Figure 4). Due to protocol restrictions, Molly had to hire a dog walker to walk her dog to the dog park in the ravine, which reduced her socialization with other dog owners:

There is a nice green space (trail) here but then there [are] a lot of dogs and a lot of people and bicycles … It gets hard to adjust to the restrictions on us because of COVID though I’ve always enjoyed socializing with other dog walkers and people.

Residents who wanted to use the green trails and ravine were excluded from the bubble and unable to participate in scheduled and unscheduled activities in the building. Jenny walked her dog to the ravine daily. She had come from the countryside and when she moved to Edmonton, she selected this building because it was close to the ravine. The ravine was the landmark connecting Jenny with her previous lifestyle and memories of being close to nature, which drove her to exclude herself from the bubble:

I grew up in the country and there was always physical activity. There was cutting grass and picking berries. You don’t spend all your time inside the house. I prefer to be outside in fresh air and we don’t get fresh air inside the building … It’s just that when I enter the building, I have to be wearing a mask.

The bakery owner pointed out some residents walked to her store to purchase baked goods and chatted with her and other customers before COVID-19. During COVID-19 all indoor amenities were protocol-restricted and excluded from the bubble. These local amenities lost the function of being landmarks navigating residents to arrive and the function of nodes providing opportunities for additional social and physical activities, though alternatively the bakery store and the pharmacy provided delivery services to the building residents if needed.

Discussion

The bubble strategy

With the support of the surrounding built environment and the residential building’s COVID-19 protocols, Ravineside residents established a bubble to balance virus transmission prevention with the ability to do physical and social activities. The bubble strategy was impacted by built environment spaces reflecting elements of nodes, paths, landmarks, edges, and districts (Lynch 1964). Ravineside was a landmark of the bubble, within which residents completed indoor physical activity and social activities in nodes including their apartments and the community activity room, as well as paths like the elevators, stairs and building corridors. As an extension of the bubble, neighborhood paths, edges and landmarks further supported older adults to conduct outdoor activities such as recreational walking with companions from the building. Residents’ walking was supported by less-busy sidewalks where physical distancing from other pedestrians outside the bubble was possible even without extra lane closures from the city for extra space, and pleasant outdoor greenery and flowers were present to enjoy. Building edges played the role of balancing residents’ needs for connecting with the world outside the bubble and protecting themselves within a virus-safe environment. Building patios and balconies became edges where residents connected with family/friend visitors, other building residents, nature, and surrounding community residents from a safe distance. All these elements above constructed a safe environment which made the bubble become a district where residents felt both safe and able to engage in physical activity and social activities.

McFarlane (2021) has argued that a focus on the quality of specific built environment spaces in communities is essential to virus transmission prevention. The building common activity room became a node that allowed residents to practice physical distancing of four feet (as Sherry mentioned). Although density during the collective use of the space would have made such gathering unsafe, when combined with the bubble strategy, residents felt it to be virus-safe. Some neighborhood spaces such as the green trails and ravines were excluded from the bubble, due to the high use of these spaces by those outside the bubble. However, the operational quality of these spaces appeared to greatly impact the overcrowded nature of these spaces. For example, even though the green trails were wider than two meters, the trails’ two-way design without clear demarcations for directional movement resulted in crowding of users, making it almost impossible to practice physical distancing. Thus, design as well as operational quality of spaces appear to be important.

According to Lynch (1964), a landmark contains unique and memorable aspects for people. In this study, the residential building was a landmark for the residents where they had their homes and experienced daily interactions with neighbors, which became the central core of the COVID-19 bubble. The ravine was a landmark for the residents like Jenny because the natural elements connected her with her previous life in the countryside. Landmarks could be temperate and seasonal. Trees and appealing residential front gardens with flowers were found as landmarks for residents like Maggie and Pearl who had the desire to access them and appreciate them in the summer time. Pedestrian and housing density appeared to impact the physical and social activities of participants. In this study, low pedestrian density of the neighborhood appeared to support residents’ comfort of walking on the sidewalks safely in the context of COVID. However, it is also important to note they were generally uncomfortable walking alone. Streets with few pedestrians may create higher comfort levels for walking alone (Jacobs 2011). Additionally, close proximity of homes with front gardens to walk to for enjoyment and observation appear to be critical to motivating walking behaviors. Even for recreational walking, some density may thus be a helpful factor. Stakeholders reported that prior to the COVID-19 pandemic, building residents visited nearby businesses to socialize, which demonstrates how nodes are possible when mixed land use is supported by a sufficient density. Residents also reported that their balconies in a multi-residential building allowed for socialization with each other and with families living in the adjacent townhouses. The number and extent of these social interactions appear to have been made possible by the older adults living in higher density multi-family housing rather than single family homes far away from other neighbors. Thus, balance must be made in the need for activities like physical activity and social activities enabled by a sufficient density and the need for physical distancing during pandemics like COVID-19. The need for accommodating a sufficient density with the possibility of safe distancing may be achievable through improving both design and operational parameters in the built environment.

