Abstract
Having contact with nature can be beneficial for health and wellbeing, but many older adults face barriers with getting outdoors. We conducted a systematic review of quantitative studies on health and wellbeing impacts of indoor forms of nature (both real and simulated/artificial), for older adults in residential settings. Search terms relating to older adults and indoor nature were run in 13 scientific databases (MEDLINE, CINAHL, AgeLine, Environment Complete, AMED, PsychINFO, EMBASE, HMIC, PsychARTICLES, Global Health, Web of Knowledge, Dissertations and Theses Global, and ASSIA). We also pursued grey literature, global clinical trials registries, and a range of supplementary methods. Of 6,131 articles screened against eligibility criteria, 26 studies were accepted into the review, and were quality-appraised using the Effective Public Health Practice Project (EPHPP) tool. The participants were 930 adults aged over 60. Nature interventions and health/wellbeing outcomes were heterogeneous, which necessitated a narrative synthesis. The evidence base was generally weak, with 18 of 26 studies having a high risk of bias. However, several higher-quality studies found indoor gardening and horticulture programs were effective for cognition, psychological wellbeing, social outcomes, and life satisfaction. There is inconsistent evidence that indoor nature exposures are beneficial for older care residents. We expect that successful interventions were, at least partly, facilitating social interaction, supporting feelings of autonomy/control, and promoting skill development, that is, factors not necessarily associated with nature per se. Higher-quality studies with improved reporting standards are needed to further elucidate these mechanisms.
Highlights
IntroductionTime spent in “nearby nature” - usually the home’s garden - has been associated with improved concentration (Ottosson & Grahn, 2005), reduced agitation (Whear et al, 2014), supported feelings of competence (Rappe & Topo, 2007), and increased quality of life (QoL) for residents (Raske, 2010), including for those with dementia (Whear et al, 2014)
Though several higher-quality studies indicated improvements in dementia-related, social, and psychological wellbeing outcomes; the vast majority of studies were of weak quality, which made it difficult to present a comprehensive overview
Mechanisms underlying these interactions may include provision of opportunities for social stimulation, development of skills, and/or having responsibility to care for nature, but further research is needed to fully elucidate these associations
Summary
Time spent in “nearby nature” - usually the home’s garden - has been associated with improved concentration (Ottosson & Grahn, 2005), reduced agitation (Whear et al, 2014), supported feelings of competence (Rappe & Topo, 2007), and increased quality of life (QoL) for residents (Raske, 2010), including for those with dementia (Whear et al, 2014) Despite these findings, various barriers, such as physical mobility issues, staff shortages and concerns for residents’ safety, can make access to nature difficult for long-term care residents (Hernandez, 2007; Kearney & Winterbottom, 2006; Morgan & Stewart, 1999; Reynolds, 2016; Rodiek, 2006). The review question was: “is exposure to indoor nature beneficial for the health and wellbeing of older adults in residential settings?”
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