The impacts of ageing on connection to nature: the varied responses of older adults

The importance of nature and wishes for nature-based experiences among older adults in assisted living facilities

Nature-based interventions potentially support physical, mental, and social health. Understanding the needs of the target group is essential when developing such methods as part-of-care. This cross-sectional mixed method survey explores the wishes for nature-based experiences among older adults in assisted living facilities, 854 respondents were included. Diagnoses were confirmed from medical records, while functioning, wellbeing and the meaning of nature were inquired. Respondents' average age was 83 years; 73% were women, and 54% had dementia. Only 24% could move about outdoors independently, 55% suffered from loneliness, and 45% felt depressed at least sometimes. In thematic analyses, open-ended answers highlighted the multifaceted meaning of nature. Nature is a valued source of resilience and a place for physical activity. Although 96% considered nature important, only 51% could have nature contact as often as desired. Respondents provided clear, feasible wishes for activities and 83% were interested in participating in nature-based interventions.

Green spaces and the impact on cognitive frailty: a scoping review

Some literature indicates that contact with green spaces can benefit health and wellbeing, but it is unclear whether this is protective of cognitive health in older people. Using Arskey and O'Malley's framework the aim was to investigate ageing, cognitive frailty and the effects of green access including any causality. The evidence was somewhat inconsistent but suggestive for a beneficial role of green space exposure on cognitive functions. Results suggested that globally, the poorer urban environments are high risk for older people's mental health and these places often lack parks and green spaces. There is evidence that the level of activity and social participation may be greater with access to green spaces and therefore reduces health risks. Green spaces seem to have a role in preventing cognitive frailty, especially for more vulnerable older populations living in poorer urban environments.

Well-Being Outcomes from the Delivery of RASCALs, a Group Activity Intervention Using Nature-Focused Livestream Broadcasts

Group activities and connection with nature are associated with improved well-being for older adults. This quasi-experiment tests the effectiveness of RASCALs, an innovative program of group activities using nature-focused livestream broadcasts. Assisted living residents in the experimental group (n = 16) lived in buildings that received RASCALs programming twice a week for 3 months. Compared to residents in the comparison group (n = 17) who received regular group activity programming, they experienced significant positive change in the Positive Relations with Others domain of well-being (β = .873, p = .008). Combining nature-focused livestream broadcasts with groups activities for older adults in assisted living communities may be an innovative and effective way to overcome barriers to accessing nature and improve residents' well-being.

Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative

PURPOSE

This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence.

METHODS

The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships.

RESULTS

NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling.

CONCLUSIONS

Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.

Mental health and well-being in times of COVID-19: A mixed-methods study of the role of neighborhood parks, outdoor spaces, and nature among US older adults

The role of parks and nature to support well-being during the COVID-19 pandemic is uncertain. To examine this topic, we used mixed-methods data collected in April-May 2020 from US adults aged ≥55 in the COVID-19 Coping Study. We quantitatively evaluated the associations between number of neighborhood parks and depression, anxiety, and loneliness; and conducted qualitative thematic analysis of participants' outdoor experiences. Among urban residents, depression and anxiety were inversely associated with the number of neighborhood parks. Thematic analysis identified diverse engagement in greenspaces that boosted physical, mental, and social well-being. The therapeutic potential of outdoor and greenspaces should be considered for interventions during future epidemics.

Exploring the type of social support available to aged male hypertensive clients in Ghana

Objective

To explores the social support available to aged hypertensive male clients in a municipality in Ghana.

Methods

The inclusion criteria were as follows: age ≥60 years and are known hypertensive patients. Data were collected from 186 selected aged male hypertensive patients for 3 months. The questionnaire was self-developed and open-ended. The data were processed and analyzed using SPSS version 23. Some of the variables were subjected to statistical tests and ranks in the order of importance to respondents. The enrolled respondents were allowed to participate in the study after their informed consent was obtained. It was evident that respondents do not obtain much support or help in taking care of their condition.