To maintain the virus-safe bubble, residents lost opportunities for connecting with family/friends through indoor visits, meals with family/friends, and hugs that required closer physical distance at intimate and personal levels (Hall and Hall 1966). Some challenges were accommodated by adapting the built environment (e.g. using patios to see visitors) while others were not (e.g. a resident could not eat together with her husband who lived in a long-term care facility). The requirements of a bubble strategy to be exclusive (Gupta 2020) also meant residents who did not follow the building protocol were excluded from the bubble. For example, Jenny was excluded from the bubble because she walked her dog in the protocol-restricted green trails and ravine area. Nielson et al. (2019) have argued group activity participation is critical for preventing social exclusion and creating a sense of belonging in congregate senior residential environments. Low and Smart (2020) also noted the risk of increasing social segregation caused by COVID-19-related physical distancing. Being excluded from the bubble reduced Jenny’s opportunities to join activities like gathering with neighbors, building activities, and shopping at the farmers’ market bus. Better operational management of the available nearby green trails and ravine through directional and distancing programming may have assisted with preventing these amenities nearby from protocol restriction.

Towards a more inclusive bubble strategy through improvements to the built environment

Researchers have been calling for improvements to the resilient and inclusive features of cities and communities to cope with the ongoing pandemic and upcoming recovery stages (e.g. Kordshakeri and Fazeli 2020). The bubble strategy along with built environment supports for older adults can be used for both the short-term pandemic and longer-term contexts in the recovery phase, and future epidemics. This section highlights built environment features found to facilitate bubble maintenance and proposes design considerations for addressing challenges.

Building common spaces critically support residents’ physical and social activities. To maximize use of common spaces, in addition to setting up nodes for exercise such as a common activity room, designers can consider improving the physical activity promoting potential of vertical and horizontal paths in buildings. Stairwells and corridors can be used to support people’s indoor walking, stair climbing, and other physical activity (Nicoll and Zimring 2009, Lee et al. 2012; Ruff et al. 2014). Older adults were observed to exercise by using daily objects in the surrounding built environment rather than specialized equipment in designated gym spaces (Chen et al. 2021). Similarly, Maggie and Jenny in this study conducted daily physical activity in one of the two building emergency stairwells. Despite elevator restrictions allowing no more than two bubble residents at any given time during COVID-19, other residents who were physically able to use the stairs choose to wait for the elevator, possibly due to inappropriate stairwell locations and designs such as the over-steep stair slopes indicated by Meggie. Future independent-living buildings for older adults can consider designing more age-friendly stairwells with improved accessibility, proximity, and visibility through locations and materials (e.g. open stairwells, fire-rated glazing on fire stairwell doors and walls), appropriate stair slopes for older populations, non-slip materials, and adequate illumination and ventilation, to enhance diversity of physical activity opportunities for older adults.

Edges including residential balconies, yards, or patios with plants have been researched and found to ease people’s stress and improve physical activity (e.g. Chalmin-Pui et al. 2021). Since COVID-19, researchers have commented on the likely importance of residential building balconies for fresh air and sunshine, and communications with people on nearby balconies or streets to improve mental health (e.g. Grigoriadou 2020). Our research provides support to such commentaries and revealed additional social wellbeing uses for building edge spaces such as balancing bubble maintenance with residents’ family/friend visits. Due to safety concerns and reasons such as construction costs, many congregate-living buildings for older adults are not designed with attached balconies and patios. Future buildings are encouraged to consider designing at least one attached patio/balcony for each apartment/unit to allow for additional opportunities for social interactions. Each patio/balcony should be carefully oriented for maximizing opportunities for receiving sunshine, having views of green spaces and/or nearby communities, and communicating with other patios/balconies without obstructions. Additionally, such buildings should include common outdoor spaces, such as a common area patio or green space for residents whose own balconies cannot be accessed directly from outside.

Street width aligned with pedestrian-friendly street scales foster important benefits such as vibrancy of the area and crime prevention (Jacobs 2011). Streets and sidewalks should remain a pleasant scale for pedestrians but in the meantime allow for temporary adaptations to accommodate pedestrians’ physical distancing and safe outdoor gathering (Bereitschaft and Scheller 2020). For neighborhoods with fewer pedestrians, like that in this study, innovations can include creating regular small waiting areas beside sidewalks to function as detour/wait spaces where two pedestrians not from the same bubble can meet on the sidewalk. In addition, local amenity nodes like the community bakery could consider setting up sidewalk-connected patios that would allow residents to walk there to purchase goods and socialize in a physically distanced way outdoors.

