Literature review on the benefits of access to outdoor environments for older people

Prepared by Susana Alves and Takemi Sugiyama, OPENspace Research Centre, Edinburgh College of Art

December 2006

1. Benefits from physical activity
2. Benefits from contact with natural elements
3. Benefits from social interaction
4. References

1. Benefits from physical activity

Participation in regular physical activities has substantial benefits for the health and functioning of all people, including older people (e.g., Mazzeo, Cavanagh, Evans, Fiatrane 1998). A physically active lifestyle is found to minimise the physiological changes associated with ageing and help delay or prevent the onset of common chronic diseases including cardiovascular diseases, diabetes, arthritis and osteoporosis (Singh, 2002). A review by Keysor and Jette (2001) indicates that participation in regular physical activity improves older people’s functional capability through enhancing muscle strength, aerobic capacity, balance and flexibility. It is known that such enhancements help reduce the possibility of falling, which is a major cause of disabilities in late life (Skelton, 2001). Participation in regular physical activity thus contributes greatly to independent lifestyles in older people.

Participation in physical activity has also been shown to generate positive effects on the cognitive functioning of older people. A large-scale prospective study in the US has illustrated that older women who regularly walk a longer distance are less likely to develop cognitive decline during the next 6 to 8 years compared to those who walk only a short distance (Yaffe, Barnes, Nevitt, Lui L-Y, & Covinsky, 2001). Another longitudinal study, Weuve et. al. (2004) demonstrated that a higher level of physical activity (walking for more than 1.5 hours per week) is strongly associated with higher cognitive performance and better memory in older women. This may be because cerebral blood flow enhanced by frequent longer walking is one of the potential mechanisms that maintain cognitive functions (Weuve, Kang, Manson, Breteler, Ware, & Grodstein, 2004).

Physical activity also has a positive effect on negative emotions, such as depression. Depression, which involves lowered mood, feelings of hopelessness and lack of interest, is recognised as the most frequent mental problem among older adults (Blazer, 2003). A 5-year prospective study has identified that physical activity such as a long walk, exercise and swimming has a protective effect against subsequent depression (Strawbridge, Deleger, Roberts, & Kaplan, 2002). Strawbridge et al ascribed increased levels of neurotransmitters such as endorphins and enhanced self-esteem as a result of activity participation as plausible explanations. Social interaction during activity participation is another potential reason for better well-being since outdoor activities such as walking and gardening are associated with more frequent contact with friends and neighbours (Bertera, 2003). Regular physical activity is also associated with life satisfaction, as demonstrated by Silverstein & Parker (2002). These authors examined the leisure activity of older Swedes and their retrospective change in life satisfaction in a nine-year period. They found that those who increased activity participation during the period tended to perceive their life condition better.

2. Benefits from contact with natural elements

The benefits from exposure to natural environments derive also from less physically active forms of contact with nature. Extensive research has demonstrated the restorative effects of the natural environment (Kaplan, 1995). Restoration from mental fatigue can be obtained through visual contact with nature, such as through a window, as well as in pursuing activities in natural green areas, such as gardening. A study by Ulrich, Simons, Losito, & Fiorito (1991) shows that exposure to a 10-minute video of natural settings (after viewing a stressful film) brought faster and more complete stress recovery in comparison to the same length video of urban settings. A study on visual contact reported that the view of natural elements (garden or landscaped areas) from home contributes substantially to residents’ satisfaction and well-being (Kaplan, 2001).

Exposure to natural daylight is another health benefit from contact with nature. Despite recent concerns about the risk of skin cancer, research shows that moderate exposure to sun can be beneficial, indeed vital for good health. Since human intake of Vitamin D from foods is very modest, the major source of vitamin D comes from the action of sunlight on people’s skin. Research has demonstrated that vitamin D can be an effective method for reducing fractures in those over 65 (since lack of vitamin D makes development of osteoporosis more likely), protect against some cancers, such as breast cancer, acts against mood disorders such as seasonal affective disorder and promotes normal cell growth thus maintaining a healthy immune system.

Getting outdoors also helps maintain the right temporal cues, reinforcing the cycle of day and night, which are important to maintaining the quality of night-time sleep. Increased exposure to naturalistic light, independent from the effect of physical activity, can alleviate the symptoms of insomnia (Hood, Bruck, & Kennedy, 2004). Thus, simply getting outdoors can produce a positive effect on people’s sleep quality – an important concern as people age.