Results

The result revealed that the repondents has no support to help take care of their condition as evident by the responses in the study. The scores on average mean for some variables are (AM = 2.25, SD = 0.381) more than the test value of 2.50. Some of these supports were on feeding support (M = 3.97, SD = 0.278, n = 186), health support (M = 2.87, SD = 0.167, n = 186), and cleaning support (M = 2.59, SD = 0.868, n = 186). Supports such as clothing, socialization, medication, washing, transportation, and financial support were lacking.

Conclusions

Based on the finding that certain forms of support were lacking, the study concludes that steps undertaken by the government, community, religious bodies, and family toward improving these supports can be of immense help for aged male hypertensive patients living in the Ejura-Sekyedumase municipality.

Social Isolation in Older Adults: A Qualitative Study on the Social Dimensions of Group Outdoor Health Walks

Physical distancing practices during the COVID-19 global pandemic contributed to a high degree of social isolation among older adults. To reduce loneliness and other ill effects of social isolation, public health experts recommended outdoor social gathering, with physical distancing. Adopting a case study approach, we explored how social aspects of group outdoor health walks (GOHWs) mitigate social isolation for older adults and improve individual social wellbeing. We used semi-structured interviews to understand the experiences of social isolation and social relationships in nine older (50-80 s) adults participating in a GOHW in Scotland, United Kingdom (UK). Verbatim transcripts were analysed through an iterative process of thematic analysis carried out by an interdisciplinary team of qualitative researchers from environmental psychology, medicine, and geography. Themes provide insight into the social dimensions of GOHWs, the mediating effects of social experiences, and the contribution these make to individual social wellbeing. GOHWs provide opportunities to be part of a group and attend to the needs of inexperienced or physically challenged individuals. Being part of the group walk fosters casual interpersonal interactions through spontaneous mixing during and after the walk. This programmatic structure counters loneliness, engenders pleasurable anticipation of regular contact with others, supports physical activity, and fosters group cohesion. These in turn contribute to individual social wellbeing, including expanding social networks, meaningful relationships, a sense of belonging, and acting on empathy for others. GOWHs may be beneficial for mitigation of social isolation as we emerge from the COVID-19 pandemic. Findings were used to propose a conceptual model to parse social constructs and inform selection or development of quantitative social measures for future studies of nature-based interventions such as GOHWs.

Older Adults' Responses to a Meaningful Activity Using Indoor-Based Nature Experiences: Bird Tales

OBJECTIVES

Bird Tales is a meaningful activity that creates indoor-based nature experiences for older adults in residential care. This study examined the impact of Bird Tales by understanding what attributes of birds take on meaning to older adults and piloting the program to assess the psychosocial impact on older adults in an assisted living facility.

METHODS

We conducted a mixed-methods study. First, we conducted focus groups with older adults. Then we used a cross-over study design with random assignment to examine the impact of the program. Potential benefits of the program were examined using individual interviews and repeated measures on psychosocial questionnaires with a paired samples t-test to compare means from pretest and posttest within the intervention group.

RESULTS

Findings from the focus group indicate multisensory, spiritual, and therapeutic aspects of birds that hold meaning for older adults. The participants in Bird Tales shared positive experiences with the program by discussing cognitively stimulating activity, interactions with others, connections to the past, and positive perceptions of birds and nature.

CONCLUSIONS

Findings from our study suggest the potential of Bird Tales as a meaningful activity for older adults in residential care settings. We discuss implications for research as well as practice and present our recommendations.

CLINICAL IMPLICATIONS

Activities in long-term care should be meaningful to meet the psychological and social needs of older adults. Older adults enjoy and may benefit from indoor-based nature activities.

