Innovative Solutions to Facilitate Accessibility for Airport Travelers with Disabilities (2020)

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8 2.1 Introduction Travelers with disabilities and older adults make up a large and growing market for the avia- tion industry. With nearly 20 percent of the U.S. population reported as having a disability and an estimated 10,000 people per day turning 65 years old, this market is quickly growing (Brault 2012, Heimlich 2010). A recent study from the Centers for Disease Control and Prevention (CDC) estimates that one in four American adults (25.7 percent, or 61.4 million) now has a disability (Centers for Disease Control and Prevention 2018). Among Canadians 15 years and older, 6.2 million—or 22 percent of the population—have a disability (Statistics Canada 2018). An estimated 80 million people in Europe have disabilities. According to the most recent World Health Organization statistics, more than 1 billion people globally (15 percent of the population) are estimated to have disabilities (World Health Orga- nization 2011). The number and percentage of people affected by a disability are expected to rise in the coming decades due to increasing longevity. This is especially the case in developed nations in North America and Europe, where postwar baby boomers are now reaching retirement age and experiencing limitations in their physical, sensory, and cognitive abilities. But, even in nations with young populations, such as China and India, the absolute number of older adults makes improvements in accessibility a growing priority. Figure 2-1 shows the incidence of disability by age for the U.S. population, with levels of dis- ability and severe disability increasing sharply with age. By ages 55 to 64, more than a quarter of individuals have a disability. According to the 2010 U.S. Census, approximately half of Ameri- cans 65 and older have a disability of some type, and more than a third have a severe disability (Brault 2012). The U.S. Census Bureau projects that the number of Americans 65 and older will jump 78 percent from 2010 to 2030 and 100 percent from 2010 to 2050 (West et al. 2014). As the older population continues to expand over the next decades, improvements to physical accessibility and customer service are a necessity if airports are to meet the needs of this rapidly expanding demographic. In other countries and regions, the pressure is even greater. Japan has the highest median age, where 26.3 percent of the population in 2017 was already age 65 and over, compared to 15 percent in the United States and 17 percent in Canada. While the median age on average in Europe is 19 percent, some countries such as Italy (22.4 percent), Greece (21.4 percent), and Germany (21.2 percent) also have significantly older populations (Haider 2017). Accord- ing to the World Health Organization, the percentage of people over age 60—11 percent in 2000—will nearly double to 22 percent of the world population (2 billion people) in 2050. C H A P T E R 2 Understanding the Needs of Travelers with Disabilities and of Older Adults

Understanding the Needs of Travelers with Disabilities and of Older Adults 9 Those 80 years or older will have quadrupled during the same period to 395 million (World Health Organization 2014). Other key factors that are contributing to the growth and importance of the disability market in general and for commercial aviation in particular include the following: • Spread of disability rights laws worldwide, now spurred on by the United Nations Convention on the Rights of Persons with Disabilities (CRPD) leading to improvements in access to the built environment, education, and employment; • Improvements in accessibility and technology that enable people with disabilities to partici- pate fully in society, realize their potential, and travel like everyone else; • Increases in disposable income stemming from improved accessibility, equality, and employ- ment; and • Globalization leading to the spread of families, not just across nations but also across continents. As a result of globalization, older, often unaccompanied family members—many of whom have physical, sensory, or cognitive disabilities—are traveling as never before to visit children and grandchildren overseas. For example, on flights between India and the Philippines and Figure 2-1. Disability prevalence and the need for assistance by age (Source: U.S. Census Bureau 2010).

