Aim To evaluate the process of daily going outside in a nursing home garden and explore the effect of garden use on quality of life and neuropsychiatric symptoms in persons with dementia. Design A feasibility study with quantitative and qualitative approaches. Methods Twenty residents with a diagnosis of moderate‐to‐severe dementia participated. The intervention consisted of at least 30 min of garden use, whereby any activity outside is possible as long as it is person‐centred and fitting within usual daily nursing home practice. Interviews were held with caregivers, and questionnaires were sent to other disciplines involved. Quality of life (QUALIDEM) and neuropsychiatric symptoms (NPI‐NH) were collected at baseline, intervention and postintervention. Results Caregivers experienced and observed benefits of going outside for themselves, in residents and relatives. Incorporating daily garden use does not imply an additional task, but rather rearranging priorities and doing the usual activities outside a part of the time.

ObjectivesConsidering the importance of going outside in a natural environment for people in general, and people living with dementia in particular, we want to unravel the aspects by which garden use affects quality of life (QoL) and behavioral and psychological symptoms of dementia (BPSD) in people living with dementia in nursing homes.DesignSystematic review.Setting and participantsPeople living with dementia in nursing homes.MethodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic bibliographic databases were searched (May 2022). Quantitative, qualitative and mixed-methods studies describing the effect of garden use on QoL, BPSD, or other outcomes related to QoL or BPSD in people living with dementia in nursing homes were included. The methodological quality of individual studies was assessed with the Mixed Methods Appraisal Tool (MMAT) and a narrative synthesis of the results was performed.ResultsAfter screening title and abstract (N = 498), and full-text assessment (N = 67), 19 publications were included. These described 17 studies and three types of interventions: (1) interventions regarding the evaluation of effects of specifically designed nursing home gardens, (2) participation of the people living with dementia in outside activities, and (3) other interventions, for example, garden visits and different seasons.Conclusions and implicationsOverall, first studies appear to suggest positive effects of garden use on QoL, BPSD, or other outcomes related to QoL or BPSD (stress, sleep, and mood) in people living with dementia in nursing homes. However, consensus regarding measurements and key outcomes, taking into account the physical, social, and organizational aspects when designing the garden use intervention, is necessary for the reliable evaluation of these interventions.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283267, identifier: CRD42021283267.