AvÐÔ°®

The thesis shows that a large part of the residential care facilities do not offer older adults access to outdoor environments such as balconies, patios, or gardens. The survey is a total mapping and includes the approximately 2,000 Swedish residential care facilities that exist for older adults.  

The results show that: 

• 62 percent of the residential care facilities have low access to balconies, patios, and outdoor rooms intended for older adults. 
• 83 percent of the facilities also lack these places for the care workers. 
• Only 54 percent of the facilities have access to own gardens. 
• 87 percent of the facilities lack proximity to central locations in cities and towns in the form of public squares.

The thesis is written by physical therapist Madeleine Liljegren, dual doctoral student at the University AvÐÔ°® and Chalmers University of Technology. She argues that these shortcomings make it more difficult for older adults to spend time outdoors, even though outdoor stays have documented health benefits, especially for older adults with frail health.

"Previous research has shown that older adults in the frailest health benefit the most from contact with nature and outdoor stays. Paradoxically, these are the persons who have low access to outdoor environments. Older adults who cannot independently move between indoor and outdoor environments also point out shortcomings in personal support from assistant nurses, activity leaders, occupational therapists, physical therapists, and nurses," says Madeleine Liljegren.

A resource for health and well-being

Interviews with both older adults and care workers at residential care facilities show that older adults want to use the outdoor environments as living environments, and the care workers see the potential in using them as arenas for person-centered care and rehabilitation. The outdoor environments meet a fundamental human need for both older adults and care workers and contribute to a meaningful everyday life. Using the outdoor environments in a strategic way would not only promote the health of older adults but also improve the working environment for the care workers, which is especially important since care workers in elderly care have the highest rate of sick leave in Sweden.

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"Outdoor environments are an underutilized resource for both older adults and care workers in relation to their health and well-being. There is a great need for them to become an integrated part of care and rehabilitation," says Madeleine Liljegren.

National governance

The research results clearly show that access to outdoor environments at residential care facilities is crucial for both health and well-being. For the outdoor environments to function as an important arena for person-centered interventions, both a changed perception of their importance and better planning of them are required. National guidelines are needed to ensure that all residential care facilities have access to outdoor environments that are adapted to older adults’ needs and wishes and support the care worker’s working methods.

"For this to become reality, national governance is required from decision-makers, authorities, and managers at residential care facilities, and care workers, architects, and landscape architects must receive education in how the outdoor environments should be designed and can be used," concludes Madeleine Liljegren.

Long-term change

The research is part of the interdisciplinary OUT-FIT project led by Professor Helle Wijk, a collaboration between the Institute of Health and Care AvÐÔ°®s at the University AvÐÔ°®, Professor Göran Lindahl at the Institute of Architecture and Civil Engineering, Chalmers University of Technology, and Lecturer Anna Bengtsson at the Institute of People and Society, Swedish University of Agricultural AvÐÔ°®s. As part of a postdoc project, a proposal has also been developed for a national strategy to ensure access to outdoor environments and outdoor stays at residential care facilities. In addition, another doctoral project has started that measures the effect of person-centered walks in outdoor environments on the health of older adults and care workers, as well as a study that maps access to outdoor environments at all Swedish supported housing for older adults. 
 

Doctoral thesis: