Environmental Influences on Outdoor Usage in Facilities for the Elderly
Susan Rodiek, PhD
The Ronald L Skaggs Endowed Professor in Health Facilities Design,
Texas A&M University, USA
(Click to download full paper)
In a rapidly ageing global society with diminishing resources, it is increasingly important to find low-cost preventive ways to maintain health in older adults. Having access to nature and the outdoors is widely accepted as a therapeutic environmental intervention for promoting health in elderly residents of long-term care settings.
Research is beginning to confirm multiple health benefits associated with outdoor usage, such as lower blood pressure, improved hormone balance, increased physical activity, and better sleep patterns. However, many studies have reported that outdoor space is commonly underutilised by elderly residents, which reduces potential health benefits. The purpose of this hypothesis-driven study was to determine how the designed environment may encourage or discourage outdoor usage by re´sidents.
The study was conducted in 68 randomly-selected assisted living facilities in three climatically-diverse megapolitan regions of the United States (Houston, Chicago, and Seattle). Residents and staff (N=1604) completed written surveys on outdoor usage and preferences, using corresponding staff questions to verify resident responses.
The outdoor areas at each facility were evaluated with a 63-item environmental assessment tool, testing seven core design principles derived from the existing evidence base on this topic.
After controlling for demographic factors such as gender and mobility, findings showed that the quality of the outdoor environment significantly influenced residents’ frequency and duration of outdoor usage, walking, and family visitation. At places where outdoor areas were rated as easier to access, and more connected to “the world beyond the facility walls,” residents had higher levels of outdoor usage and received longer visits from family members.
At places rated as having safe, comfortable, visually appealing, and well-maintained walkways, residents spent significantly more time walking. In addition, there was strong correlation between outdoor usage, walking, physical activity, environmental satisfaction, and self-reported health of the residents surveyed.
The implications of this study are that well-designed outdoor environments can have a major impact on health related behaviour in long-term care settings, potentially leading to substantial therapeutic benefits. By better understanding specific features that promote outdoor usage and physical activity, environmental designers can significantly impact the health and wellbeing of a growing population of frail elderly residents.
Keywords: ageing, outdoor environment, health
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