The Effects of Urban Green Space on Depressive Symptoms of Mid-Aged and Elderly Urban Residents in China: Evidence from the China Health and Retirement Longitudinal Study

The aim of this study is to assess the impacts of urban green space on depressive symptoms among Chinese urban residents aged 45 and older. In total, 7397 urban respondents were included in this study. Each respondent participated in the China Health and Retirement Longitudinal Study Wave 3 (2015). Environmental-level variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the multilevel regression analysis. Almost one-third of the sample population suffered from depressive symptoms (31.20%). The multilevel logistic regression model showed that green coverage ratio of city-built districts is negatively associated with the prevalence of depressive symptoms among urban mid-aged (OR = 0.79, p < 0.05) and elderly (OR = 0.75, p < 0.05) residents, and the public recreational green space helps to reduce elderly people’s depressive symptoms (OR = 0.77, p < 0.05). This study adds insights about the impact of green space and other environmental factors on depressive symptoms among mid-aged and elderly urban dwellers. It is important to provide enough and accessible overall urban green spaces; additionally, attention should also be paid to specific green space forms such as public recreational green space.

Promoting outdoor recreation among older adults in Sweden - a theoretical and empirical foundation for the development of an intervention

BACKGROUND

Disengagement from outdoor recreation may diminish the positive benefits on health and well-being in old age. The purpose of this study is to present a contextual, theoretical, and empirical rationale for an intervention, aiming to promote continued engagement in outdoor recreation for older adults in a Swedish context.

METHODS

The paper includes a contextualization of outdoor recreation in Sweden, a presentation of evidence on health benefits related to engagement in outdoor recreation, together with theoretical frameworks that may guide future intervention designs. To add empirical knowledge, a mixed methods approach was applied, including an empirical data collection based on a quantitative survey (n = 266) and individual semi-structured interviews with older adults (n = 12). Survey data were presented with descriptive statistics. Associations between disengagement from previously performed activities and age and gender was analyzed with Chi2 tests. Transcripts and handwritten notes from the interviews were analyzed qualitatively to identify key themes, as well as patterns and disparities among respondents.

RESULTS

Outdoor recreation was rated as important/very important by 90% of respondents of the survey. The interviews highlighted that engagement in outdoor recreation aided respondents to keep fit but had also relevance in terms of identity, experiences, and daily routines. Outdoor recreation close to the place of residence was most common and walking was the most frequently reported activity. While 80% considered their health to be good/very good, disability and long-term diseases were common and during the previous year, more than half of all respondents had disengaged from activities previously performed. Reasons for disengagement were mainly related to health decline or that activities were too demanding but also due to social loss. The interviews indicated that continued engagement was important but challenging, and that disengagement could be considered as a loss or accepted due to changing circumstances.

CONCLUSIONS

In the design of an intervention aiming to promote engagement in outdoor recreation for older adults, the following features are proposed to be considered: person-centeredness, promoting functioning, addressing self-ageism, providing environmental support, promoting subjective mobility needs and adaptation to find new ways to engage in outdoor recreation.

Connectedness to Nature Does Not Explain the Variation in Physical Activity and Body Composition in Adults and Older People

Connectedness to nature (CN) is a significant predictor of pro-environmental behaviours, human health and well-being. However, research on how this connection to the natural world might promote a more active lifestyle and improve body mass composition according to gender is lacking. This study investigated the influence of CN on physical activity (PA) and body composition in adults and older people. We recruited a sample of 219 individuals (77 men and 142 women), and a self-administered questionnaire was used to measure CN and obtain demographic data. Body composition was assessed by bioimpedance, and PA was assessed by accelerometry. Correlations and stepwise multiple regressions were used in data analysis. CN's association with other variables was more pronounced in women than in men, and we only identified significant associations with steps/day and body composition. However, this variable would not be included in the regression models that we developed. Adiposity levels and muscle status were significant predictors of PA in women. In both genders, age, percentage of fat mass and fat-free mass were selected as regressors in the models developed for visceral fat area and muscle condition (R2 Adjusted ≥ 0.908).

Gardens as resources in advanced age in aotearoa NZ: More than therapeutic

For older people gardens may be paradoxical sites. Whilst gardening is associated in multiple ways with wellbeing and health, gardens may also become a source of frustration and worry as ageing bodies limit gardening activities. Yet determination remains. However, little of the well-established body of work on gardens and old age includes people in advanced age. In this paper, we draw on interviews with Māori and non-Māori 85-90-year olds in Aotearoa, New Zealand, focusing on how they talk about their wellbeing in relation to past, present, and future experiences of home gardening. Our research shows home gardens and gardening figure prominently and positively in the narratives of people in advanced age. Most of our participants described themselves as active gardeners; most also lived with multimorbidity, sometimes severe and complex. Applying positioning theory, we examine how our participants connect gardens and gardening to identity; connectedness; and adaptation and renegotiation of health and wellbeing in ageing bodies. Home gardens are 'more than therapeutic'; while they are protective of health and wellbeing, they are also enabling places for the expression and performance of agency in advanced age. These understandings have practical implications for supporting wellbeing amongst those in advanced age.

Investigating the Association between Outdoor Environment and Outdoor Activities for Seniors Living in Old Residential Communities

Many seniors live in old residential communities (ORCs) with low-quality outdoor environment (OE), which hinders the residents’ outdoor daily activities (ODAs). This paper empirically investigates the association of OE on ODAs for seniors living in ORCs. A questionnaire was designed and distributed in six central districts of Nanjing city. A total of 258 questionnaires was finally collected, of which 60.08%, 29.46%, 9.69%, and 0.78% respondents were scattered into four age groups (61–69, 70–79, 80–89, and ≥90), respectively. Based on reliability analysis, correlation analysis, and regression analysis, the results show that: (1) social activities are mainly associated with noise; (2) leisure activities are significantly associated with road accessibility, slip-resistance measures, greenery, and staff; (3) utilitarian-type activities are significantly associated with stairway accessibility, slip-resistance measures, greenery, and seating; (4) there is a significant association between nature-exposure activities and layout, greenery, and poor air quality. The findings could guide Chinese officials when renewing ORCs by addressing the most important outdoor environmental factors associated with ODAs.

Safety perceptions of older adults on an urban greenway: Interplay of the social and built environment

BACKGROUND

Creating neighbourhood places for older adults to be socially and physically active is a global health priority. Safety is integral to older adult mobility. In greenway research, perceived safety is often only partially or superficially explored. Our study comprehensively examines older adults' experiences and perceived safety for walking on a new urban greenway in Vancouver, Canada-the Arbutus Greenway.

METHODS

We integrated mixed methods: i) observational count data to describe the use and context of the greenway over 3 years (2017; 2018; 2019), and; ii) semi-structured interviews with older adults at two time points (2017, n = 27; 2019, n = 16).

RESULTS

and discussion: We conducted thematic analysis to illuminate older adults' experiences across three safety domains: personal safety, traffic safety, and security. Built environment features such as benches, paving, road markings, and natural foliage buffers intersected with elements of the social environment to influence older adults' perceived safety. While the greenway supported active transportation, leisure, and social engagement for many older adults, certain factors also provoked fears, especially for older adults with mobility limitations. We advocate for a multidimensional lens to better understand how urban interventions influence perceived safety, and identify practical solutions to encourage mobility for all ages and abilities.

Neighborhood Urban Design and Outdoor Later Life: An Objective Assessment of Out-of-Home Time and Physical Activity Among Older Adults in Barcelona

This study explores how older adults' time out-of-home and physical activity (PA) are associated with the provision of urban open spaces (green spaces, plazas, and boulevards) and microelements (street trees and benches) in their neighborhoods. The authors used data from 103 residents in Barcelona and matched it to official geospatial data. The authors adjusted a set of mixed-effects linear regressions, both for the entire sample and also stratified by age and gender. For the entire sample, the percentage of green spaces showed a positive association with neighborhood time out-of-home and PA, while participants' PA also showed a positive association with the presence of benches. Outdoor time among older women was not associated with any of the measured exposures. For men, the provision of green spaces and benches was positively associated with time out-of-home and PA. These results could inform the design of urban spaces that aim to encourage outdoor activity among older adults.

