Health Benefits of Outdoor Senior Living Spaces
Designing the outside environment has been an overlooked opportunity to create meaningful places that are rich in association, encourage good health and exercise, and are responsive to the magic of the changing seasons.” ~ Elizabeth Brawley
In a society with diminishing resources and a rapidly aging population, it has become increasingly important to find cost-effective ways to promote and maintain health in older adults. In this article we will explore the relationship between health and natural settings, and the why’s, what’s and how’s of beneficial and therapeutic outdoor living spaces and amenities.
Landscapes that promote healthy behavior have the advantage of being relatively permanent and inexpensive after initial investment. Unlike programmed activities that require the ongoing cost and availability of staff to provide continued services, the environment can provide health-promoting opportunities on an ongoing basis, at the cost of basic upkeep and maintenance.
Issues that must be taken into consideration when designing outdoor spaces specific to each community include:
- How can the garden address varying physical considerations and achieve individual goals, such as providing exercise and improved manual dexterity?
- How can the garden support psychological considerations, such as independence and socialization?
- How might the garden engage residents in helpful daily tasks that engender a sense of contribution and belonging (such as checking bird feeders, tending plants, and raising the flag)? And how might those “helpful tasks” benefit other goals, such as exercise, dexterity and motor coordination skills?
- What programs are currently underway or planned?
- Should there be structured, casual, and spontaneous activities? What are the daily routines and how are special events handled? Who participates? How can families, friends and visiting children enjoy the garden? Is there a garden, or a separate area, for staff too?
1) Why? Health benefits of Natural Spaces
The social psychologist, Erich Fromm, first coined the term ‘biophilia’ (love of life) in 1964 to describe the instinctual and innate human attraction to nature. In the 1980’s Edward O. Wilson (biologist), propagated the term when he pioneered a new school of thought focused on the need to bring humans back in contact with nature.
“There is a pattern of evidence that suggests that well designed gardens can reduce stress, lower blood pressure, and relax people. Also there is research that shows experiencing nature and looking at gardens reduces pain. Nature seems to reduce pain by blocking stress and reducing the extent to which residents focus on themselves and their discomfort.” according to leading expert, Dr. Roger Ulrich. Stressful or negative emotions such as fear or anger diminish while levels of pleasant feelings increase. Laboratory and clinical studies have shown that viewing nature produces stress recovery quickly evident in physiological changes in the parasympathetic nervous system, for instance, in blood pressure and heart activity (Ulrich, 1991).
Download ‘Kwalu Spring Outdoor catalog‘ for ideas & tips on refreshing outdoor spaces, below:
2) How? Senior Specific Considerations
Some studies even show that gardens are capable of limiting the physical effects of reduced mobility or immobility, including osteoporosis, incontinence and even muscular atrophy. But there is a dual between increasing mobility levels and risks of falls. Senior living outdoor spaces need to address both equally.
Of particular concern are the physical challenges inherent in the aging process. A range of abilities need to be accommodated, including individuals requiring wheelchairs and walkers; those who stoop or cannot bend easily; those requiring frequent rests; and those that may need assistance with activities. These concerns influence the design pathways; the placement of chairs and benches, features and activity areas; and the design of architectural components, such as the width of a porch.
Injuries from falls are a major concern, as are diminished strength, stamina and visual acuity, varying sensory abilities, sunlight sensitivity, awareness, and sense of orientation. Elderly adults with gait problems, Parkinson’s disease, severe arthritis and those recovering from strokes are predictably vulnerable to falls. Falls occur at times other than when people are walking. In a garden, people may fall getting in and out of wheelchairs, on and off benches and chairs, or near doors as they try to open them. Diminished sight adds to the problem. Sunlight levels are a concern as certain medications cause sun sensitivity while others may interfere with an individual’s ability to regulate body temperature. Glare and sudden transitions between different levels of light can also lead to falls as elderly eyes fail to adjust easily.
