Abstract
PurposeThe aim of this study was to investigate the associations between quality of life and both perceived and objective availability of local green and blue spaces in people with dementia, including potential variation across rural/urban settings and those with/without opportunities to go outdoors.MethodsThis study was based on 1540 community-dwelling people with dementia in the Improving the experience of Dementia and Enhancing Active Life (IDEAL) programme. Quality of life was measured by the Quality of Life in Alzheimer’s Disease (QoL-AD) scale. A list of 12 types of green and blue spaces was used to measure perceived availability while objective availability was estimated using geographic information system data. Regression modelling was employed to investigate the associations of quality of life with perceived and objective availability of green and blue spaces, adjusting for individual factors and deprivation level. Interaction terms with rural/urban areas or opportunities to go outdoors were fitted to test whether the associations differed across these subgroups.ResultsHigher QoL-AD scores were associated with higher perceived availability of local green and blue spaces (0.82; 95% CI 0.06, 1.58) but not objective availability. The positive association between perceived availability and quality of life was stronger for urban (1.50; 95% CI 0.52, 2.48) than rural residents but did not differ between participants with and without opportunities to go outdoors.ConclusionsOnly perceived availability was related to quality of life in people with dementia. Future research may investigate how people with dementia utilise green and blue spaces and improve dementia-friendliness of these spaces.
Highlights
Interaction with the natural environment, such as visiting gardens, parks, woodlands and rivers and coastal areas, termed green and blue spaces, has been associated with better health and wellbeing in the general population [1, 2] as well as among people with dementia [3,4,5,6]
Most existing studies are based on relatively small numbers of people with dementia living in residential care settings and have generally used qualitative methods [3]
The analysis investigated whether the associations of quality of life with perceived and objective availability of green and blue spaces varied across those with different individual and area-level factors
Summary
Interaction with the natural environment, such as visiting gardens, parks, woodlands and rivers and coastal areas, termed green and blue spaces, has been associated with better health and wellbeing in the general population [1, 2] as well as among people with dementia [3,4,5,6]. Perceptions of the natural environment are likely to be linked to experiences of environmental interactions in the wider context of social networks, mobility and sociocultural systems [11] Individual factors, such as sociodemographic characteristics and health status, as well as collective factors, such as values, norms and social networks, may modify behaviour and the use of the environment in certain subgroups [11, 12]. To investigate the role of green and blue spaces in supporting people to live well with dementia, it is important to consider variation between perceived and objective measures and investigate the potential impact of these on quality of life, a key outcome measure in dementia care research focusing on individual perception of wellbeing, happiness, goodness and satisfaction with various aspects of life [16, 17]. The analysis investigated whether the associations of quality of life with perceived and objective availability of green and blue spaces varied across those with different individual (with and without opportunities to go outdoors) and area-level (urban and rural settings) factors
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