Why the Supermarket Is the Next Frontier in Dementia-Friendly Design

For most of us, a trip to the supermarket is a chore we barely think about. For the more than 55 million people worldwide living with dementia, it can be a high-stakes expedition through noise, clutter, unfamiliar layouts and machines that seem designed to trip them up. Now, the first comprehensive review of how people living with dementia experience retail environments reveals just how much cognitive, sensory and social engineering goes into a simple shopping trip — and why some of the industry’s best-intentioned fixes may be backfiring.

The scoping review, published in Frontiers in Dementia, was led by researchers affiliated with the National Institute for Health and Care Research Applied Research Collaborations across the UK, including Lancaster University, the University of Liverpool and King’s College London. The team searched PubMed, PsycINFO, CINAHL, MEDLINE and EMBASE for studies published between 2007 and 2025, and supplemented the academic record with grey-literature searches of Google to capture the guidance documents, charity reports and retailer announcements that never make it into peer-reviewed journals. That decision proved crucial: of the 74 resources ultimately included, only ten were academic studies. The other 59 were non-academic materials — the practical, real-world output of a retail sector that has been racing ahead of the evidence base.

The numbers tell their own story. The ten academic studies involved 2,012 participants, including 1,172 people living with dementia and 734 informal carers, and all employed qualitative methods such as interviews, focus groups and participant observations. The 19,157 deduplicated academic records screened down to just ten relevant studies, while 1,561 deduplicated non-academic materials yielded 59 — a striking asymmetry that the authors say reflects a fundamental gap in cross-disciplinary knowledge exchange. The literature on dementia and retail comes almost entirely from medicine, health and social science rather than business and marketing, meaning the people who know the clinical picture best have little say in commercial design, and the people who design stores best have little clinical insight.

From the lived-experience studies, the researchers distilled four overarching themes through reflexive thematic analysis. The first was a reliance on familiarity and predictability. People living with dementia consistently described how knowing a shop — its layout, its staff, its routines — reduced cognitive effort and generated feelings of safety, independence and confidence. Conversely, when retailers reorganised products, altered layouts or revised packaging, established mental maps were disrupted, rendering previously navigable environments confusing and disorienting. Many participants responded by restricting their shopping to small, local shops they knew well and avoiding larger supermarkets altogether — a gradual contraction of their accessible world that researchers have described as a shrinking world.

The second theme concerned cognitive demands that begin long before anyone sets foot in the store. Participants described difficulties remembering the purpose of the trip, gathering necessary items such as keys, wallets and shopping lists, and retaining task goals across transitions. Compensatory strategies like written notes were common but precarious, easily forgotten or misplaced. Once inside, the sheer quantity of available products — dozens of brands for a single item — generated overwhelm and confusion. The third theme was sensory overload and time pressure: noise from music, announcements and crowds reduced concentration, while bright lighting and visually cluttered displays contributed to cognitive overload. Some participants even experienced visual illusions created by store interiors designed for aesthetic appeal, such as mirrors at vegetable stands giving the impression of more produce, or automatic glass doors difficult to distinguish from surrounding walls.

The fourth theme — payment, technology and feelings of exposure — may be the most viral of the findings, because it implicates the self-service checkout that has become ubiquitous across the retail sector. Self-service checkouts and card readers requiring multiple steps and rapid responses caused stress and feelings of exclusion. Difficulties remembering PIN numbers, counting money and managing queues often led to reliance on carers or avoidance of certain shops. Anticipation of these challenges frequently generated anxiety before entering the store, with some participants actively planning how to avoid self-service checkouts or selecting shops based on the availability of staffed tills. What looks like convenience to the average shopper looks like a barrier to someone whose cognitive symptoms make rapid, multi-step machine interactions stressful.

Against this backdrop, the review mapped a wide range of interventions and guidance, which the authors classified into three broad categories: staff training, environmental changes and technology-related interventions. Academic recommendations consistently emphasised supportive social interactions, with people living with dementia prioritising shops where staff were patient, understanding and willing to offer assistance when confusion arose. Dementia awareness training for retail staff was repeatedly highlighted, ideally providing insight into what it is like to live with dementia alongside an understanding of how environmental factors such as spatial design or soundscapes may exacerbate difficulties. Environmental recommendations included simplified and predictable store layouts, consistent product placement, clearer signage, controlled lighting, reduced visual clutter and quieter shopping periods. Technology-related proposals included the availability of staff-assisted checkouts, simplified payment processes and the introduction of slow check-out counters to reduce time pressure.

