Purpose The benefits of “green dementia care”, whereby people living with dementia are supported to connect with nature, are increasingly being recognised. Evidence suggests that these benefits span physical, emotional and social spheres and can make a significant contribution towards quality of life. However, care settings often present specific challenges to promoting such connections due to a range of factors including risk-averse cultures and environmental limitations. The purpose of this paper is to report on a project that aims to explore the opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in residential care and extra care housing schemes in the UK. Design/methodology/approach Data were gathered from 144 responses to an online survey by managers/staff of extra care housing schemes and care homes in the UK. In depth-case studies were carried out at three care homes and three extra care housing schemes, involving interviews with residents, staff and family carers. Findings A wide variety of nature-based activities were reported, both outdoor and indoor. Positive benefits reported included improved mood, higher levels of social interaction and increased motivation for residents, and greater job satisfaction for staff. The design and layout of indoor and outdoor spaces is key, in addition to staff who feel enabled to promote connections with nature. Research limitations/implications This paper is based on a relatively small research project in which the participants were self-selecting and therefore not necessarily representative. Practical implications The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes. Social implications Outdoor activities can promote social interaction for people living with dementia in care settings. The authors’ findings are relevant to the recent policy focus on social prescribing. Originality/value The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes.

The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRaP URL' above for details on accessing the published version and note that access may require a subscription.For more information, please contact wrapteam@worc.ac.uk 13 18 28 37 44 46 52 2 3 Green dementia care in accommodation and care settings: a literature review Abstract 8 9 Purpose 10 11 This literature review examined the recent evidence relating to green (nature-based) 12 dementia care for people living with dementia in long-term accommodation and care settings 14 (housing for older people that provides both accommodation and care, such as residential 15 care homes, nursing homes and extra care housing schemes). The review formed part of a 16 pilot study exploring interaction with nature for people living with dementia in care homes 17 and extra care housing schemes in the UK. Rather than a comprehensive systematic or 19 critical literature review, the intention was to increase understanding of green dementia care 20to support the pilot study. 22Approach 23 24The review drew together the published and grey literature on the impacts of green (nature-25 based) dementia care, the barriers and enablers and good practice in provision. People 26 living with dementia in accommodation and care settings are the focus of this review, due to 27 the research study of which the review is part. Evidence relating to the impacts of engaging 29 with nature on people in general, older people and residents in accommodation and care is 30 also briefly examined as it has a bearing on people living with dementia. 31 32 Findings 33 34 Although interaction with the natural environment may not guarantee sustained wellbeing for 35 all people living with dementia, there is some compelling evidence for a number of health 36 and wellbeing benefits for many. However, there is a clear need for more large-scale 38 rigorous research in this area, particularly with reference to health and wellbeing outcomes 39 for people living with dementia in accommodation and care settings for which the evidence is 40 limited. There is a stronger evidence base on barriers and enablers to accessing nature for 41 people living with dementia in such settings. 42 43 Research limitations 45 This literature review was conducted to support a pilot study exploring green (nature-based) 47 dementia care in care homes and extra care housing schemes in the UK. Consequently, the 48 focus of the review was on green dementia care in accommodation and care settings. The 49 study, and thus the review, also focused on direct contact with nature (whether that occurs 50 outdoors or indoors) rather than indirect contact (e.g. viewing nature in a photograph, on a 51 TV screen or through a window) or simulated nature (e.g. robot pets). Therefore, this is not a 53 full review of all aspects of green dementia care.54 55 Originality/Value 56 57 This paper presents an up-to-date review...

Purpose The purpose of this paper is to share findings from the evaluation of dementia adventure (DA) holidays provided in 2016 and drawing on these data, to share reflections on positive risk-taking, which are inherent in outdoor activities, and consider the implications for research and practice with people with dementia. Design/methodology/approach Data are drawn from the 2016 internal evaluation report, using mixed methods design, of DA holidays independently reviewed by Dr Ruth Bartlett at the University of Southampton. Findings DA holidays are leading to a range of social, emotional and physical well-being outcomes, as well as wider benefits for the community of people with dementia, their family and carers. Practical implications Drawing on what positive risk-taking means for individuals, families and organisations, top ten considerations for positive risk taking outdoor activities are presented. Originality/value The number of organisations providing adventure experiences and holidays for people with dementia in the UK remains very low with just a handful of organisations. The impact and evaluation of these holidays is just emerging and whilst compelling needs replication, with larger sample sizes supported by clinical and scientific expertise to deepen our understanding of the impact of positive risk-taking outdoor activities. Additionally, there is a need for thinking and acting differently summarised by the phrase “THINK OUTSIDE” in developing a wide range of nature based positive risk-taking activities with people with dementia.

green spot that I can relax in and find some peace simply 'being' in. Occasionally, I sight deer over the fields early in the morning and an egret flying down to the little stream beyond the park. These brief glimpses of beautiful wildlife connect me to nature in a way that feels profoundly good for my well-being. I believe human well-being depends on contact with nature. Kaplan said that the natural world satisfies our need for contemplation, escape, restoration and distraction (Kaplan, 1995).Think about people living with dementia for a moment; conjure up someone in your mind. Where is this person in your mind's eye? Chances are you have probably pictured someone sitting in a chair in a day-care facility, or at home on their own or lying in bed in a long-stay care home. Chances are you did not picture someone walking around a

PurposeThe purpose of this paper is to share the key findings of the Wandering in the Woods action research project conducted by Dementia Adventure. Practical implications for changing practices in the dementia care and health and well‐being sectors are highlighted.Design/methodology/approachQualitative and quantitative data were gathered using the participatory appraisal method in small groups both before and after “woodland adventure” days out.FindingsThere was a 41 per cent increase in participants rating “exercise” as a factor which is “very important” to them. A number of potential physical, emotional, and social benefits of activity out in woodlands, for people with dementia, were identified.Research limitations/implicationsThe research is conducted with three relatively small groups, which vary in composition across the study, for practical reasons associated with care and capability of participants.Practical implicationsSuggestions are shared and questions posed for individuals wanting to practically embed the learning from this project.Originality/valueResearch looking at the benefits of green exercise and experiences of people living with dementia in care taking activity out in nature is very limited, this paper significantly contributes to this growing body of knowledge.

The Mental Capacity Advocacy Project (MCAP) with older people is a three-year pilot project funded by the Department of Health and Age Concern England; the pilot phase of this project is due to finish in October 2009. In this article, the MCAP co-ordinator, Neil Mapes, highlights some of the voices from the project, discusses some of the emerging issues with the Mental Capacity Act (2005), and highlights the MCAP resources and key messages from the work to date.