10 Innovative Solutions to Facilitate Accessibility for Airport Travelers with Disabilities North America, the carriers from India and the Philippines report that they regularly receive 40 or more requests for wheelchair assistance. 2.2 Disability Travel Market: Open Doors Organization Studies In 2015, Open Doors Organization commissioned Mandala Research, Ltd. to conduct its third nationwide survey on the general travel habits and patterns of American adults (aged 18 and older) with disabilities. This was a follow-up to the groundbreaking Open Doors Organiza- tion studies carried out by Harris Interactive in 2002 and 2005. The 2015 study explores many of the same topics and reveals trends over time (Open Doors Organization 2015). These first-ever U.S. surveys on travel by people with disabilities yielded some surprising results, including the high percentage of people traveling and their level of expenditure. General findings of note from the Open Doors Organization 2015 study include the following: • 71 percent (26 million) of adults with disabilities traveled at least once in a 2-year period, a percentage that has been stable since 2002; • Annual expenditures on just their own travel totaled $17.3 billion, up from $13.6 billion in 2002; • Most adults with disabilities traveled with one or more adult family members, friends, or companions, meaning that the actual economic impact was at least double; and • A subgroup of frequent travelers (approximately 1 in 5) traveled at least 6 times every 2 years. Findings from the Open Doors Organization 2015 study that relate specifically to air travel showed that: • Nearly a third of adults with disabilities (31 percent) traveled by air in a 2-year period, typi- cally taking 2 trips in 2 years; • Spending on just their own flights increased to a total of $4.5 billion annually, up from $3.2 billion in 2005; and • More than one out of four travelers with disabilities (28 percent, or more than 7 million) traveled internationally in the past 5 years—most commonly to Europe, the Caribbean, and South and Central America—and individually spent about $2,500 on just their own interna- tional travel. Technology plays a key role in helping individuals with disabilities travel, as shown in the following: • Six out of 10 travelers with disabilities (62 percent) use the Internet to book their trips, up from 51 percent in 2005; • Another 6 out of 10 (58 percent) use the Internet to find out about accessible travel facilities; • Half (46 percent) use the Internet to support other travel needs; and • Six out of 10 (57 percent) also use mobile devices to assist in their travel. These figures compare favorably with the general population and show how important it is for the travel industry to make its websites and mobile apps accessible to everyone. Moreover, the Open Doors Organization findings are borne out by the research of the Rehabilitation Engineer- ing Research Center for Wireless Technologies (Wireless RERC), which has been measuring the use of smartphones and other mobile devices in nationwide surveys since 2002 and comparing their results with findings from the Pew Research Center on the general population (Morris et al. 2017). The Open Doors Organization studies also explored the barriers that individuals with dis- abilities face during air travel. In 2015, two-thirds of respondents (72 percent) reported that they

Understanding the Needs of Travelers with Disabilities and of Older Adults 11 encountered obstacles when dealing with airlines and at the airport (65 percent). While still high, these percentages have declined significantly since 2005 when they measured 84 percent and 82 percent, respectively, showing a positive trend. However, the Open Doors Organization study cannot say definitively that the change is due to improvements in airline and airport facilities and services. The most common obstacles reported at airports in all three studies were “long distance to or between gates” and “long lines.” In the 2015 study—as shown in Table 2-1—“lack of seating in airport” ranked third in importance, followed by “difficulty getting assistance with baggage,” “difficulty finding my way,” and “difficulties with Security or TSA.” “Communication obstacles” were another frequent barrier, most notably “difficulty understanding baggage carousel infor- mation.” These top complaints among travelers with disabilities differ little from those of the general traveling public. 2.3 Disability Definition, Types, and Incidences The definition of disability varies from nation to nation and from one international organiza- tion to another. The definition has continued to change as attitudes about disability change and as people with disabilities have gained a voice in how they are perceived and defined. The United Nations’ current definition of disability, embodied in Article 1 of the CRPD, reflects the perspective of the worldwide disability community: Persons with disabilities include those who have long-term physical, mental, intellectual, or sensory impairments, which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others. As the preamble to the CRPD notes, disability should not defined by the person’s functional limitations viewed in isolation but instead “results from the interaction between persons with Note: NA = not available. Table 2-1. Major Obstacles Encountered at Airports, 2005 and 2015