Poisonous Plants and Insects. Adults with dementia and visiting children need protection from toxic plants. In addition to common allergies to poison ivy, poison oak, and sumac, many plants, even common bulbs can be irritants or cause allergies. Pollen allergies or hay fever, are caused by a small number of plants (grasses, weeds, and specific tree species) that depend on wind for cross-pollination. The American Medical Association (AMA) Guide is a good source for information and many poison control centers publish information on native poisonous and non-poisonous plants. Insect bites, particularly bee stings, can cause allergic reactions. Without the consultation of medical practitioners, it can be difficult for designers to evaluate the danger of bee stings, flea, spider, tick and mosquito bites. A perceived threat, from a bee for example, will often undermine the use of the garden and can be as limiting as a real threat.
The garden must be perceived to be safe. The entire garden should be clearly visible from key interior and exterior places. For example, a porch with clear views of the garden allows staff to keep an eye on individual residents while leading a group activity on the porch. A greenhouse window in a kitchen or activity room provides a prominent display area for seasonal activities while also providing staff a clear view of the garden. To ensure a sense of security and comfort, pathways should be firm and level with clear circulation, destinations and frequent places to pause and rest.
3) What? Physical Features to take into Account
The goal of each and every garden is to meet the physical, social, psychological and spiritual needs of individuals enjoying the garden. The existing site conditions must be analyzed and design created to promote a positive quality of life. The design of the outdoor environment should be in harmony with and take advantage of nature’s beauty and restorative powers.
Some senior living companies are taking advantage of this locating their communities adjacent to state parks, lakes, oceans, rivers and other natural assets. Connective trails can then offer residents scenic pathways from their homes/ neighborhood through adjoining wetlands. Many communities also have outdoor plazas and walking trails within the community’s grounds.
According to a study conducted in 2010 by Texas A&M University’s Center for Health Systems and Design, there are strong correlation between outdoor usage, levels of walking and physical activity, environmental satisfaction, and the self-reported health of residents.
Some examples of key elements to include in outdoor spaces to maximize these benefits include:
Structured shade near the entry (porches, trellises, etc.) provide a progression of light levels and protective spaces when entering the garden – an important consideration for an individual to comfortably adjust to changing light levels and exposure to the elements.
Of all the architectural elements, the porch is iconic – something that evokes fond memories. It offers protection from the elements, sheltering from the hot summer sun and providing a protected area to listen to the rain. It acts as a social seating area, and a great location for cards, chess etc.. It allows for a sense of familiarity and safety, being adjacent to the building but giving accessible views of the garden.
There is an opportunity to safely introduce specialized areas with more challenging paving surfaces and gradients into the garden setting. Gardens offer an excellent resource for occupational and physical therapists and to introduce familiar “everyday” scenarios into their therapeutic regimen. This might include varying paving surfaces (brick, cobble, stonedust, etc.) as well as carefully graded pathways, ramps and steps and other outdoor routines, such as mailboxes. In close collaboration with staff, these features can introduce a sense of challenge and adventure into the garden experience.
There has been an increasing focus on the benefits of ‘memory gardens’ for those residents diagnosed with dementias. Part of the care of all residents, but especially critical to this sub-population is the focus on hobbies the residents have enjoyed in the past.
Tapping into a person’s interests can, not only spark memories, it can kindle joy. While joy is an emotion that can be rare for people with Alzheimer’s/dementia, it’s one that every person deserves to feel—and is capable of feeling—at every stage of the disease. With the right level of support and assistance, tending to flowers and other plants can also help a resident connect to the past and the future. They may recall childhood memories, or those of being in a graden with their own children, or look forward to enjoying homegrown squash at an autumn harvest festival in the care community or home’s neighborhood.
Gardens that have continuous paths can also restore a sense of autonomy by giving people with short and long-term memory loss the ability to wander freely without becoming lost or disoriented. The addition of landmarks and activity zones can assist both mood patterns and pacing.
Best of all, these settings can also stimulate long-term memories, especially when seniors engage in gardening activities such as raking, weeding or picking flowers. The positive feelings that memory gardens can incite will even promote increased engagement and reality orientation.
Nurturing mind, body, and spirit in this way can even help a client function with more dexterity, independence, or confidence. By facilitating their best abilities to function, they can become more than just care receivers—they can be caregivers again too, as they water a garden, a pot of rosemary, or a tomato plant and tends to its health.
