The Great Outdoors

Access to the outdoors is known to have a positive impact on wellbeing, due to such benefits as exercise and activity as well as the promotion of social inclusion and interaction, however, for people with dementia, this access is often denied. The reasons for this are wide ranging including disorientation and a lack of appropriate support to compensate for this, inadequate public transport provision and the negative and stigmatising attitudes of the wider community. 

A similar exclusion from outdoor spaces is experienced by people with dementia living in care homes. For in spite of the widespread availability of gardens and other outdoor spaces within these settings, my experiences as nurse suggest that these outdoor spaces are rarely used by residents. While inadequacies in dementia care are often attributed to corresponding inadequacies in the front line workforce, wider factors are also at play in this exclusion. These include the inappropriate design of outdoor spaces and the lack of availability of staff to facilitate access to these spaces.

Also important are care home cultures which place an overriding focus on minimising levels of risk amongst the resident group. Thus having a resident ‘wandering off’ on their own outside or falling over and hurting themselves are seen as incidents to be avoided at all costs, with care home staff having to account for and justify their actions should such incidents happen on their shift. Consequently, in their negotiation of the fine line between care on one hand and control on the other, due to the wish of care home staff to avoid such events, the emphasis is normally placed on the latter. This can lead to overcautious and task centred approach to care and a subsequent ‘institutionalisation’ of more vulnerable residents with a focus on ensuring their physical safety rather than on their individual social and psychological needs and aspirations. This is exacerbated by the fact that people with dementia are not always able to fully express these needs as well as by high levels of staff turnover and the increasing scale of care homes meaning that staff often do not gain familiarity with each resident and be ‘person centred’ in their practice.  In view of these multiple barriers to outdoor access, measures aimed at overcoming them should adopt a similarly eclectic approach. These measures could include the incorporation within each persons care plan a consideration of their need for outdoor access and how this will be achieved and which potentially permits an acceptable level of risk in this achievement.  ‘Dementia friendly’ spaces and support to access them also need to be available both for people living in care homes as well as in the wider community.  While on a wider level, government policy and legislation should  recognise that access to the outdoors for people with dementia is a basic human right and key to the promotion of their social inclusion.

Follow this link to find out more: http://www.tandfonline.com/doi/full/10.1080/13607863.2016.1222351