12 Innovative Solutions to Facilitate Accessibility for Airport Travelers with Disabilities impairments and attitudinal and environmental barriers.” This is commonly referred to as a “social model” of disability, in contrast to the older “medical model.” In the United States, federal law defines disability as “a physical or mental impairment that, on a permanent or temporary basis, substantially limits one or more major life activities, has a record of such an impairment, or is regarded as having such an impairment.” Major life activities include “functions such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.” For convenience of analysis and discussion, disabilities may be broadly categorized into a number of types: • Reduced Mobility (lower body): Ambulatory and Nonambulatory, • Arm and Hand Limitations (upper body), • Hearing Loss: Deaf and Hard of Hearing, • Vision Loss: Blind and Low Vision, • Speech and Language Disabilities, • Intellectual or Cognitive Disabilities, • Psychiatric Disabilities, and • Medical Disabilities. Invisible or Hidden Disabilities—another category that is receiving widespread attention in the industry—typically refers to intellectual, psychiatric, and medical disabilities (i.e., those that may not be readily apparent visually). Sensory disabilities may also fall into this group. Estimates of the incidence of the types of disability in the United States vary widely. In 2010, the U.S. Census Bureau estimated that among adults 15 and older • 30.6 million (12.6 percent) had difficulty walking or used a wheelchair, walker, or cane; • 19.9 million (8.2 percent) had difficulty with upper body functions, including lifting and grasping; • 15.2 million (6.3 percent) experienced difficulty with some kind of cognitive, mental, or emotional functioning; • 9.4 million (3.9 percent) had difficulty with at least one activity of daily living (bathing, dressing, and so on); • 8.1 million (3.3 percent) had difficulty seeing, of whom 2.1 million were blind; • 7.6 million (3.1 percent) had difficulty hearing, of whom 1.1 million were deaf; and • 2.8 million (1.2 percent) had difficulty with speech. In the 2010 U.S. Census Bureau study, 39 percent of adults had multiple disabilities affecting a variety of functions. This is more common among older adults because of the normal process of aging and its impact—to some degree—on physical, sensory, and cogni- tive abilities. According to a recent CDC study, one in four noninstitutionalized U.S. adults (25.7 percent, representing an estimated 61.4 million persons) now has a disability. Mobility was the most prevalent disability type (13.7 percent), followed by cognition (10.8 percent), independent living (6.8 percent), hearing (5.9 percent), vision (4.6 percent), and self-care (3.7 percent) (Centers for Disease Control and Prevention 2018). Whatever the general category or subcategory, each individual with a disability is unique and functions differently based on his or her own physiology, psychology, history, economic status, and countless other factors. For that reason, U.S. disability rights laws require accommodation of the person with the disability and specify that this may entail “reasonable modification” of services or facilities to meet that person’s specific needs.

Understanding the Needs of Travelers with Disabilities and of Older Adults 13 Among the main factors that affect how independently an individual traveler may function and the level of assistance that person may require are • The severity of the disability, • How long the person has had the disability and when it was acquired (early or late in life), • The training the person has received in managing the effects of the disability, • The assistive devices to which the person has access, and • The accessibility of the environment. While the aviation industry has no influence over a person’s inherent limitations, it does have the power to ensure that the environment is universally accessible. With fully inclusive, accessible services and facilities, it matters less what a person’s specific disability is because most will be able to function independently or with minimal assistance. A guiding principle of the [International Air Transport Association] IATA Airport Devel- opment Reference Manual, 10th ed. (2016) for airport planners and designers is that people with disabilities should be allowed to be as self-reliant as possible. To that end, international aviation organizations such as IATA, ACI (2018), and the International Civil Aviation Orga- nization (ICAO) (2013) have recently become advocates for universal design. The Canadian Transportation Agency (2007) and FAA (2012, 2016a) also recommend the use of universal design principles in their advisories. Universal design has a much broader scope than the mini- mum accessibility standards referenced by the ADA, as explained in more detail in Chapter 11. 2.4 User Needs in Aviation This section will focus on the needs of individuals with disabilities as air travelers, categorized by the general types of functional limitation. The intent is to convey an overview of the types of facilities, services, and information that will likely be required by these customers rather than a detailed description of each disability or medical condition. A more detailed discussion of the needs of each group is explored in the following chapters devoted to each journey segment. 2.4.1 Reduced Mobility As previously noted, the most common type of disability among Americans 15 and older is reduced mobility. Of the estimated 30.6 million people (12.6 percent) who have ambulatory difficulties, about 3.6 million (1.5 percent) use a wheelchair, and 11.6 million (4.8 percent) use a cane, crutches, or walker to assist with mobility (Brault 2012). The CDC puts the number of adults with mobility disabilities even higher at 32.7 million (13.9 percent) (Centers for Disease Control and Prevention 2018). For the purpose of analysis, individuals with reduced mobility fall into two main categories: nonambulatory and ambulatory (also referred to as semiambulatory). People who are non- ambulatory cannot walk at all and use manual or electric wheelchairs full time. Individuals who are paraplegic (paralysis affecting only the lower limbs) more commonly use manual wheelchairs. Those who are quadriplegic (paralysis affecting trunk and upper limbs, as well) use electric wheelchairs. Individuals who are nonambulatory typically use their own mobility devices in the airport and, wherever possible, check and reclaim them at the door of the plane. They may or may not request assistance from the airline to go through Security and help with hand luggage. Many will navigate independently and, thus, need to locate accessible routes and facilities where they deviate from the general path of travel. These routes and areas include elevators or ramps for

14 Innovative Solutions to Facilitate Accessibility for Airport Travelers with Disabilities level changes and accessible facilities such as parking, restrooms, companion restrooms, charg- ing stations, and so on. Persons who are ambulatory may not be able to manage long distances, stand for a long time, or climb stairs. According to U.S. Census Bureau findings, while most do not use an assistive device, a significant number do use a cane, walker, rollator (walker with four wheels), crutches, manual wheelchair, or electric scooter. Those traveling with a manual wheelchair may prefer to have it tagged at check-in unless they have a family member or companion to provide assistance. Many of these individuals will request wheelchair assistance or an electric cart to the gate, espe- cially at larger airports. For individuals with reduced mobility, not only is physical accessibility important, but also • Detailed information online about accessible facilities and services, including ground trans- portation options as well as distances and times to gates; • Ready access to assistance on arrival from ground transportation; • Designated accessible curbside drop-off and pickup areas that are also identified on digital maps; • Elevators—preferably the high-volume, flow-through type—that are adequate for demand and in easy view of escalators and stairs; • Designated Security line with prominent signage for people with disabilities (beneficial to all travelers with disabilities, including those who are unescorted); • Adequate seating in all functional areas, including check-in and baggage claim and at frequent intervals along corridors and walkways; • Timely, reliable, and well-trained assistance providers; and • Safe transport and timely return of mobility aids. 2.4.2 Upper Body Limitations The second most common physical disabilities, affecting roughly 19.9 million Americans, are those involving the upper body. Included in this group are individuals with quadriplegia, with hemiplegia (most commonly caused by stroke), with absent or partially missing arms and hands, or affected by medical conditions such as arthritis, tendonitis, and carpal tunnel syn- drome. These disabilities result in limits to reach range, hand and arm strength, and fine motor skills that affect a person’s ability to grasp, lift, push, and pull (Centers for Disease Control and Prevention 2018). As there are few assistive devices to help with these types of physical functions, travelers rely heavily on good design throughout the airport. At a minimum, this would include compliance with Americans with Disabilities Act Standards for Accessible Design, which specify that oper- able parts “be operable with one hand and shall not require tight grasping, pinching, or twisting of the wrist” and require a force of 5 pounds or less to activate. The controls must also fall within an unobstructed reach range of 48 inches maximum and 15 inches minimum. Of particular benefit to individuals with upper body limitations are: • Automatic doors; • Lever door handles and locks, as shown in Figure 2-2; • Open vestibule entries to restrooms; • Ticketless parking systems; • Low- or no-lift bag drop; • Flat baggage carousels; • Remote baggage drop and baggage delivery services; • Curbside check-in and porter services;

