How does the outdoor environment affect older people’s quality of life?
- Key findings
- Quality of Life (QoL)
- What aspects of QoL are affected by outdoor environments?
- How significant are outdoor environments for older people’s quality of life?
- Findings on links between environmental support, outdoor activity and aspects of quality of life
- References
1. Key findings
1.1 Is there a problem at present?
The inaccessibility and difficulties presented by many outdoor environments is a major problem affecting older people at present. This is further aggravated by a lack of awareness about design features that could support independent activities and make a difference to the quality of their daily lives.
OISD:WISE and SURFACE‘s in-depth interviews of 200 older people showed that at least half of the interviewees faced problems in getting outdoors due to barriers in the environment and lack of supportive facilities. Concerns about safety were also significant: the most commonly mentioned places where people felt unsafe after dark were city or town centres and high streets and streets with pubs on, as well as deserted streets and places.
1.2 What stops older people from going out?
Our I’DGO focus group and interview results illustrate how many aspects of the outdoor environment make it inaccessible or hinder outdoor activities.
- Bad or poorly maintained pavements. A typical response was: “Maintenance of pavements and roads: they are diabolical around here.” Another: “It’s not always level, smooth, and safe to walk on. You can be very unstable.”
- Fear of crime and undesirable young people (especially when in groups). “What shame you couldn’t enjoy going out for walk at night, just frightened.” Another: “When they wear trainers, you can’t hear their footsteps.” On young people: “They probably won’t harm you, but they look so threatening. They march up the road and ride the bicycles up and down the pavement.” And: “If I see four or five boys coming toward me, I panic. You can pass them and they make rude remarks and things like that, and you’re quite frightened”
- Lack of benches. This is related to the difficulty in walking a long distance because of health conditions associated with ageing, such as short breath and lack of stamina. Responses include: “I’ve got a bad back. I can’t walk the same as I used to be. I’ve got to have a seat.” People need “Benches here and there to have a rest and to sit down.”
- Lack of accessible public toilets. One respondent said: “[Getting to] a toilet is a big problem… I’ve got to plan where the next toilet is.” Often toilets are not easy to get to: “You have to go down stairs”.
- Traffic and car parking. This is mainly related to heavy traffic in conjunction with poor provision of pavements or location of traffic lights, which make walking and crossing the road difficult and unpleasant. Cars parked on pavements also make it difficult for everyone, and especially older people with mobility impairment, to walk.
1.3
Why does getting outdoors matter?
Central to prolonging the independence of older people is enabling them to live in their own homes for as long as possible. Current research demonstrates that, as people age, remaining in a familiar home and neighbourhood tends to become more important. There is also a shortage of alternative accommodation; over the past few years, the number of residential care homes for older people closing down has greatly exceeded the number established (Laing and Buisson, 2002).
Research on the design of home environments that maximise older people’s independence has led to innovations such as ‘Smart Homes’, but very little research has addressed the outdoor environments that surround these homes. If older people are to remain at home, they need to be able to continue to use the wider environment, including their local neighbourhood, and to go outdoors, otherwise they will be effectively trapped inside.
The outdoor environment is important not only in terms of independence, but also in terms of affecting everyday experience for older people. Any approach to people’s independence and well-being must take into account the emotional and psychological as well as physical impacts and obstacles in the landscape that affect quality of life (Price and Stoneham, 2001).
Getting outdoors offers physical, sociological and psychological benefits for older people. Physical inactivity is a major underlying cause of disease and disability (WHO, 2003). Despite abundant scientific evidence of the multiple health benefits of physical activity, and national and local level strategies to promote an active lifestyle, the majority of older people are not sufficiently active to maintain good health. In the UK, more than 80 percent of people aged between 65 and 74 years old do not meet the recommended level of physical activity (Joint Health Survey Unit, 2004; Scottish Executive, 2005). Since physical inactivity is a very common, yet preventable, risk factor, supporting people in having an active lifestyle is one of the most important health initiatives, and getting outdoors has been shown to be one of the best ways to keep active. Supportive outdoors spaces, i.e. spaces that are easy for older people to use, contribute to a more active life-style and are correlated with older people’s life satisfaction and health (Sugiyama and Ward Thompson, 2006; Sugiyama and Ward Thompson, 2007c).
The social benefits of getting outdoors include practical considerations such as being able to get to the shops or the post office, as well as being able to visit friends and have informal contact with neighbours. Activities in open spaces are associated with greater social integration and stronger social networks among neighbours (Kuo, Sullivan, Coley and Brunson, 1998) and reduced fear of crime (Kweon, Sullivan, and Wiley, 1998).