The grey literature revealed that many of these recommendations have already been implemented in practice, particularly across the UK. Retailers have introduced relaxed or slow shopping lanes providing more time and encouraging conversations with checkout workers. Shops have improved layouts through contrasting colours and clear fonts for toilets, checkouts and navigation, and embedded dementia-friendly toilets. Some retailers have launched quiet or inclusive shopping hours in which noise levels are lowered and additional support is provided. In 2021, the Association of Convenience Stores estimated that around 4,500 independent shops had dementia friends working within them, and major retailers have participated in the Alzheimer’s Society Dementia Friends training initiative. The authors note a striking congruence: much of this practical guidance was issued before the empirical exploration of retail experiences for people living with dementia had even occurred — the Alzheimer’s Society’s dementia-friendly retail guide dates to 2016, predating 70 percent of the academic articles included in the review — yet it aligns closely with what the qualitative literature now recommends.

But the review also sounds a cautionary note that may surprise advocates of dementia-friendly retail. Many current initiatives, particularly environmental adaptations such as slow shopping lanes and quiet shopping hours, function as mechanisms that divide people living with dementia from the wider population. While intended to enhance accessibility, critics suggest such interventions risk reinforcing a them-and-us divide and inadvertently contributing to stigmatisation. Stigma is well established as a factor that can negatively influence outcomes for people living with dementia, including reduced engagement and reluctance to seek support or disclose needs. Within the Dementia Inequalities Model, stigma operates as a key structural and social determinant shaping access to resources, service use and help-seeking behaviour. From this perspective, retail adaptations that visibly single out people living with dementia may inadvertently exacerbate existing inequalities despite their inclusive intentions. The authors suggest that many dementia-friendly initiatives align with principles of universal design and may be better conceptualised as human-friendly services — reduced noise and clearer signage benefit older adults, people with sensory sensitivities, parents with young children and anyone experiencing temporary stress, not solely people living with dementia. Importantly, they acknowledge that these criticisms are not derived from people living with dementia themselves, and no empirical research has yet explored their own perspectives on these initiatives.

The most critical gap the review identifies is the near-total absence of rigorous evaluation. Despite widespread adoption of dementia-friendly initiatives across the retail sector, no studies have systematically measured their impact on shopping independence or overall engagement for people living with dementia, and the long-term sustainability and effectiveness of environmental adaptations and staff training remain unknown. The authors call for longitudinal quantitative or mixed-methods studies assessing how staff training and environmental modifications promote autonomy, reduce cognitive and sensory burden, and improve shopping experiences, alongside international comparisons to identify culturally relevant strategies. They also argue for cross-disciplinary collaboration: health sciences often identify a need while lacking the marketing expertise to develop viable solutions, while business literature lacks sufficient clinical insight to create appropriate adaptations. Combining both fields, supported by people living with dementia in a co-research capacity, could yield commercially viable access solutions that serve an expanding consumer demographic while enabling people living with dementia to maintain agency, identity and autonomy through everyday retail choices. Until then, the supermarket — that most ordinary of community spaces — remains a place where the difference between inclusion and exclusion can hinge on something as small as where the baked beans are moved this week.

Subject of Research: Dementia inclusive retail outlets: a scoping review of strategies to support people living with dementia in the retail industry

Article Title: Dementia inclusive retail outlets: a scoping review of strategies to support people living with dementia in the retail industry

Article References: Readman, M. R., Fox, S., Godfrey, A., Farnood, A., Smith, S. K., Luijnenburg, O., Wareing, L., Brar, M., Ramos, R., & Polden, M. (2026). Dementia inclusive retail outlets: a scoping review of strategies to support people living with dementia in the retail industry. Frontiers in Dementia, 5, Article 1852323. https://doi.org/10.3389/frdem.2026.1852323

Image Credits: AI Generated

DOI: 10.3389/frdem.2026.1852323

Keywords: Dementia, inclusive, retail, outlets, scoping, review, strategies, support, people, living, industry, scientific research