To support people’s physical distancing in green spaces, some parks in New York City have expanded running tracks during COVID-19 (Eltarabily and Elghezanwy 2020). In our study, although the green trails were found to be wider than two meters for physical distancing, it still became a building protocol (i.e. restricted area mainly because of a lack of demarcations separating pedestrians, pets, and bicycles from different directions). As such, rather than simply conducting the expansion, trails or other walking paths could be designed and operated with clear demarcations separating one-way users moving in different directions, or be temporarily designated one-way only, to allow for physical distancing and use by many users.

Whether the density of spaces is considered for temporary spaces (e.g. ravine) or the population density of a neighbourhood, balancing the needs for distancing for safety during epidemics and for sufficient density to help achieve amenity accessibility (e.g. nearby grocery store and pharmacy) and social interactions (e.g. through balconies nearby to each other in a multi-family apartment building) which are important for health, is essential. Echoing McFarlane (2021), who indicated that built environment factors impact viral spread in communities during COVID-19, our study presented a bubble strategy that could be considered to help with virus prevention no matter how dense of a community. Improving the designs and operations of neighborhoods and their amenities may be the critical missing link in achieving this balance.

Limitations and future research

Due to physical distancing restrictions, researchers were not able to enter the building during COVID-19 to conduct in-person observations, resident recruitment, and interviews. Potential challenges to residents’ physical and social activity maintenance not reported by residents and stakeholders could not be directly observed in this study. All interviews were conducted in spring and summer months of the COVID-19 pandemic and did not include residents’ lived experiences of their activities and surrounding built environments in winter weather. Despite limitations, the findings of our case study provide an increased understanding of possible strategies that could be used to both protect congregate- and independent-living older adults against virus transmission and assist with physical and social activities maintenance. The analyses of built environment factors supporting and challenging a bubble strategy highlights potential built environment design, planning, and operations solutions for this and future pandemics/epidemics. Further studies should consider analyzing multiple data types to better understand how specific built environment components, like green trails and building edge spaces, can be better designed to support bubble maintenance. To gather a deeper understanding of how a bubble strategy and built environment features could be further employed to support the physical and social activities of older adults, future case studies should be conducted with other independent-living buildings and extended care facilities, in various locations locally, nationally and internationally, to compare and contrast the characteristics of bubbles and built environments.

Conclusion

This qualitative multiple methods case study included multisensory building and neighborhood observations and their mapping, and interviews capturing the lived experiences of various independent-living older residents and stakeholders of a congregate-living building and surrounding neighborhood, to understand a bubble strategy established during COVID-19 and how the built environment supported or challenged the strategy to support physical and social activities. We illustrated complex and nuanced relationships between human and nonhuman factors that allowed for bubble maintenance. Built environment characteristics supporting and challenging a bubble in building interiors, building edges, and neighborhoods were discussed and considerations for improving built environment design/planning/operations were presented for the ongoing pandemic and future epidemics.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Public Health Agency of Canada [1819-HQ-000051].

Notes on contributors

Hui Ren

Housing for Health: The Housing for Health Project based at the University of Alberta in Edmonton, Canada is working to improve housing developments and the neighborhoods around them to better support protective health factors like active transportation, active recreation, active mobility in buildings, healthy food and beverage access, and social connection of residents. With chronic diseases like heart disease, strokes, diabetes and cancers, and mental health issues now leading causes of mortality, morbidity and/or healthcare costs globally, and even contributing to mortality and morbidity burdens of pandemics like COVID-19, improving these key protective factors for physical and mental health outcomes is crucial.

Megan Strickfaden

Megan Strickfaden, PhD, is a professor in the Department of Human Ecology, University of Alberta (Canada) and an adjunct professor in the Faculty of Architecture and Arts, Hasselt University (Belgium), the School of Design at the Queensland University of Technology (QUT) Brisbane (Australia), and the College of Fashion and Design at Donghua University (China). She is a design anthropologist, researcher and educator with hundreds of scholarly outcomes (patents, designed products, exhibitions, films) across thirty-years. She bridges theory with practice through specialized product design.

John C. Spence

Tori Hui Ren PhD, Jodie A. Stearns PhD and Hayford M. Avedzi PhD were former Post-Doctoral Fellows with Housing for Health. Marcus Jackson MSc is a Research Assistant with Housing for Health. John C. Spence PhD is Co-Investigator of Housing for Health. Karen K. Lee MD MHSc is Director and Principal Investigator of Housing for Health.

For more information on Housing for Health and team members, please see http://www.uab.ca/h4h The Housing for Health Project has been made possible in part through funding from the Public Health Agency of Canada. However, the views expressed herein do not necessarily represent the view of the Public Health Agency of Canada.