Connections with nature for people living with dementia

Abstract

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.

Green dementia care in accommodation and care settings: a literature review

“…This paper has presented an up-to-date review of literature relating to green dementia care in accommodation and care settings. Although the focus of the review was on people living with dementia in accommodation and care settings, it was successful in increasing understanding in this area in order to support a pilot study that explored opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK (Evans et al , 2019). It has demonstrated the impacts, value and accessibility of nature engagement for people living with dementia in these settings and identified gaps in the evidence base.…”

“…Conference papers, websites and news articles were also important sources of information as were communications with HDRC members and project advisory group members relating to in-house nature intervention strategies among UK housing providers. This review formed part of a pilot study exploring interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK (Evans et al , 2019), thus the review focussed mainly on UK literature published from 2006 to 2018 but also included international literature written in English where it was thought to add useful viewpoints on the topic.…”

“…This paper reports on a review of UK and international literature conducted in 2017 (with final amendments in 2019) as part of a pilot study that explored the opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK (Evans et al , 2019). The purpose of the review was to examine recent literature in order to increase understanding of green dementia care to support the subsequent research activities, rather than to conduct a qualitative systematic or critical literature review.…”

Nature-Based Video with Music for Individuals Experiencing an Episode of Sundown Syndrome

“…To mitigate agitated and aggressive behaviors associated with dementia, many health care practitioners have prescribed pharmacological measures, such as anti-psychotic and benzodiazepine medications. These drugs have been found to be of limited effectiveness and have adverse side effects, including onset of diabetes, weight gain, gait disturbances with falls, cardiac effects, stroke, dysphagia, urinary retention, constipation, and increased cognitive impairment (American Psychiatric Association, 2016; Azermai et al, 2012;Evans et al, 2019). Consequently, there is a need for evidence-based non-pharmaceutical alternatives for individuals with dementia that assist in reducing agitation and promote improved mood without negative side effects (Austrom et al, 2018;Scales et al, 2018).…”

“…Stephen Kaplan (1987) discusses that people often prefer settings with water, trees, and foliage. Nature-based activities, such as walking in nature, participating in horticulture, as well as viewing simulated nature (e.g., video or photographs), have appeared to improve the mood and reduce agitation for residents with dementia receiving long-term care (Bossen, 2010;Evans et al, 2019;Lakhani et al, 2019;Moeller et al, 2018). An example of simulated naturebased activity was conducted by Reynolds et al (2018) that exposed 14 memory care residents (8 females age: 85.5 ± 2.1 years and 6 males age: 84.7 ± 5.8 years) with moderate to severe dementia to a 1-hour nature video of a waterfall with distant view of mountains as a treatment, and a vin-tage movie was used as a control.…”