Access to the natural world outside my home is hugely important to me. Unless I am unwell I go out every single day in all weathers. I’d feel trapped if I couldn’t do this . Maybe it’s because of the personal significance of the outdoors that I’m so aghast when I go into a dementia care settings where people are restricted to an indoor existence without even a garden. No wonder they are depressed , agitated or aggressive. I might resort to hysteria or violence if I were similarly detained.
So I’m going to steer you in the direction of two reports today that about people with dementia accessing nature. Even though it was published five years ago Natural England’s ‘Greening Dementia’ is an interesting read and remains relevant. A PDF file of this report is at the bottom of the page reached by following this link. It reviewed the evidence of benefits and barriers for people with dementia when it came to accessing green spaces outdoors and gave recommendations for further research and reviews of existing and future projects. I was encouraged that it emphasised that this further work should actively involve people with dementia and be user lead.
Because the majority of people with dementia live in their own homes, the report suggested that intervention might be best targeted as those in the early to moderate stages to make the best use of resources. However I’d argue against this. It seems to me that people in the later stages of dementia have the potential to benefit greatly, particularly as the outdoor environment is such a rich multi- sensory resource. Improvements might be harder to measure in this group from an ethical and objective stance but this should not be a reason to exclude them from such potentially beneficial occupation.
The study found that access to the outdoors had multi-factorial benefits. Improvements to physical and mental health, communication, cognition, multi-sensory engagement and social interaction were indicated. However lots of questions remained unanswered. For instance what were the effects of being in difference outside environments, comparing woodlands to a park or the seaside for instance? How did people’s engagement with natural world outside differ at different stages of dementia progression? The evidence about barriers for going outdoors for people with dementia was also limited.
Three years later and a further report ‘Is it Nice Outside?’ followed. You can read it by following the link in the last sentence and downloading the article at the end of the page. This gathered the views of people with dementia and their carers so that barriers to accessing the outdoor environment could be addressed.
A full discussion is not possible in a short article but a number of things struck me as I was reading the report.
- Although for a few they triggered bad memories, places with access to water were the most popular places to visit be it a lake in the local park or the seaside. I would imagine that this applies to the general population too. There is something quite wonderful about the power of water both to calm and invigorate.
- People with dementia saw their disease as far less a barrier to accessing the outside than their carers did. Granted, lack of insight may play a part here but there are lessons to be learnt about empowering those who support people with dementia to be more comfortable with risk taking.
- The biggest barrier to access was transportation. Public transport isn’t always available and people with dementia and their carers have frequently given up driving.
- Public parks were the green spaces that were the nearest geographically to the largest proportion of the people involved in the study. Might it therefore make sense for there to be a concerted effort to make these accessible to people with dementia as a priority? The importance of this becomes more clear when the transport difficulties that I’ve just mentioned above are taken into consideration.
- Something specific to do in the green area was important. The importance of organised activities was stressed so as ‘to make a day off it’.
- Signage, toilets, restaurants and somewhere to sit all would make such a difference.
And on a final note I’ve included this quote from one of the participants from the study. It makes up for the fact that this is a short piece of writing. It says it all!
“What it is, the fact that if you are out in the open area, it brings a whole new
perspective to how you feel, you are not in an enclosed space indoors where
you are thinking well, this is my world, that’s their world out there. You go out
into their world, as one might say, you enjoy walking, swimming whatever,
anything which gives you more exercise to the body, actually exercises the
mind as well and fresh air is excellent for people with dementia of any sort
because mine should be getting worse all the time but it’s not. It is staying
stable and as a result I am still walking, volunteer walk leader and I thoroughly
enjoy it, I now walk about 60 miles a month on average.”