The Relationship between Nature Deprivation and Individual Wellbeing across Urban Gradients under COVID-19

Lockdown aiming at slowing COVID-19 transmission has altered nature accessibility patterns, creating quasi-experimental conditions to assess if retracted nature contact and perceived nature deprivation influence physical and emotional wellbeing. We measure through on-line survey methods (n = 529) how pandemic mandates limiting personal movement and outdoor nature access within the United States affect self-assessed nature exposure, perceived nature deprivation, and subsequent flourishing as measured by the Harvard Flourishing Index. Results indicate that perceived nature deprivation strongly associates with local nature contact, time in nature, and access to municipal nature during the pandemic, after controlling for lockdown mandates, job status, household composition, and sociodemographic variables. Our hypothesis is that individuals with strong perceived nature deprivation under COVID-19 leads to diminished wellbeing proved true. Interaction models of flourishing showed positive modification of nature affinity with age and qualitative modification of nature deprivation with race. Our results demonstrate the potential of local nature contact to support individual wellbeing in a background context of emotional distress and social isolation, important in guiding public health policies beyond pandemics.

"Human Flourishing with Dignity": A Meta-Ethnography of the Meaning of Gardens for Elderly in Nursing Homes and Residential Care Settings

This study aims to identify and synthesize qualitative research regarding residents' experiences of gardens while living in nursing homes and residential care facilities. To provide an optimal nursing environment inspired by nature, we need to derive knowledge from the residents' perspective. An interpretive meta-synthesis approach, a meta-ethnography, was chosen for this study. Altogether, six articles representing three continents and comprising 124 participants were included. The six articles that fulfilled the inclusion criteria were analyzed and synthesized according to Noblit & Hare's seven phases of meta-ethnography and the recent eMERGe guidelines. Four themes were identified: (1) The garden-a place to feel a connection with life, (2) the garden-a place to sense and find comfort, (3) the garden-a place to feel healthy and alive, and (4) the garden-a place to relate past and present. An overarching metaphor, "human flourishing with dignity," offers a deeper understanding of the meaning of the garden for older people in nursing homes and residential care. This meta-ethnography provides a reflective, systematic, data-driven synthesis based on literature spanning ten years. Rather than simply relying on retelling, the narration of experiences according to the primary researcher's descriptions and interpretations results in new knowledge. The significance of gardens for older people's health and well-being needs to be given greater attention and space in nursing practice, education, and health policies.

Residential Greenness and Frailty Among Older Adults: A Longitudinal Cohort in China

OBJECTIVES

Frailty is an accumulation of deficits characterized by reduced resilience to stressors and increased vulnerability to adverse outcomes. There is evolving evidence on the health benefits of residential greenness, but little is known about its impact on frailty.

DESIGN

A longitudinal cohort study.

SETTING AND PARTICIPANTS

We included older adults aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with a 12-year follow-up.

METHODS

We assessed residential greenness by calculating the Normalized Difference Vegetation Index (NDVI) in the 500 m radius around participants' residence. We used 39 self-reported health items to construct a frailty index (FI) as a proportion of accumulated deficits. We defined an FI of ≤0.21 as nonfrail and prefrail, and an FI of >0.21 as frail. We used the mixed effects logistic regression models to examine the association between residential greenness and frailty, adjusted for a number of covariates.

RESULTS

We had 16,238 participants, with a mean age of 83.0 years (standard deviation: 11.5). The mean baseline NDVI and FI were 0.40, and 0.12, respectively. Compared to the participants living in the lowest quartile of residential greenness, those in the highest quartile had a 14% [odds ratio (OR): 0.86, 95% confidence interval (CI): 0.77, 0.97] lower odds of frailty. The association was stronger among urban vs rural residents. Additionally, each 0.1-unit increase in annual average NDVI was related to a 2% higher odds of improvement in the frailty status (OR: 1.02, 95% CI: 1.00, 1.04).

