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Visiting Outdoor Green Environments Positively Iimpacts Self-Rated Health among Older People In Long-Term Care

Originally Published:
2006
Key Point Summary
Key Point Summary Author(s):
YoungSeon Choi
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Key Concepts/Context

The restorative effects of nature in enhancing well-being are well documented. Seeing greenery or being in nature reduces stress, promotes attention capacity, and improves mood. Studies of older people living in institutions indicate positive associations between well-being of the residents and closeness of a green environment. Visiting an outdoor green environment is associated with better ability to concentrate and improved mood among the older people living in nursing homes. Plants and garden environments may contribute to psychological and social well-being of older people with dementia, according to nursing staff. Although health-related factors can impact on self-rated health among the older people living in nursing care, results from previous studies indicate that outdoor visits may also have an impact. It is suggested that the more often older people visit outdoors, the better their self-rated health is. Because poor health may have a confounding impact on the effects of outdoor visits, it is important to analyze how health-related factors, such as physical mobility and social isolation, are associated with the frequency of outdoor visits and whether they have an impact on the effect of outdoor visits on self-rated health. 

Objectives

The objective of the study was to describe the relationship between the reported frequency of outdoor visits to a green environment and self-rated health among older people living in a nursing home. It was hypothesized that with increasing frequency of outdoor visits, self-rated health improves.

Methods

The participants for the study (45 women) were chosen from among the residents of Kustaankartano nursing home and service center in Helsinki, Finland. The participants had no major cognitive hearing or speech impairments. Self-rated health was assessed using the question: “At the present time, would you say that your health is excellent, very good, good, fair, or poor?” Health-related quality of life was measured using the Nottingham Health Profile (NHP), which consists of 38 binary “yes” or “no” items addressing distresses in physical, medical, and social health. NHP is a profile measure consisting of six dimensions related to health: energy level, sleep, pain, physical mobility, emotional reactions, and social isolation. Visiting outdoors was defined as either entering the courtyard or being on the balcony. The frequency of visiting outdoors was addressed by the question: “How often do you visit outdoors?” Answers were divided into five groups: never, sometimes yearly, sometimes monthly, sometimes weekly, and daily. A questionnaire including items related to visiting outdoors (season of visiting, accompanying person, where to go and what to do there) was completed during the interview. The t-test was used to analyze differences in self-rated health between those visiting outdoors year-round and only in summer. Associations between the reported frequency of visiting outdoors and separate NHP dimensions were determined using the Spearman correlation coefficient. Associations between the reported frequency of visiting outdoors, NHP dimensions, and self-rated health were analyzed using linear regression analysis. 

Design Implications
No limitations have been discussed in the study.
Findings

A strong positive association was established between the reported frequency of visiting outdoors and self-rated health even when taking into account health-related distresses measured using the NHP. The main hindrances related to outdoor visits were lack of assistance and uncomfortable weather conditions. The results suggest that providing opportunities to visit outdoor green environments may promote the well-being of older individuals living in nursing homes.

Limitations

No limitations have been discussed in the study.

Design Category
Building location/site optimization
Outcome Category
Patient / resident health outcomes
Key Point Summary Author(s):
YoungSeon Choi
Primary Author
Rappe, E.