In exploring the psychological benefits of getting outdoors, contact with nature has been shown to reduce mental fatigue, thus, aiding in the restoration of people’s attentional resources (Kaplan and Kaplan, 1989; Kaplan, 1995), reduce stress by leading to positively-toned emotional states (Ulrich, 1983; Ulrich, Simons, Losito, Fiorito, Miles, and Zelson, 1991), and help other processes, such as reflection, particularly as people’s favourite places are also very frequently natural settings (Korpela and Hartig, 1996).
1.4
What is significant for quality of life?
Quality of life is a multi-layered concept that includes physical, social and cultural aspects of a person’s engagement with the environment (see section 2, below). Access to and activities in outdoor environments contribute to older people’s quality of life in a number of ways.
Past Studies
The literature in environment-behaviour studies suggests that outdoor environments have various benefits for older people:
- physiological benefits, which are concerned with the maintenance and enhancement of physical health and functioning;
- psychological benefits that include stress reduction, restoration from mental fatigue, satisfaction with life and sense of well-being.
The benefits of activities in outdoor spaces can be structured in three modes of engagement:
- participation in physical activity;
- exposure to outdoor natural elements;
- engagement in socially-related activities.
(For more information, see the Literature Review on the Benefits of Access to Outdoor Environments for Older People by Susana Alves, (2006) (See Literature Review )
1.5
What aspects need to be changed to improve the use of outdoor environments?
The following lists the environmental and personal characteristics which an OPENspace survey of over 270 older people has shown influence time spent outdoors, either in walking to go to places, recreation, gardening or performing other activities. These are characteristics which should be considered in working to promote older people’s use of outdoor environments.
a) Environment-related characteristics
- Paths to neighbourhood open spaces. The pavement of the footways should be well-maintained and the paths should be easy to walk on, enjoyable and without barriers.
- Distance. Like most other people, our respondents would rather use open spaces that are within 5-10 minutes from their residences. However, they are willing to take a little longer to get to open spaces if good paths are provided.
- Pleasantness of neighbourhood open spaces. In addition to well-maintained spaces, pleasantness that makes a difference to older people in this context refers to the amount of trees and plants, and suitable spaces for children to play and people to socialize.
- Facilities and amenities. The presence of seats, toilets and shelters are important for older people to feel comfortable and able to cope with variable personal and environmental conditions.
- Waterscapes. Previous research has shown that waterscapes make the environment attractive and are one of the most preferred environmental features. Our findings show that the presence of a fountain or an accessible body of water, such as a river, lakeside or beach can contribute to older people spending a longer time outdoors.
- Nuisance: Lack of nuisance, especially concerning unattended dogs, dog fouling and youngsters hanging around, can encourage older people to walk for recreational purposes.
b) Person-related characteristics
We also recognize that personal characteristics play a major role in the use of outdoor spaces. Our OPENspace survey findings showed that positive appraisal of the environment was likely to increase use of outdoors. For instance, participants who perceived their environments as supportive were more likely to be higher-level walkers, and those who walked more were healthier (reported fewer unhealthy days). It is clear that this is a complex relationship; the main point is that how people appraise their environments will affect how they use them. The key elements presented in the section above (i.e., paths, distance, facilities, waterscapes) offers guidance on what in the environment may lead to positive appraisal.
A person’s level of functional capability also affects their use of the environment. Our findings showed that participants with better functional capability appraised their environments as more supportive, were more satisfied with life, and spent more time walking outdoors. So environmental interventions should be sensitive to older people’s different levels of functional capability.
In relation to the pursuit of activities, the findings showed that participants with a wider range of activities were more satisfied with life. Thus, it is reasonable to propose that the number and type of activities available should be considered when planning environmental interventions.
1.6
What can help people enjoy the outdoors more?
The experiential and social aspects of people’s engagement with outdoor spaces are closely tied to environmental aspects, because of the transactional nature of the relationship. However, it seems useful to try to disentangle these aspects in order to better understand older people’s relationship with outdoor spaces and use this information when planning outdoor environments.
Some of the experiential aspects related to the “use” of outdoor spaces are:
- Perception of supportiveness. If people perceive their open spaces as facilitating rather then hindering their activities, they are more likely to spend time outdoors and to have positive experiences.
- Pleasantness. This can be manifested through:
- Provision of facilities and amenities. Furnished places can be inviting and create more opportunities for people to interact socially.