Understanding the Needs of Travelers with Disabilities and of Older Adults 15 • Assistance with carry-on luggage, as mandated by the Air Carrier Access Act; and • New biometric technologies that reduce or eliminate document checks. 2.4.3 Vision Loss An estimated 31.3 million American adults (18 and over) experience vision loss, defined as people with difficulty seeing—even with glasses or contact lenses—or who are legally blind (Centers for Disease Control and Prevention 2018). Typically, people with vision loss are grouped into two main categories: Blind or Low Vision. Individuals with low vision still rely mainly on their remaining vision, using scanners or magnifiers to access print information and scalable fonts on computers and mobile devices. Those who are blind depend on their aural, tactile, and olfactory senses and, therefore, rely on technologies such as screen readers, VoiceOver (on iOS mobile devices) or TalkBack (on Android devices), and haptic devices. Individuals who lose their vision later in life due to conditions such as age-related macular degeneration, glaucoma, diabetic retinopathy, or cataracts typically depend on audible information and tactile lettering rather than Braille. According to the National Federation of the Blind, fewer than 10 percent of Americans who are legally blind are Braille readers, and only 10 percent of blind children now learn it. Individuals who are deaf–blind usually retain some usable hearing or sight and rely on the same assistive devices and technologies as those with just one sensory disability. Persons with severe or complete loss of both senses face a much greater challenge, although new technolo- gies are now opening up the world for those who can afford them. Deaf–blind communication devices enable face-to-face communication through the exchange of text and Braille messages between two portable devices: a Braille keyboard with Braille display and a smartphone. These devices, such as the one by Humanware shown in Figure 2-3, also enable users to communicate via email and the Internet using built-in Wi-Fi and Bluetooth. Figure 2-2. Universally designed lever handle and lock at Paris–Charles de Gaulle Airport.

16 Innovative Solutions to Facilitate Accessibility for Airport Travelers with Disabilities While most individuals who are deaf–blind travel with a companion, under Air Carrier Access Act regulations they must be allowed to fly alone if they can establish a means of communica- tion with carrier personnel and can assist in their own evacuation in case of emergency. At the airport, like most other individuals with vision loss, they rely on the assistance of sighted guides provided by airlines or their subcontractors as also mandated by the Air Carrier Access Act. In Europe, under Regulation (EC) 1107/2006, the service is subcontracted by the airport (European Commission 2006). For independent navigation, the most common assistive devices for individuals with signifi- cant vision loss remain the white cane and guide dog, although a myriad of geolocation apps are now in development in the U.S. and worldwide. See Chapter 8 in ACRP Research Report 177 for detailed discussions of these technologies (Harding et al. 2017). Aira—a new wayfinding solution—is an app-based subscription service that connects a person with vision loss to a remotely located, sighted agent for assistance. Aira, which stands for Artificial Intelligence + Remote Assistance, combines multiple working components (e.g., a mobile app, smart glasses or a smartphone camera, an agent, and a dashboard) to provide instant access to visual information for tasks of daily living and navigation. As of December 2018, 22 U.S. airports had joined the Aira Airport Network, details of which are provided in Chapter 12. Figure 2-4 shows a passenger wearing smart glasses and using the Aira app in an airport check-in area. Figure 2-3. Humanware Brailliant BI 14 Braille display (Source: Humanware). Figure 2-4. An Aira user wears smart glasses to navigate an airport (Source: Aira).

Understanding the Needs of Travelers with Disabilities and of Older Adults 17 For travelers with vision loss at airports, the following are particularly important: • Automatic doors; • Accessible websites and apps with detailed information in appropriate formats (e.g., text maps and detailed directories); • Ready access to assistance on arrival from ground transportation; • Timely, reliable, and well-trained service providers that offer assistance appropriate to the individual’s needs (e.g., a sighted guide escort rather than a wheelchair); • Awareness training for frontline staff in how to guide and give directions; • Accessibility of static and digital signage, including its location at eye level to allow for close approach; • Regular self-evaluation by airports to detect safety hazards such as protruding objects and crowd-control tape that are not detectable by a cane and lack of tactile warning strips at cross- walks and elsewhere; and • SARAs inside and outside of Security, especially at larger airports. 2.4.4 Hearing Loss There are an estimated 14.1 million American adults—approximately 5.9 percent of the population—who experience hearing loss (Centers for Disease Control and Prevention 2018). Individuals with hearing loss generally fall under one of two categories: deaf or hard of hearing. Those who are deaf have severe or complete hearing loss and rely primarily on their vision to access information, although they may use assistive devices such as hearing aids or cochlear implants and communicate orally rather than through sign language or cued speech (Harding et al. 2017). Individuals who are hard of hearing retain some functional hearing abilities and primarily communicate using their hearing and speech. Of the assistive devices and technologies available, hearing aids are the most common as they are easy to use and benefit the broadest range of people with hearing loss. Hearing aids amplify sound, can be used in one or both ears, and are personalized to meet the needs of each user. However, in noisy environments such as an airport, hearing aids may have minimal benefit to the user due to the magnification of ambient sound. In this case, travelers who are hard of hear- ing may need to rely more on visual communication at the airport than they typically would in their everyday lives (Harding et al. 2017). Hearing loop technology transmits sound directly from microphones and PA systems to hear- ing aids equipped with telecoils (or t-coils) (Figure 2-5). Installing this technology in check-in Figure 2-5. Portable induction loop with microphone (Source: Oval Window Audio).