Finally, consider the experiences of first time residents and visitors, and encourage their “discovery” of the garden by creating clear, identifiable interior signage and other way-finding strategies. Introduce small display areas within the facility that highlight garden activities or feature “what is in bloom” to encourage the garden’s exploration and enjoyment.
4) Aesthetics and Practical considerations for enhancing the social experience.
Critical to resident well-being an in relation to the natural setting are elements that build community – shared open space, places for gathering, recreation amenities and pedestrian connectivity – help create and support successful design. Integrating open space at different scales is the key. From large walkways and common areas for socializing and programmed events, to beautifully landscaped dining terraces, courtyards, gazebos, fountains and water features, senior living communities require an outdoor landscape that is functional and that encourages social interaction. Integrating and expanding the notion of lifelong wellness into senior living landscapes goes beyond basic fitness to help people “age in place” vitally and successfully.
Sitting spaces throughout the community also address a range of needs – allowing for conversation in small groups and providing necessary privacy and independence for residents and visiting families.
Garden furnishings are vital in making these socialization spaces both attractive and extremely functional. Look for seating and tables specifically designed by furniture companies that focus on senior living, such as Kwalu. These products will focus on the ergonomics of seniors, specifically the seat height and rake (angle) of the back. Deep outdoor chairs (typical of residential furniture companies) actually decrease the independence of residents, forcing them to rely on the help of staff for ingress and egress.
Chairs should have sturdy arms, which can be used to help a person rise and the chair width large enough to accommodate someone of generous proportions. They also need to heavy and sturdy to withstand wind or residents bumping into them or using the chairs to brace themselves while moving around.
Benches and chairs should be plentiful but carefully placed to encourage walking in the garden and to provide a choice of settings and destinations. While both chairs and benches should be offered in the garden, chairs can be easier for an aging person to use. Benches should be wide enough for two individuals to sit comfortably together for conversation. Look for dining tables of various sizes that accommodate umbrellas if needed, as this can also increase the likelihood of these spaces being used.
Consider the material from which the seating and tables are manufactured. Wood degrades over time, causing hazardous splinters and an increased risk of liability due to falls. It requires significant upkeep in order to maintain aesthetic appeal. Metal in colder climates is unpleasant for the elderly, can corrode in damp/ seaside environments and can be particularly hazardous in hot climates, leading to burns. Wood-like polymers, like Kwalu’s, offer color gradations that mimic wood, but are UV stable and come with a 10-year warranty. They also require little- to no-maintenance, saving in labor and downtime, whereas wood and metal products need to be removed from service.
Lastly, consider the style and material from which cushions are made. Typical outdoor cushions retain water, making it necessary to remove them during inclement weather. They also have numerous ties that either break or require excessive time to attach or detach the cushion from the frame. These types of cushions also necessitate storage units. Kwalu cushions for outdoor products feature quick-dry construction, and utilize an interlocking system that makes removing cushions due to weather conditions unnecessary. They are, however easily removable for cleaning when required.
Kwalu also offers raised planting tables and trash receptacles to complete the aesthetic environment. Plant beds that are raised to accommodate individual preferences to sit, stand or stoop can expand participation in garden activities. Consider varying planter heights in 4-inch increments from 24 inches to 36 inches. Large planters can encourage socialization with two or three residents in wheelchairs or those sitting in chairs can easily work with plants.
Bird feeders, rain gauges and other amenities such as a flagpole or hanging baskets can build upon familiar daily routines while creating opportunities for exercise and improving motor-coordination skills. Good views of birds and wildlife can also greatly enhance the use of garden and outdoor spaces, and increase the likelihood of these spaces being utilized.
According to Charles Cook, “Your deepest roots are in nature. No matter who you are, where you live, or what kind of life you lead, you remain irrevocably linked with the rest of creation”. Seniors are not distinct from this group, and by following the suggestions made in this article, we can provide a healthy, nourishing natural environment that creates physical, emotional and social benefits for those in our care.