- Well-maintained open spaces. This can make it more attractive to spend time outdoors, by engaging in comparatively leisurely activities, such as watching nature, or physically active pursuits, such as sports.
2. Quality of Life - What do we mean by quality of life?
Quality of life is a key concept in this research project. It involves both physical and psychological components. We have followed a social model for quality of life that views the individual as an active being, capable of coping successfully with major life changes if personal and environmental contexts are appropriate. Peace et al (2003) have taken the concept of quality of life further by suggesting that a “life of quality” is one where mastery can be exercised in relation to the social and material fabric of one’s life: one can make choices and modify the constraints posed by the environment.
This transactional approach to quality of life leads to the consideration of the aspects of the environment which facilitate or hinder human activity. The “quality” of the environment in this context therefore involves the interaction between environmental and individual aspects. In this sense, individual differences between people play a great role and the same environment may offer different opportunities to different individuals.
According to Lawton (1986), the environment offers three vital functions to older people: maintenance, stimulation and support. The support function of the environment is important for older people to remain active and independent. In this project, we considered the supportiveness of outdoor environment as involving: (1) personally meaningful activities, (2) environmental features which hinder or facilitate outdoor activities; and (3) unmet needs of daily activities, that is, the discrepancy between what a person wants and what the settings “affords” (Gibson, 1979). The same environment may have different degrees of supportiveness for different people based on its affordances - what it offers people in terms of opportunities to do things — and how they are appraised. Our findings have highlighted specific aspects of older people’s quality of life which are influenced by outdoor spaces.
3.
What aspects of QoL are affected
by outdoor environments?
3.1 Results from the literature review
Some environmental attributes help people carry out activities, while others thwart people’s plans or intentions. The literature (e.g., Frank, Schmid, Sallis, Chapman, and Saelens, 2005; Humpel, Owen, Leslie, 2002; Owen, Humpel, Leslie, Bauman, Sallis, 2004; Saelens, Sallis, Frank, 2003) indicates that environmental determinants of activity participation include:
- land-use diversity
- street pattern (connectivity)
- access to shops
- access to recreational facilities
- qualities of the pavement
- aesthetics
- safety from traffic and crime
3.2 Findings from I’DGO Focus Groups
We conducted focus group discussions to better understand the ways in which the outdoor environment relates to older people’s quality of life. Participants identified a number of ways in which access to outdoor environments benefited their quality of life, as follows.
- Possibility for meeting people and socialising. For example, “I think the pleasure is meeting with people when you are out.”
- Enjoyment of outdoor environment. This referred to the “simple joy of being outside” for getting fresh air, sunshine, gardening, watching singing birds and the scenery. One person said: “I just sit back in the garden and I am quite content sitting there”. Another stated: “A bench in the sun. I enjoy that, if we get the weather.”
- Escape from indoors or from routine places. Participants said: “Being indoors all the time is claustrophobic . . . and boring.” Another person: “You get institutionalized if you didn’t get out.”
- Good feelings or positive experience. Participants mentioned that gardening and walking made them “feel good”. For instance, one person said: “You wake up feeling rotten … and you say right, I’ll go for a walk, and you feel better when you come back”. Another said: “I spent a fair amount of time in my garden. This gives you satisfaction. It reminds me that you still can do things to help yourself.”
Table 1 (below) presents a general framework outlining the different aspects of quality of life that are influenced by the outdoor environment and activities outdoors. The table derives from a review of the literature and focus group findings. The most important aspects of quality of life influenced by outdoor environments include safety, health, experiences related to living conditions (i.e., sense of community, satisfaction with neighbourhood), enjoyment or stimulation, and sense of independence.