18 Innovative Solutions to Facilitate Accessibility for Airport Travelers with Disabilities and gate areas can greatly improve communication. Hearing loops, also known as audio induction loops, are fairly common in Europe as hearing aids with t-coils have long been standard there. Now that sales of hearing aids with t-coils are on the rise—up from 37 percent in 2001 to an estimated 70 percent to 80 percent today—U.S. airports may be more encour- aged to try this technology (www.hasloops.com/faq/). A February 2019 article in Sound & Communication reports that this is indeed the case with Austin–Bergstrom International Air- port in Texas, Phoenix Sky Harbor International Airport, and Sarasota–Bradenton International Airport in Florida, joining early adopters Grand Rapids Gerald R. Ford International Airport and Greater Rochester International Airport (Frazier 2019). Hearing loop installation is also in the planning stage at Memphis International Airport. Air Carrier Access Act regulations (Part 382.53) require people with hearing loss to self- identify to the air carrier in order to get prompt access to verbal announcements. As the pre- amble to Part 382 explains, this regulation is in lieu of requiring air carriers to use a particular medium—such as an LED screen or other means—to visually present information disseminated by a PA system. However, few people who are deaf or hard of hearing ask for any accommoda- tions since their requests tend to be overlooked, relying instead on airline text messages for gate changes or delays and keeping a close eye on the podium. A growing trend that addresses this gap is the use of gate information displays to provide real-time, visual boarding announcements. Like the general population, individuals who are deaf or hard of hearing navigate primarily through the use of visual cues and signage, although airport and airline apps are also appreciated. Problems typically arise when, for whatever reason, information needs to be exchanged through direct communication with airline or airport personnel, who seldom know sign language. Travelers with hearing loss benefit from the following: • Captioning of videos and virtual tours on websites and apps, • Detailed visual maps and directories, online and at the airport, • Captioning on airport TVs, • Announcements in visual format (e.g., gate information displays, baggage information display screens, and visual paging), • Assistive communication technology (e.g., hearing loops, remote video interpreting via tablets, and public video phones), • Communication by text with airports and airlines (e.g., live chat, Twitter, Facebook, WhatsApp, and SMS text alerts for flight changes and emergency messages), • Communication training for frontline staff and first responders, and • Good lighting and avoidance of glare to better facilitate visual communication. Chapter 11 includes sections on designing for low vision and on the DeafSpace Project, which addresses the specific environmental needs of individuals who are deaf. 2.4.5 Cognitive Disabilities A cognitive disability, also known as an intellectual disability, refers to limitations in a person’s ability to learn at an expected level and function independently in daily life. This is the second most common disability and currently affects an estimated 25.8 million American adults (10.8 percent of the population 18 years and older) (Centers for Disease Control and Prevention 2018). Cognitive disabilities encompass a broad range of limitations, with severity varying for each person. Many cognitive disabilities—such as Down syndrome and autism—are present at birth; whereas, others (such as dementia) develop as a person ages. From 2000 to 2014, the incidence rate of children diagnosed with autism increased from one in 150 children to one in 59 children and is four times more common among boys than