With regard to active engagement in natural environments, recent research has found that the amount of time people spend in open green spaces is associated with a reduced risk of developing stress-related illnesses (Grahn and Stigdotter, 2003). Similarly, Hartig, Evans, Jamner, Davis, Garling, (2003) demonstrated that those who walked in a natural setting exhibited increase in positive affect, decreased anger and higher attention performance compared with those who walked in a built-up urban environment. Studies on therapeutic landscapes and horticultural therapy also explore the psychological benefits generated from gardening activities and contact with nature (Milligan, Gatrell, Bingley, 2004). In a quasi-experimental study that examined the effect of horticultural therapy on people living in long-term care facilities, Barnicle and Midden (2003) found that people who participated in a seven-week horticultural programme showed a significant increase in psychological well-being compared to those who did not participate. Gardening activity can enhance older people’s sense of achievement, confidence and satisfaction (Milligan et al., 2004). These studies suggest that horticultural activity brings a positive outcome in older people’s well-being. However, it can be also argued that social interaction while gardening accounts for at least some of the favourable effects.

Several studies have explored the effects of access to green spaces on health. A longitudinal study in Japan investigated the association between older people’s longevity and the existence of nearby green spaces in which they could walk around (Takano, Nakamura, Watanabe, 2002). The five-year survival percentage of older people who live in an area with walkable green spaces was significantly higher than that of people living in an area without such spaces. Another study explored health benefits in use of neighbourhood green spaces in the Netherlands. The amount of green in the neighbourhood was positively associated with people’s health status, measured as the number of symptoms of illness (de Vries, Verheij, Groenewegen, & Spreeuwenberg, 2003). The effect of green spaces on health was stronger for older people, who were likely to be more exposed to neighbourhood environments. Although it is not clear in these studies whether it is participation in physical activity, contact with nature or social integration that lead to benefits, they presented clear evidence of the health advantages of neighbourhood green spaces.

3. Benefits from social interaction

Outdoor open spaces also serve as a place for social interaction among older people. Several studies have confirmed the link between attributes of outdoor spaces and the formation of a social network among neighbours. As Greenbaum (1982) indicates, social ties among neighbours grow initially through repeated visual contact, greeting and short conversation, which mostly occur outside. Kuo, Sullivan, Coley, & Brunson (1998), for instance, have identified that the “greenness” of an open space is associated with a frequent use of the space by residents who live nearby, thus fostering stronger social ties among them.
Another study in Ireland demonstrated that people living in mixed-use, pedestrian-oriented neighbourhoods, which provide more opportunities for walking, and hence a greater chance for neighbours to meet each other outdoors, tend to know neighbours better and engage in social activities more often than those living in car-dependent neighbourhoods (Leyden, 2003). Since the planning and design of neighbourhood environments influence the way people interact informally in outdoor spaces, environmental factors have a considerable impact on the quantity/quality of informal social contacts and the sense of community among neighbours.

Empirical research has examined the benefits of social interaction in outdoors spaces on health and functional status (Avlund, Lund, Holstein, & Due, 2004). A large-scale study in Japan and the U.S. has also shown that older people with a greater number of social contacts report fewer depressive symptoms (Sugisawa, Shibata, Hougham, Sugihara, & Liang, 2002). Furthermore, a longitudinal study has found that frequent participation (daily-weekly) in social activities is conducive to a decreased risk of dementia (Wang, Karp, Winblad, & Fratiglioni, 2002). These studies did not specifically address social engagement among neighbours. However, this type of locally-based social interaction can be particularly important for people as ageing advances. In fact, a nation-wide study in the U.K. found that older people consider having good relationships with neighbours as an important constituent of their QoL (Bowling, Gabriel, Dykes, Dowding, & Evans, 2003).

There are several pathways that explain the link between social interaction with neighbours and enhanced quality of life. The practical help provided to each other is one of the obvious advantages of a social network. There is evidence that social support buffers the effect of stressful life events on mental illnesses such as depression (Kawachi and Berkman, 2001). Another explanation of this linkage is that social engagement provides older people with a meaningful social role, which then confers a sense of value, purpose, identity and attachment to one’s community (Berkman, Glass, Brissette, Seeman, 2000). The process of ageing is often characterised as the gradual loss of social roles. Enhanced social ties with neighbours may provide older people with new social roles, which can have a positive effect on their well-being.

Social interaction fostered by the use of open space can also enhance people’s sense of community safety. The concept of “weak ties” advocated by Granovetter (1983) is relevant in this context. This theory contends that, in comparison to strong ties (between friends), which tend to be localised and formed among relatively homogeneous members, weak ties (between acquaintances) can bridge different social groups within a community. Weak ties thus help form a loosely integrated broader social network, where people know each other regardless of their differences. It can be argued that in a community bonded with weak ties, more people are likely to engage in informal surveillance and intervene in neighbourhood disturbances. A criminology study has corroborated that the coexistence of strong and weak ties in a neighbourhood has a deterrent effect against crime (Bellair, 1997). Following the same line of studies, Kweon et al. (1998) showed that frequent social engagement with neighbours in an urban community is associated with reduced fear of crime among older people. Outdoor open spaces play an important role in this context by helping maintain and extend social networks among community members. Since parks and open spaces are places where people belonging to different social groups can interact and get to know each other, these places can promote social networks and mitigate stressful experiences associated with community safety.

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