Green dementia care in accommodation and care settings – opportunities, barriers and good practice.
This 12 month mixed methods pilot study, funded by the Abbeyfield Research Foundation, explored the opportunities, good practice, enablers and barriers relating to green (nature-based) dementia care for people living with dementia in accommodation and care settings, particularly care homes and extra care housing schemes or villages. Key research tasks included: examining current evidence for the impact of interaction with the natural environment on people living with dementia; gathering information on opportunities for people living with dementia in these settings to engage with the natural environment; and exploring barriers and enablers to engagement. The study was conducted by the Housing and Dementia Research Consortium (HDRC) in partnership with the Association for Dementia Studies (ADS) at the University of Worcester.
There is growing interest in the impacts of engaging with nature on the physical, psychological, emotional, social and spiritual health and wellbeing of people living with dementia. 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 includes a range of health-promoting interventions encompassing living organisms (plants and animals) and natural elements (e.g. the weather). Green care links traditional health care to gardening (horticultural therapy), agriculture (green care farming), animals (animal assisted interventions) and exercising in the natural environment (green exercise).
Increasing numbers of people with dementia are supported in care homes (residential care homes or care homes with nursing), while extra care housing is now widely viewed as an alternative form of accommodation that can provide opportunities for maximising independence. Many people living with dementia in such settings 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. For people with dementia the loss of nature in their lives is often sudden and occurs when they move from their own home into accommodation and care settings. Due to fears about the physical risks involved, residents living with dementia are often discouraged from going outdoors, which means that they can quickly lose confidence to go outdoors with or without support. This puts them at risk of losing their nature relatedness (personal connection to nature) and the benefits engaging with nature may bring to their health and wellbeing.
It is hoped that the findings of this pilot study will inform the development of a large-scale multi-site, multi-provider research project involving in-depth evaluation of the impact of nature-based interventions on the health and wellbeing of people with dementia in care settings. This research theme is one of the top research priorities of the Housing and Dementia Research Consortium (the HDRC is a UK wide network of around 100 housing and care providers and commissioners and other interested parties including academics, architects, advisors, researchers, policy makers and third sector organisations committed to research and knowledge exchange across the sector). High quality, large-scale research in this area is necessary in order to inform policy and practice concerning green dementia care, including any impacts on the health and wellbeing of individuals and the cost effectiveness of care. This pilot study was an important step in developing an understanding of the opportunities for people living with dementia in residential care and extra care housing to engage with the natural world, to explore what works and why, and to identify the main barriers and enablers to engagement.
A summary report of the study can be found at: https://housingdementiaresearch.files.wordpress.com/2018/11/hdrc-green-dementia-care-summary_housinglin.pdf