Understanding the Needs of Travelers with Disabilities and of Older Adults 19 among girls (Centers for Disease Control and Prevention 2018). Autism spectrum disorder is an umbrella term because the challenges experienced by each person and the severity at which they are affected is different for everyone. Asperger’s is a mild form of autism that primarily affects one’s social skills without impacting cognitive abilities such as speaking, learning, following directions, and caring for oneself. For those with more severe autism, common characteristics include limited verbal and nonverbal communication, repetitive behaviors and interests, and limited social skills (www.autismspeaks.org). Sensory processing difficulties are also common among individuals with autism. Individuals with sensory processing difficulties have trouble processing information from the five senses and can easily become overwhelmed, uncomfortable, and distressed. This, paired with a child’s inability to communicate what he or she is feeling. can lead to behaviors such as running, jump- ing, or flapping the hands. When this feeling becomes too overwhelming, meltdowns occur that may include behaviors such as crying, yelling, and even injuring oneself or others. To avoid such incidents, families and travel companions often have go-to calming strategies such as a weighted blanket, a toy to fidget with or chew on, and noise-cancelling headphones. Being able to go to a quiet space to jump and run can also help. Individuals with autism often find visual tools—such as picture schedules or social stories—to be especially useful in new situations. These help to prepare for an activity and the transitions from one task to another because not knowing what is next, especially in a new activity like air travel, is often a major stressor. Other tools that may help minimize stress are check-off activity lists, reward systems, and predetermined quiet time (Ford-Lanza 2017). In response to the rapid rise in autism, airports and airlines are now trying to meet the needs of these children and young adults. In addition to familiarization programs that bring children with autism and developmental disabilities and their families to the airport, a number of airports post social stories online to help with pretrip preparation and create quiet spaces and sensory rooms, such as the one opened in 2018 at Lehigh Valley International Airport in Pennsylvania (Figure 2-6). Other airports, primarily in the UK, offer a means to voluntarily self-identify through the use of colored lanyards, buttons, and stickers so that frontline staff are alerted that an individual may have a cognitive or other hidden disability. Program details are provided in subsequent chapters. Another cognitive disability that is just beginning to receive heightened attention in the aviation industry is dementia, now affecting a growing number of individuals at the opposite end of the age spectrum. Approximately 47.5 million people worldwide have some form of Figure 2-6. Lehigh Valley International Airport sensory room (Source: Joe Mancini, The Arc of Philadelphia).

20 Innovative Solutions to Facilitate Accessibility for Airport Travelers with Disabilities dementia, with common types including Alzheimer’s, Parkinson’s, and Huntington’s. Dementia is an umbrella term, encompassing a range of cognitive limitations such as memory loss, personality changes, and issues with language, communication, and thinking. Under Air Carrier Access Act regulations Part 382.29, individuals with cognitive disabilities must be permitted to travel alone if they are able to understand and follow instructions of in-flight personnel in case of emergency. The following international airports are working to improve the travel experience for persons with dementia: • London Gatwick Airport uses videos from “Dementia-Friendly UK” as part of its staff aware- ness training. • London Heathrow, in partnership with the Alzheimer’s Society, has created a program that includes educational tips for travelers with dementia and training for frontline airport staff, assistance staff, and security personnel. • Dementia Australia has recognized Brisbane Airport in Queensland, Australia, as Australia’s first dementia-friendly airport, thanks to the airport’s targeted airport guide and staff train- ing developed by the Dementia Centre for Research Collaboration at Queensland University of Technology. The centre’s design guidelines for persons with dementia are discussed in Chapter 11. In North America, Minneapolis–Saint Paul International Airport has formed a Dementia- Friendly Airport Working Group to determine how to best serve the needs of these customers, while Air Canada has a complimentary Unaccompanied Adult program to ensure that adults with cognitive disabilities cannot wander and become lost. A similar fee-based program was previously available at Northwest Airlines. Rather than offer such services itself, United Airlines has created a new program called Signature Service in partnership with Global Airport Concierge. Additional details on this VIP service are provided in Chapter 3. Travelers with cognitive disabilities are best served by • Use of plain language on airport information and signage, accompanied by pictograms, where possible (which benefit foreign travelers, as well); • Specific mention on airport and airline websites that assistance services are available for per- sons with cognitive disabilities such as autism, dementia, and developmental disabilities; • Ready access to assistance on arrival from ground transportation; • Assistance service that provides continual oversight, if needed; • Targeted facilities and services such as familiarization programs, social stories, quiet rooms and paths of travel, and sensory rooms; • Awareness training for frontline staff on interacting and communicating with travelers with autism, dementia, and other cognitive disabilities; and • Use of universal design standards, including those that specifically address the needs of persons with autism and dementia (see Chapter 11). 2.5 Older Adults As older adults are more likely to have multiple functional limitations—physical, sensory, and cognitive—much of the above discussion for each type of disability applies to them, as well. However, an important distinction between individuals with disabilities and older adults is that the former are generally aware of their limitations, while the latter may not realize the extent to which aging has affected their abilities since it is a gradual process about which they may even be in denial (Wolfe 2003). If left uncorrected, declining vision, hearing, or mobility may make these individuals more accident prone, especially in unfamiliar and complex environments like airports.

