Graphic: The 8 Domains of Livability with 9th Domain Added
Has anyone heard of Environmental Gerontology?
I asked a group of 30 healthcare professionals during my workshop titled
Nurturing Care Outdoors.
No one raised their hands.
Before asking this question, I performed a short skit, acting out quotes from qualitative research studies that examined older adults [age 60+], including those living with dementia and mobility impairments, sensory experiences with the natural world.
Here are a few of the quotes I presented:
I don't like it when the door is locked because sometimes, I have to wait a long time before someone can help me get out.
I go out about every day and look around. It keeps your mind working.
There is something that I think a lot of us talk about missing is the freedom to be outside. At present here, all of our doors are locked except that front one. I know we need the security, but we need something to be done where, you know, where we're not locked in.
These quotes highlight the common barriers older adults who depend on others to gain outdoor access experience and some of the delights being in Nature and the spaciousness of the outdoors brings.
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, reported feeling a sense of wellbeing from the Fresh Air.
Fresh Air was perceived positively and played a significant role in engagement with Nature. Experiencing Fresh air enabled them to engage with and enjoy the natural world and help them feel alive, "connecting them to the environment and feeling a part of the larger world"
Think for a moment about the experience of Fresh Air. Being outdoors and inhaling fresh air is inherently multisensory, encompassing sensations of wind, natural sounds, and smells and a sense of spaciousness.
Imagine for a moment, Fresh Air, a simple pleasure that also gives meaning to life that often goes unnoticed as a form of care.
Imagine, living in a residential care community that did not value your daily access to Fresh Air as paramount for your health and wellbeing?
Think for a moment about the people you know, the people you are caring with, who lack daily access to Nature. When we depend on others to support our access to and experience of natural landscapes, we are more likely to become Nature deprived.
People of all ages who can access Nature without support, spend less time interacting with the natural world than previous generations.
Meaningful moments outdoors have been shown to prevent loneliness, boost quality of life and wellbeing, and have numerous positive impacts on physiological, psychological, social, spiritual, and environmental health, often simultaneously –for all ages, including those providing care to others!
However, for older adults living in residential care communities, individuals living with dementia or mobility impairments, and those who live independently with in-home care and support, accessing the outdoors and Nature can be challenging, primarily when their ability to do so depends on others.
Think for a moment about some of the barriers you currently have to sharing care outdoors. Can you relate to any enablers and barriers cited in this graphic?
Has anyone heard of Environmental Gerontology?
Decades of research have shown that our environments significantly affect longevity.
We've learned that the aging process is shaped by genetic factors, variations in human development, and, above all, our dialogue with the environment. Environmental Gerontology strives to know, analyze, modify, and optimize the relationship between individuals and their environments: natural, physical [built], and social.
Dan Buettner discovered that people living in what he co-termed the Blue Zones live longer and healthier lives not due to pills, supplements, or extreme exercise but because their environments
nudge them into:
Moving naturally every 20min
They live in towns built for humans, not just cars
They walk, walk, and walk
They knead bread and grind corn
They live, work, and play outdoors, surrounded by healthy ecosystems and biodiversity
They enjoy high levels of nature connectedness.
They grow gardens
As Dan Buettner says, "They live rewardingly inconvenient lives".
Additionally, the healthiest longest living humans, live with a sense of purpose and meaning, what the Japanese call Ikigai, not just hobbies and activities, but they live for a purpose greater than themselves; they live with a responsibility for their community, the natural environment and future generations.
I will never forget meeting 'Anne' in the hallway in the residential care community where I worked as an activity director. Anne lived with her husband for nearly sixty years in their hand-made cabin in the mountains overlooking the Pacific Ocean. They were true homesteaders; Anne churned her butter, grew much of the food they consumed, and was outdoors more than indoors. After her husband died, Anne moved into an assisted living in town.
The day I found her, she was frantically walking the halls with a large bag filled with clothes hanging from her walker.
Anne, are you okay? I asked.
She responded with tears in her eyes:
I just want to do my own laundry!
Anne's new home did not provide her with the 'rewardingly inconvenient living' she needed to continue having independence, autonomy, and value. In addition, her new home did not have biodiverse-rich outdoor spaces where she could enjoy the fresh air, gardening, listen and watch the birds, and hang her laundry on a clothesline.
Anne's mental and physical health and wellbeing deteriorated quickly.
The World Health Organization Age-Friendly Citities Framework and and AARP's Domains of Livability highlight the importance of ensuring our towns and cities support our ability to continue participating and navigating our environments throughout our lifespan; what Dr. Andrew Scharlach calls Aging-Friendly Cities. I prefer the term aging-friendly, as aging is a lifelong process, and aging-friendly communities promote connectedness, health, and wellbeing for all ages.
