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This chapter provides a review of literature relating to the connection between the outdoor environment in residential aged care facilities and the physical and psychological health of aged care residents. The review particularly pays attention to the impact of access to nature and outdoor areas on the overall wellbeing of individuals living in aged care facilities. Attention is also paid to the perceptions of aged care residents about the physical environment in residential aged care facilities. The review also identifies gaps in literature and suggestions for further research.
The impact of the physical environment in residential aged care facilities on the health of senior residents is a topic that has attracted increased scholarly attention in the recent past amidst growing population ageing and the increased demand for aged care. According to Bardenhagen and Rodiek (2015), access to outdoor space and nature can provide important physical and psychological benefits for aged residents by accelerating recovery from illness, reducing stress, improving sleep patterns, lowering blood pressure, enhancing vitamin D absorption, minimising fall risk, as well as increasing overall wellbeing and longevity. This arises from the long held view that the natural surrounding can positively affect one’s health and general wellbeing. Besides physical and psychological benefits, improved outdoor space can also boost resident satisfaction with aged care as well as occupancy levels (Bardenhagen and Rodiek, 2015; Nordin et al., 2015; Ausserhofer et al., 2015). The implication is that residential aged care facilities ought to be designed in a manner that promotes the physical and psychological wellbeing of aged residents.
Actually, in line with its extensive advocacy for active ageing, the World Health Organisation (WHO) has provided guidelines for the design of residential aged care facilities. The guidelines generally require that residential aged facilities should be designed in accordance with three fundamental principles: health, safety, and participation (Miller et al., 2014). Essentially, the facilities should promote physical wellbeing, prevent injuries, and foster socialisation and involvement in meaningful activity. This contributes to more successful aging. In fact, as put by Malderen et al. (2013), the physical environment in which older adults live is one of the major determinants of healthy aging.
Literature has documented the physical and psychological benefits associated with the outdoor environment in residential aged care facilities. In their systematic review of 17 studies (nine quantitative, seven qualitative, and one mixed methods), Whear et al. (2014) established that garden and outdoor spaces positively impacted the physical and mental wellbeing of individuals with dementia living in aged care facilities. The review particularly found that garden use was associated with reduced levels of agitation. Nonetheless, the mechanism through which gardens and outdoor spaces reduce agitation remains quite unclear. A randomised controlled study of 601 residents with dementia living in 38 residential aged care homes in Australia, however, found that positive environmental stimuli affected neither agitation nor depression (Chenoweth et al., 2014). Even so, the study found that there was an improvement in the quality of life, though not significant. A review of 14 studies conducted in the period 1994-2014 also did not find significant……………………………………