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Bringing Care Outdoors: The Benefits of Sensory Engagement with Nature for Older Adults

Updated: Apr 28, 2023

Quotes are from qualitative studies examining how adults (age 60+) describe their experience of the natural world.

It is crucial to stay connected to the environment as we age, but this can be difficult for older adults living in care homes who may have limited opportunities to experience the outdoors and Nature.

A review of studies shows the tremendous advantages that sensory exposure to the natural world brings to older adults.

The review synthesized qualitative research on older adults' sensory engagement with Nature, including those living with dementia. The research was conducted by searching ten databases and 20 organizations, and 27 studies were included.

The review found that older adults' sensory experiences of the outdoors are centered on the visual dimension and multisensory experiences of "being" and "doing" in Nature.

A Window View

Visual engagement with Nature, such as viewing trees and mountains from a window, can provide long-term contact with the natural environment for older adults, including people living in care homes.

Care home staff can facilitate this engagement by maximizing views of outdoor spaces and encouraging planting gardens, building habitats for wildlife, such as bird baths and feeders, and growing native plants that attract birds, bees, and butterflies.

Peace and Tranquility

Mindfulness meditation, noticing Nature, joy watching, awe walking, and sitting, are easy ways to engage residents and people we care for experience and engage with Nature.

The review found that the fresh air, peace, and tranquility of being outdoors in Nature provide implicit multisensory experiences, such as the sensation of wind and raindrops on the skin.

Twelve studies highlighted older adults' visual experiences in Nature, focusing on their active engagement in looking and observing. They were depicted as taking pleasure in studying the beauty and intricacy of plants and flowers indoors and outdoors.

"I think it brings you back to Nature and makes you realize there is more to life. Even just sitting watching flowers, looking at the flowers, the different colours, the different shapes of petals and all that, you could spend ages."

Older adults' sensory engagement with Nature often involves visually appreciating it outdoors or indoors. This is supported by the themes of "descriptions from 'the window'" and "sensory descriptions that emphasize vision" found in the qualitative research studies.

The descriptions suggest that older adults find joy in observing Nature and may have a deeper connection to the familiar and local surroundings when they sit and watch. Sitting may be due to physical limitations, but it allows for a more immersive experience.

In other instances, it was reported that walking improves older adult's visual perception of Nature and also serves as a way to maintain mental alertness :

"These walks have opened my eyes about the beauty that surrounds me and puts my problems and fears into a perspective that is easier to live with."
"I go out about every day and look around. It keeps your mind working."

Older adults' descriptions of doing in Nature, such as gardening, reflect the embodied Nature of the activity and offer heightened sensory awareness through touch and smell. The review found that connecting with the natural environment provides pleasure and enjoyment for older adults and contributes to a feeling of "oneness with nature."

This connection to Nature has been found to positively influence the quality of life for people living with dementia and may bring "effortless attention, leading to Attention Restoration, which is important for those affected by a decline in attention.

Descriptions of being in Nature emphasized the positive benefits of being outdoors and experiencing the fresh air. Participants, including those living with early to moderate dementia, described feeling a sense of wellbeing from being in the fresh air. The air was seen as good for both the mind and body and contributed to a positive sensory experience of Nature.

Fresh air was perceived positively by older adults and played a significant role in their engagement with Nature, leading to feelings of wellbeing. The experience of being in fresh air was deemed inherently multisensory, encompassing sensations of wind, natural sounds and smells, and a sense of spaciousness.

The review also highlights the importance of older adults feeling connected to Nature and the outdoors. This connection can positively influence their sense of self, relationships, agency, wellness, and place.

Being outdoors for social interaction and independence

Being outside allowed older adults to engage in various activities, such as observing the surroundings, reading, drinking coffee, and having meals and picnics. They appreciated the outdoors as it allowed them to elevate their daily routines and connect with others through social interaction.