Graphic: The 8 Domains of Livability with 9th Domain Added
The most important domain is missing from the WHO's framework and AARP's.
I have added the 9th Domain:
Biodiversity, Healthy Ecosystems, Local Food Production and the Natural Environment.
As you can imagine, clean air, water, and soil are paramount for healthy aging, as are nutrient-rich local food access to biodiverse-rich green and blue spaces.
We are all aging in a climate-changing world experiencing extraordinary biodiversity loss.
The "WWF's 2022 Living Planet Report found an average 69% decline in global populations of mammals, fish, birds, reptiles, and amphibians since 1970. The 2019 landmark Global Assessment Report by the Intergovernmental Platform on Biodiversity and Ecosystem Services reported 1 million animal and plant species are now threatened with extinction—the highest number in human history."
The main driver of biodiversity loss is humans' land use – primarily for food production. When land is converted for conventional agriculture, some animal and plant species may lose their habitat and face extinction.
"Healthy aging and healthy longevity for most people now and in the future will not be possible without a healthy planet."
–UN Decade of Healthy Aging in a Climate Changing World.
Nature Nurtures Human Health
It is well known that healthy green and blue spaces,
including gardens and biodiverse habitats associated with
healthy longevity, higher quality of life, brain health, and lower risk of chronic conditions.
Research shows access to TREES:
- Reduces depression, isolation and loneliness
- Lowers levels of cortisol, the stress hormone
- Improves cognitive function
For ALL Ages!
I advocate for embracing Care Outdoors to enhance the wellbeing of individuals and their environments, including plants, animals, water, air, and soil.
In the profound tapestry of Environmental Gerontology, where the threads of human existence weave seamlessly with the natural world, Eco Gerontology emerges as a beacon of transformative care: Caring In, Caring For, and Caring With Nature.
As we reflect on the testimonies of older adults yearning for the embrace of Fresh Air and the freedom of being outdoors and in Nature offers, our shared responsibility to the environment becomes clear.
The absence of raised hands among healthcare professionals underscores a critical gap in understanding the symbiotic relationship between our wellbeing and the environments we inhabit.
Decades of research affirm that our surroundings intricately shape the aging process, urging us to reconsider the definition of a conducive environment. Dan Buettner's Blue Zones illuminate the path to healthier, longer lives not through artificial interventions but by immersing ourselves in environments that nurture natural movement, connection with nature, and a profound sense of purpose.
As we explore Aging-Friendly Cities, we must expand the conversation to include the often-overlooked 9th Domain: Biodiversity, Healthy Ecosystems, Local Food Production and The Natural Environment.
The wellbeing of our communities is inseparable from the health of our planet. The call for an interconnected approach to healthy aging becomes more urgent in a world grappling with biodiversity loss and climate change.
In fostering ecosystem health and biodiversity, communities safeguard human health and contribute to preserving our planet for future generations.
The concluding note is a resounding call—to envision a future where Care Outdoors is not just a practice but a collective ethos, where our homes, communities, and cities echo with the vitality of Nature. In this vision, the pursuit of healthy aging converges with the stewardship of our planet, creating a legacy of living in harmony with Nature that transcends generations.
Bengtsson, A., & Carlsson, G. (2006). Outdoor environments at three nursing homes: Focus group interviews with staff. Journal of Housing for the Elderly, 19(3-4), 49-69.
Durvasula, S., Kok, C., Sambrook, P. N., Cumming, R. G., Lord, S. R., March, L. M., ... & Cameron, I. D. (2010). Sunlight and health: attitudes of older people living in intermediate care facilities in southern Australia. Archives of gerontology and geriatrics, 51(3), e94-e99.
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.
Raske, M. (2010). Nursing home quality of life: Study of an enabling garden. Journal of Gerontological Social Work, 53(4), 336-351.
Reynolds, L. (2011). The perceived value of nature andNaturef gardens by older adults living in residential care. University of Kentucky.
Rodiek, S. (2006). Resident perceptions of physical environment features that influence outdoor usage at assisted living facilities. Journal of Housing for the Elderly, 19(3-4), 95-107.
Scharlach, A. E. (2017). Aging in context: Individual and environmental pathways to aging-friendly communities—The 2015 Matthew A. Pollack Award Lecture. The Gerontologist, 57(4), 606-618.
van den Berg, M. E., Winsall, M., Dyer, S. M., Breen, F., Gresham, M., & Crotty, M. (2020). Understanding the barriers and enablers to using outdoor spaces in nursing homes: A systematic review. The gerontologist, 60(4), e254-e269.