Understanding the Barriers and Enablers to Using Outdoor Spaces in Nursing Homes: A Systematic Review

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Abstract

Background and Objectives

Despite acknowledged benefits of residents in nursing homes spending time outdoors, little is known about factors related to their use of outdoor space. This systematic review summarizes reported barriers and enablers to nursing home residents’ use of outdoor spaces.

Research Design and Methods

Multiple databases were searched to May 2018. Qualitative or mixed methods studies describing barriers/enablers to use of outdoor areas by residents of nursing homes (aged 65 years and older), as reported by residents, staff, or family members were included. Study quality rating, thematic analysis, and stratified analyses were performed and confidence in findings assessed using GRADE-CERQual.

Results

Twenty-four studies were included. Nineteen collected data from residents, 15 from staff/caregivers, 7 from families. Major themes and key findings concerned: design of the outdoor area (importance of garden greenery and built features), safety concerns and staffing issues, weather and seasons (appropriate shade and shelter), design of the main building (easy to open doors and nearby access points) and social activities.

Conclusions and Implications

Providing gardens with seasonal plants and interactive features, weather protected seating, manageable doors at accessible thresholds, planned social activities, and appropriate clothing are fundamental to facilitate nursing home residents’ access to the outdoors. Cultural change at an organizational level, addressing perceptions of safety as a barrier is important. Incorporation of the recommendations in this review by architects, facility managers, and policy makers in the design and management of nursing homes, may increase use of outdoor areas and improve the quality of life of residents.

Registration

The protocol is registered in Prospero (CRD42018100249).

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Most cited references 49

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Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series

Simon Lewin, Andrew Booth, Claire Glenton … (2018)

The GRADE-CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’) approach provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. Confidence in the evidence from qualitative evidence syntheses is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. CERQual provides a systematic and transparent framework for assessing confidence in individual review findings, based on consideration of four components: (1) methodological limitations, (2) coherence, (3) adequacy of data, and (4) relevance. A fifth component, dissemination (or publication) bias, may also be important and is being explored. As with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach for effectiveness evidence, CERQual suggests summarising evidence in succinct, transparent, and informative Summary of Qualitative Findings tables. These tables are designed to communicate the review findings and the CERQual assessment of confidence in each finding. This article is the first of a seven-part series providing guidance on how to apply the CERQual approach. In this paper, we describe the rationale and conceptual basis for CERQual, the aims of the approach, how the approach was developed, and its main components. We also outline the purpose and structure of this series and discuss the growing role for qualitative evidence in decision-making. Papers 3, 4, 5, 6, and 7 in this series discuss each CERQual component, including the rationale for including the component in the approach, how the component is conceptualised, and how it should be assessed. Paper 2 discusses how to make an overall assessment of confidence in a review finding and how to create a Summary of Qualitative Findings table. The series is intended primarily for those undertaking qualitative evidence syntheses or using their findings in decision-making processes but is also relevant to guideline development agencies, primary qualitative researchers, and implementation scientists and practitioners. Electronic supplementary material The online version of this article (10.1186/s13012-017-0688-3) contains supplementary material, which is available to authorized users.

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Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report.

Philipe de Souto Barreto, John E. Morley, Wojtek Chodzko-Zajko … (2016)

A taskforce, under the auspices of The International Association of Gerontology and Geriatrics-Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section, composed of experts from the fields of exercise science and geriatrics, met in Toulouse, in December 2015, with the aim of establishing recommendations of physical activity and exercise for older adults living in long-term care facilities (LTCFs). Due to the high heterogeneity in terms of functional ability and cognitive function that characterizes older adults living in LTCFs, taskforce members established 2 sets of recommendations: recommendations for reducing sedentary behaviors for all LTCF residents and recommendations for defining specific, evidence-based guidelines for exercise training for subgroups of LTCF residents. To promote a successful implementation of recommendations, taskforce experts highlighted the importance of promoting residents' motivation and pleasure, the key factors that can be increased when taking into account residents' desires, preferences, beliefs, and attitudes toward physical activity and exercise. The importance of organizational factors related to LTCFs and health care systems were recognized by the experts. In conclusion, this taskforce report proposes standards for the elaboration of strategies to increase physical activity as well as to prescribe exercise programs for older adults living in LTCFs. This report should be used as a guide for professionals working in LTCF settings.

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Epidemiology of falls in residential aged care: analysis of more than 70,000 falls from residents of bavarian nursing homes.

Hans-Helmut König, Kilian Rapp, Clemens Becker … (2012)

Falls and fall-related injuries are leading problems in residential aged care facilities. The objective of this study was to provide descriptive data about falls in nursing homes. Prospective recording of all falls over 1 year covering all residents from 528 nursing homes in Bavaria, Germany. Falls were reported on a standardized form that included a facility identification code, date, time of the day, sex, age, degree of care need, location of the fall, and activity leading to the fall. Data detailing homes' bed capacities and occupancy levels were used to estimate total person-years under exposure and to calculate fall rates. All analyses were stratified by residents' degree of care need. More than 70,000 falls were recorded during 42,843 person-years. The fall rate was higher in men than in women (2.18 and 1.49 falls per person-year, respectively). Fall risk differed by degree of care need with lower fall risks both in the least and highest care categories. About 75% of all falls occurred in the residents' rooms or in the bathrooms and only 22% were reported within the common areas. Transfers and walking were responsible for 41% and 36% of all falls respectively. Fall risk varied during the day. Most falls were observed between 10 am and midday and between 2 pm and 8 pm. The differing fall risk patterns in specific subgroups may help to target preventive measures. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Patricia C Heyn: Role: Decision Editor

Journal

Journal ID (nlm-ta): Gerontologist

Journal ID (iso-abbrev): Gerontologist

Journal ID (publisher-id): geront

Title: The Gerontologist

Publisher: Oxford University Press (US )

ISSN (Print): 0016-9013

ISSN (Electronic): 1758-5341

Publication date (Print): May 2020

Publication date (Electronic): 24 May 2019

Publication date PMC-release: 24 May 2019

Volume: 60

Issue: 4

Pages: e254-e269

Affiliations

[1 ] Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University , Bedford Park, Australia

[2 ] NHMRC Cognitive Decline Partnership Centre, The University of Sydney , Australia

[3 ] The Dementia Centre, HammondCare , Greenwich, Australia

Author notes

Address correspondence to: Maayken E.L. van den Berg, PhD, Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia. E-mail: maayken.vandenberg@ 123456flinders.edu.au

Article

Publisher ID: gnz055

DOI: 10.1093/geront/gnz055

PMC ID: 7228458

PubMed ID: 31218352

SO-VID: b2335b6e-c339-483a-abe7-2f697271ebb8

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 21 February 2019

Date: 22 March 2019

Page count

Pages: 16

Funding

Funded by: National Health and Medical Research Council, DOI 10.13039/501100000925;

Understanding the Barriers and Enablers to Using Outdoor Spaces in Nursing Homes: A Systematic Review

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Abstract

Background and Objectives

Research Design and Methods

Results

Conclusions and Implications

Registration

Related collections

Cardiovascular Innovations and Applications

Most cited references 49

Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series

Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report.

Epidemiology of falls in residential aged care: analysis of more than 70,000 falls from residents of bavarian nursing homes.

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