The importance of outdoor social interaction and independence for older people was highlighted in multiple studies. For some residents of nursing homes, simply being outdoors and observing others was perceived as beneficial, and social contact did not always require direct interaction with others.

A secure garden for people with Alzheimer's disease showed that while structured activities were present, when clients used the garden independently, they tended to interact with each other, potentially enhancing the enjoyment of the garden experience.

Enjoying the outdoors was linked to the contrast of being outside versus being confined inside a residential home.

Some residents expressed a desire to feel free and out in the open, and a sense of freedom was described by older adults living with early to moderate stages of dementia.

Overall, the opportunity to be outdoors and engage in outdoor activities was regarded as essential for maintaining connections with society, enhancing self-confidence, and contributing to a higher quality of life, particularly for those living with dementia. Those living with dementia also highlighted the importance of connecting with the wider world through activities like woodland walks, allowing them to escape feeling shut away.

Being in the Garden

Studies showed that simply being in a garden and experiencing Nature was as impactful as actively engaging in gardening activities, inducing a sense of calm and peace. Spending time alone in the garden for relaxation and reflection was found to have therapeutic effects for older adults struggling with depression.

The garden environment's beauty and serenity was described as bringing a new perspective to life's troubles and increasing the walker's connection to Nature. These experiences demonstrated the benefits of garden walking as a way of mind and body connection with Nature.

The absence of unwanted noise or sounds heightened the sense of peace and tranquility. The greater the connection to the peaceful environment, the more the participants felt calm and appreciated the natural world.

"I sit out there and there is an olive tree in the garden and I prefer to sit outside, it's not so lonely being outside in the open. You can hear the birds, not so lonely as always being by yourself inside"

Barriers to sensory engagement outdoors

"I don't like it when the door is locked because sometimes I have to wait for a long time before someone can help me get out."

Access to the outdoors for older individuals residing at home or in nursing/residential homes was often contingent upon the availability and eagerness of their caregivers. The demands on care workers' time and resources could pose a substantial obstacle to older people getting outside.

For care home residents, feeling 'at home' and 'comfortable' in the outdoor environment was deemed crucial. However, as one study highlighted, the 'lack of privacy and independence' was a significant deterrent to being outdoors. Independence could be further curtailed by the closure or locking of garden doors, to prevent residents from leaving on their own, which could then cause problems for other residents.

Meanings of being and doing in Nature

The meanings of being and doing in Nature were explored in nine studies. Older adults described how Nature gave them a sense of spirituality, a higher power, and oneness with the natural world. Gardening was seen as a meaningful activity that taught life cycles.

Being in Nature had the power to evoke memories and provide a sense of connection to the past.

For older adults in care homes, being in natural surroundings that connected them to their past was important for giving a sense of being at home.

This connection to the past also helped connect with the younger generations by sharing nature knowledge. These findings highlight the significance of being connected with Nature and how it can provide a sense of continuity and facilitate reflections on life's larger questions.

Let's Bring the Care Outdoors!

The systematic review sheds light on the immense benefits of connecting with Nature for older adults, including those in care homes. Care homes can provide meaningful and enjoyable experiences for their residents by maximizing views of outdoor spaces and providing opportunities for embodied experiences in Nature.

By providing accessible outdoor spaces, care homes can offer their residents a meaningful and enjoyable experience. Embracing opportunities to connect with Nature through embodied experiences, such as observing the beauty of Nature, finding joy in watching wildlife, and taking awe walks or simply sitting in awe, can positively impact the quality of life and overall wellbeing of older adults. These experiences can help older adults maintain their connection to the world around them while improving the health and wellbeing of care teams!

Can we digest this research and nurture the value of the outdoors as a 'form of care,' ensuring that older adults and those who care for them can reap the benefits of fresh air and Nature Connectedness?

I am optimistic that we can!

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Orr, N., Wagstaffe, A., Briscoe, S., & Garside, R. (2016). How do older people describe their sensory experiences of the natural world? A systematic review of the qualitative evidence. BMC geriatrics, 16, 1-16.

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