3.3
Aspects of Quality of Life Influenced by Outdoor Environments
(see Table 1 below)
| Potential benefit/ Aspect of quality of life | Scope/examples | Related category from focus group findings | Related category from literature review findings |
|---|---|---|---|
| Perceived safety | From attack/assault/ robbery; fear of groups of young people |
experience of crime | Fear of crime; safety/perceived safety; crime prevention through environmental design |
| Safety and comfort | Not falling or having accidents and safety from traffic | Being able to successfully navigate the environment; fear of crime and actual experience of crime | Safety and perceived safety |
| Physical health | Opportunities for exercise and access to fresh air | Being healthy and independent | Health and wellbeing; health related QoL; physical activity |
| Emotional wellbeing | Mental health and opportunities for relaxation | Keeping active in mind | Emotional wellbeing, satisfaction, purpose in life, and depression |
| Mobility | Ease of access to facilities/amenities and open space (inc. with assistive technology); wayfinding ability and ability to go out | Being able to successfully navigate the environment to successfully reach the destination and autonomy | Mobility/access and compatibility with assistive technology |
| Sense of community | Belonging and social support networks | Sense of community/ sense of belonging and support mechanisms | Social support |
| Satisfaction with neighbourhood | Attractiveness, cleanliness, lack of noise, safety, and security | Having an outdoor environment that affords engagement and aesthetic quality | Satisfaction. Traffic, anti-social behaviour, and management |
| Social interaction | Extent of interaction with others in the neighbourhood | Variety and purpose in daily activities and infrastructure to support socializing | Social interaction and mobility |
| Enjoyment | Going out, feeling good and relaxed | Social interaction and mobility | Activity and relaxation |
| Stimulation | Variety/purpose | Keeping active cognitively and variety and purpose in daily activities | Enjoyment and satisfaction |
| Autonomy and control | Independence, self-actualisation, self-esteem, and self-efficacy | Independence, health, and mobility | Autonomy, independence, self-actualisation, self-esteem |
| Care and support | Need to be looked after by staff and family; ease of care-giving | Not included | Not included |
Our subsequent research has focused on aspects identified within this framework to explore empirical evidence for the relationship between outdoor environment and quality of life.
4.
How significant are outdoor environments for older people’s quality
of life?
4.1 How have we measured Quality of Life?
In our research, we have measured quality of life by asking participants’ for their own perceptions of their quality of life. We developed surveys to include reliable scales that allowed participants to rate various aspects of their quality of life.
4.2 How are Quality of Life and Environment linked?
A major challenge in examining the role of the environment in relation to people’s activity lies in identifying the relevant quality of the environment. To investigate how the environment facilitates or inhibits access and activity outdoors, the “quality” of the environment must be operationally defined and we need to understand how to measure it.
The quality of the environment is conceptualised here as the extent to which it facilitates or hinders participation in activity outdoors, hence the term “supportiveness” of the environment. Since older people vary greatly in terms of lifestyle and functional capabilities, it is important to consider individual differences in the process of assessing supportiveness.
4.3 Benefits of outdoor activity for older people’s quality of life
The benefits of the outdoor environment for older people are manifested in three different modes: (1) participation in physical activity in outdoor environments, (2) exposure to outdoor natural elements, and (3) social interaction with friends and neighbours in outdoor places.
We have developed the concept of ‘environmental support’ to describe those aspects of the outdoor environment that facilitate or inhibit outdoor activities, in other words, what aspects or qualities make getting outdoors easy and enjoyable (or otherwise) for older people (Sugiyama and Ward Thompson, 2005; Sugiyama and Ward Thompson, in press 2007b).
5. Findings on links between environmental support,
outdoor activity and aspects of quality of life
In the following section we present findings from the OPENspace study which summarize aspects of older people’s quality of life affected by outdoor activity and show how supportive and unsupportive environments relate to this. These findings are based on a sample of over 300 older people in a variety of urban, suburban and rural contexts in Britain.
Life satisfaction and functional capability
Outdoor environments adjacent to where older people reside play a significant role in their quality of life. As chart 1 shows, participants living in a supportive environment tended to have higher life satisfaction. In fact, environmental support accounted for about 30% of the total variance in life satisfaction.
Chart 1. Neighbourhood Environment and Life Satisfaction
As presented in Chart 2, there is an association between participants’ functional status, perception of environmental supportiveness, and outdoor activity time. Those participants with higher functional status generally found the environment more supportive, perhaps not surprisingly. Their perception of a supportive environment (based on environmental attributes, such as comfort, pleasantness, safety, and lack of nuisance) predicted how much time they spent outdoors. Thus, those who perceived their neighbourhood environments as fairly or very supportive spent more time outdoors and were more satisfied with life. This relationship between environmental support and life satisfaction held true even after controlling for participants’ functional capability (i.e., the ease with which they can carry out activities of daily life). That is, regardless of functional status, those who perceived their surroundings as more supportive were more likely to be satisfied with life.
Chart 2. Neighbourhood Environment, Functional Capability and Outdoor Time
Health
In relation to health status, participants were asked to recall the number of days in the last 30 days in which poor physical and mental health prevented them from carrying out daily activities. Graph 3 shows that those who live in a very supportive neighbourhood were about 3 times more likely to be in good health compared to those living in a poorly supportive neighbourhood. We infer from the results that neighbourhood environments enhanced participants’ health both through the amount of physical activity undertaken and through positive experiences available in the outdoor environment.
Chart 3. Neighbourhood Environment and Health
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