The great outdoors – the importance of engaging with nature

During lockdown we, like many others, have gained a new appreciation for the importance of being able to get out and about and engage with nature from both a leisure and exercise perspective, and the role nature has on our physical and mental health. However, this is something we’ve been interested in for a while at ADS, particularly in terms of opportunities for people with dementia to get outside or connect with nature in some way. To this end, this blog brings together a few of our previous projects in one place and summarises some of their key findings.

The photos used within this blog are not from specific projects but hopefully they will make you smile and give you a dose of nature for today.

Green Dementia Care

Green Dementia Care refers to indoor and outdoor experiences and activities that aim to promote health and wellbeing through interaction with nature for people living with dementia. It links traditional health care to gardening, agriculture, animals and exercising in the natural environment. The Green Dementia Care project was a pilot study to explore what is already being done around nature-based care for people living with dementia in care homes and extra care housing, and some of the associated barriers and enablers.

Many people living with dementia in care homes or extra care housing have limited opportunities to connect with the natural world, often due to organisational concerns about safety and security, and outdoor spaces that are not fully accessible. However, engaging with the natural environment has many beneficial outcomes for some people living with dementia including:

  • Mental and emotional benefits
  • Social benefits
  • Behavioural benefits
  • Physical health and wellbeing benefits

Nature-based activities can also have a positive effect on family members in terms of engagement with the resident, engagement with staff, and emotional wellbeing. Being involved in green dementia care activities also appears to have strong positive impacts on staff in terms of morale, job satisfaction, confidence, feelings of empowerment and, to a lesser extent, positive effects on staff retention and sickness/absence.

Dementia Adventure in a Box

Dementia Adventure has recently been piloting a social licence scheme where they provide expertise and support to organisations looking to deliver nature-based activities in line with the Dementia Adventure ethos. After receiving training, delegates from participating organisations ran their own activity sessions, and during the course of the three-year pilot nearly 1,000 sessions were delivered with over 600 being nature-based. Almost 2,500 attendances were recorded by people living with dementia and nearly 600 by carers.

Case studies found a range of benefits associated with people with dementia taking part in the activities, including improved wellbeing and mood, and valuable opportunities for social interaction. Being outdoors helped sessions to feel relaxed and informal, and when people were able to take part in ‘real’ activities such as helping out on a care farm they were considered fulfilling and meaningful to the individual, and helped maintain a sense of identity.

Challenges for delegates included recruiting people to take part in activities, transport, funding, and perceptions about dementia-related stigma. Time was also an issue for delegates when the activities were not given priority within their role, or they had little support from colleagues, leaving them to organise and deliver activities on their own. A full report of the project is available on our website.

Walking with Purpose

The main aim of this study was to explore and understand walking with purpose among people living with dementia in extra care, retirement and domestic housing settings. It’s already been the subject of an earlier blog, and although the focus was not on the outdoors, many of the findings for indoor spaces were just as applicable to outdoor spaces. For example, ensuring that the physical environment is supportive of safe walking is not limited to indoor environments. Gardens and other outdoor areas also need to be dementia friendly and safe.

Having a risk averse culture can also mean that staff may discourage people from walking, especially outside, and it was interesting to note that many schemes have black mats by exit doors, which can deter people with dementia from trying to leave a building, thus limiting their ability to access outdoor spaces. The time required to support people when walking was seen as a potential barrier and a source of stress from staff, although it was promising to see that in some cases staff were able to accompany residents for outside walks.

Namaste Care Intervention UK

Although the focus of this work was on the implementation of Namaste Care more broadly, one element within the intervention was the idea of bringing the outdoors indoors through having plants and flowers in the space used for Namaste Care sessions. Such sessions are aimed at people living with advanced dementia, highlighting that the smells, textures and general feeling that you get from being around nature play an important role throughout our lives.

Environmental Assessment Tools

To date, the five environmental assessment tools developed by The King’s Fund and taken on by ADS have focused on indoor spaces, but still recognise the importance of having access to the outside and promote the need for outdoor spaces to be safe and suitable for people with dementia. In addition, future work is to be undertaken to add to the suite of tools by developing one specifically for assessing outdoor spaces. We’ll let you know when that becomes available, obviously.

Enabling Environments for People with Dementia Online Module

Not a project, but our new online module about environments definitely doesn’t ignore the great outdoors. As well as weaving elements of it throughout the course, one week is devoted to connecting with the outdoors, looking at the importance of outdoor spaces and connection to nature.

So engaging with nature and the outdoors is something we’re very passionate about, and hopefully we can continue to work in this area in the future – even if it’s raining.

Connect with ADS on twitter @DementiaStudies and on Facebook @adsuow

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