Understanding the Needs of Travelers with Disabilities and of Older Adults 21 ACRP Synthesis 51: Impacts of Aging Travelers on Airports provides a detailed summary of the needs of older air travelers and the efforts being made by airports to address them (Mein et al. 2014). The latter is addressed in more detail in Chapter 11, which also discusses the benefits of universal design (or lifespan design). Given the following list of challenges identified by that report, it is easy to understand why many older travelers request wheelchair assistance at airports even though they typically use no assistive device in their daily lives (Mein et al. 2014). Wayfinding • Unfamiliarity with a complex airport environment, • Unclear or confusing information and directional signage, and • Difficulty understanding the meaning and terminology of directional signs. Fatigue • Standing or waiting in line at check-in, passenger security screening, baggage claim, or curbside; • Long walking distances in the terminal, parking garage, and surface lots; and • Handling heavy bags at curbside, check-in, and baggage claim. Technology and equipment • Understanding the use of self-service devices, • Negotiating the Security checkpoint process, and • Using escalators and moving walkways. Amenities • Difficulty in using toilet facilities and • Using congested retail and food service concessions. Solutions to improve the experience of older adults in airports identified by Mein, Kirchhoff, and Fangen (2014) and the current research include the following: • Seating at regular intervals along concourses and near key functional areas—baggage claim, check-in, Security, and ground transportation—as well as outside restrooms; • Raised seats with arms; • Information counters or roving ambassadors both airside and landside; • Directional and informational signage with symbols and minimal text; • High-contrast, large-print signage and display screens; • Communication of information in both aural and visual formats; • Higher levels of illumination to accommodate aging eyes, gradual transitions from dark to bright spaces, and avoidance of glare; • Assistive equipment for use or rent landside and airside, including luggage carts, manual wheelchairs, and—possibly in the future—smart electric wheelchairs; • Location of elevators in close proximity to stairs and escalators to prevent falls; • Electric cart transit systems in concourses (Figure 2-7); • Automated people movers with adequate seating and lower acceleration rates; and • Companion restrooms with adult changing tables. With regard to the use of technology, Mein, Kirchhoff, and Fangen (2014) note that older adults are not a homogenous group. The younger segment (baby boomers) are much more likely to be tech savvy and to use mobile phones and apps. This is borne out in surveys by Wire- less RERC (Morris et al. 2013) and the Pew Research Center (Anderson and Perrin 2017). Pew Research Center estimates that 59 percent of adults age 65 to 69 own a smartphone, decreasing

22 Innovative Solutions to Facilitate Accessibility for Airport Travelers with Disabilities to 17 percent among people age 80 and older. Similarly, 82 percent of people age 65 to 69 have Internet at home, decreasing to 44 percent among individuals age 80 and older. Since smart- phone ownership increases with income, one would expect still higher usage rates among older adults who can afford to travel by air. According to the Pew Research Center, the number of older adults who own smartphones more than doubled from 18 percent to approximately 42 percent from 2013 to 2017. With the constant evolution and accessibility of technology, this trend is expected to continue. For those who do not often use a smartphone or the Internet, a contributing reason may be a lack of confidence in using them independently or a physical challenge ranging from vision loss to low dexterity. Once this challenge is overcome, research shows high engagement with digital devices and content (Anderson and Perrin 2017). A significant number of people with disabilities in all age groups may never use cell phones, smartphones, or other mobile technology. Therefore, airports, airlines, and service companies must ensure that the needs of these individuals are being met through traditional methods of communication and customer service. Figure 2-7. Electric cart shuttle stop at Montréal– Pierre Elliott Trudeau International Airport.