CONCLUSIONS AND IMPLICATIONS

Our study suggests that higher levels of residential greenness are related to a lower likelihood of frailty, specifically in urban areas.

Demographic biases in engagement with nature in a tropical Asian city

Urban residents can benefit from spending time in outdoor spaces and engaging with nature-related activities. Such engagement can improve health and well-being, support community cohesion, and improve environmentally-friendly behaviours. However, engagement with nature may not be equal amongst different members of society. We investigated individual variation in engagement with nature in Singapore, a high-density city in tropical Southeast Asia. Through a survey of 1000 residents, we analysed relationships between demographic factors such as age, income, and sex, and the frequency of visitation to different ecosystem types, and the frequency of engagement with different nature-related activities. Parks and neighbourhood open spaces were among the most commonly-visited outdoor spaces, with nature reserves and other natural areas being visited less frequently. Common activities included sitting outdoors, art and photography, and running, while hiking and nature recreation were less frequent. In contrast with previous studies, we found relatively small differences among different groups of the population in their preferred types of outdoor activities. Older people, those with lower incomes, and without degrees were less likely to visit most types of outdoor space and engage with most types of nature-related activities. In the case of nature reserves, the distance from the visitor’s home had a significantly negative influence on the frequency of visitation. These findings demonstrate that the benefits of engagement with nature are not equally enjoyed by all demographic groups, and that some groups lack engagement across the board. Strategies to increase nature engagement in tropical cities could include increasing the local availability and accessibility of different types of outdoor space, and education and public outreach programmes to encourage participation.

Cross-National Comparison of Environmental Factors Important to Facility-Based Senior Living

OBJECTIVE

Focusing on environmental factors important to facility-based senior living, this research intends to identify cross-national similarities and differences in perspective on elderly care between senior-living professionals in the United States and China.

BACKGROUND

American models of senior-living facility design have been introduced in China. In social and cultural context, environmental factors important to facility-based senior living are expected to be different by nation and need to be clarified.

METHOD

Questionnaire data were collected from 188 staff members working in senior-living facilities in the United States and China. Seven factors summarized through literature review were investigated. The frequencies of each factor selected by the participants as one of the three most important factors were ranked. The influence of personal and social factors on environmental perception was analyzed using analysis of variance tests.

RESULTS

Common area and cross-facility home-like decoration were similarly valued by both groups as two of the three most important factors. Residential room was valued more in the United States whereas natural lighting was valued more in China. Chinese participants with more work experience valued building layout more. Amenities were valued less than expected in both countries.

CONCLUSION

Environmental factors important to facility-based senior living are different between countries. American models of senior-living facility design should be adjusted for use in China. There is much to be gained from investigating the similarities and differences in perspective on elderly care.

"I Would Never Come Here Because I've Got My Own Garden": Older Adults' Perceptions of Small Urban Green Spaces

Green spaces are known to improve health and wellbeing via several mechanisms, such as by reducing stress and facilitating physical activity. However, little is known about the impact of the smaller green spaces typically found in urban environments on wellbeing, especially for older adults. This study investigated experiences in adults (5 males and 10 females) aged 60 years and over of small urban green spaces in a large UK city. Fifteen older adults were interviewed using semi-structured walk-along interviews and photo elicitation methods in Old Moat, Greater Manchester. Twelve of the participants lived in Old Moat at the time of the study, and the remaining three participants previously lived in Old Moat and were frequent visitors. Transcribed interviews were analyzed using Thematic Analysis. Smaller urban green spaces were perceived differently to large green spaces, and participants were more likely to use larger green spaces such as parks. The smaller green spaces were perceived as belonging to other people, which discouraged the older adults from using them. The older adults also emphasized the importance of taking care of small urban green spaces and preventing them from becoming overgrown. Urban planners should consider these factors, since they indicate that the size and type of urban green spaces may influence whether they improve health and wellbeing. Further research should investigate in more detail which types of urban green space are most conducive to facilitating physical activity and improving wellbeing.