Time spent outside is vital for good physical and mental health. Limiting access to natural light can affect people’s circadian rhythm, vitamin D synthesis, calcium absorption and general wellbeing.
Changes you can make now
- Use the Gardens and outdoor spaces checklist to check your facility for dementia-friendly outdoor design and approaches.
- Create separate outdoor areas for activities, socialising and quiet times by putting furniture in suitable places under shade, along paths, near garden beds and beside trees.
- Pot plants and put them close to sitting areas and next to entrances.
- Set up a washing line familiar to people to create a home-like atmosphere.
- Encourage people to garden, sweep and potter about in outdoor areas.
- Use fencing, paths and paving ideas in this guide and check requirements and standards are met.
- Create a no-barrier walking circuit with suitable paving and wayfinding cues for freedom of movement and independence.
- Buy outdoor furniture, including a barbeque, to create an outdoor eating area for everyday use and special occasions.
- Create an area for people to garden in, for example, raised beds reachable from a seated position, and encourage people to plant, look after and harvest vegetables, herbs and flowers.
- Set up a garden storage area with a secure shed to store garden tools.
- Create exits in existing buildings from dining areas to outdoor areas so people with dementia and staff can see the garden and easily get to it.
- Build a patio with shade cloth for a relaxed, sun-safe outdoor area and orientation cue.
- Build a special activity area, such as a bowling or putting green.
Benefits of outdoor activity
When people can freely use outdoor areas, agitation and aggression reduce, independence is promoted, and memory recall is more likely to occur. Gardening is stimulating, gives sensory pleasure and taps in to past life activities and experiences. Quality of life improves with an outdoor space or garden giving people the chance to:
- be physically active
- feel unrestrained
- be more in touch with nature
- be alone if they want to be
- socialise if they want to
- do meaningful things that make them feel at home.
Being outside is necessary for wellbeing and enjoyment of life itself (Brawley, 2004). Outdoor areas can offer privacy, areas for sociability, activities for different skills and abilities, and a place to go to break up the day. For some people the outdoor world has spiritual or religious meaning. Walking has physical and psychological benefits, and being outdoors lets people have safe sun exposure for vitamin D intake. Vitamin D is needed for musculoskeletal health and reducing the risk of bone fractures.
Vitamin D and sun exposure
Balancing independence and safety
A dementia-friendly facility aims to support independence and mobility in a safe and secure environment. While people must be safe, and the facility secure, a person’s right to free movement and non-restraint must be respected. Reduce risks through good design.
There are many ways to increase safety while encouraging independence and mobility outside.
- Increase visibility in outdoor areas.
- Design a circuit path with a continuous route.
- Use appropriately designed furniture.
- Arrange furniture so people can sit and rest.
- Use handrails where needed.
- Make walking paths level and hazard free.
- Choose low-glare surfaces.
- Choose non-trip, non-slip paving.
- Use orientation and wayfinding cues, including colour and scent.
- Put in fences that cannot be climbed.
- Put in suitable plants beside fences.
- Choose gates that merge with fences and have hidden handles and latches.
Using and enjoying outdoor spaces
Many familiar activities take place in gardens and outside spaces and are a normal part of everyday life. They include:
- hanging out washing
- raking leaves
- washing cars
- working in a shed
- sharing a meal
- cooking on a barbeque
- feeding birds
- looking after animals
- playing with children.
These simple activities might be built into a person’s care plan, be used by staff on a day-to-day basis, or be part of a planned or special event.
For a home-like environment, arrange daily living around familiar tasks relating to people’s life histories and cultural backgrounds. If mobility issues limit outdoor activity, people can still enjoy sunshine, fresh air, watching birds, sitting with others or eating meals outside.
People with dementia benefit from carefully planned outdoor settings for quiet and more noisy experiences; active experiences can meet the needs of people at different stages of impairment. People may quietly connect with the natural environment sitting under a tree or pottering in a garden bed. Or they may want to meet friends and family in the garden, wash the car, or hammer in nails in the garden shed.
Personal enjoyment: participation and engagement
Gardens give people options to control their personal space for privacy or social contact. For privacy, put seats singly beside paths and in special outside spots. For social contact, group chairs and use other outdoor features.
Fences can mean different things to different people. They can be seen as a status symbol, sign of ownership or barrier, or not be thought about at all.
Fences must be a secure barrier, and there are standard fence measurements. Fences need to be discrete. They should fit into the overall neighbourhood and be home-like. Fences are crucial in garden design for people with dementia, for looks and use.
Wanting to leave
Older people want design features that make up for physical impairment and support safe passage (Brawley, 1997). They want to keep their independence for as long as possible, and understand good design and workmanship can make a difference.
Paying for good quality workmanship, for example hard surfacing well laid to a high specification, helps reduce ongoing costs and offers successful use of outside areas for years to come.
There are many paving materials but not all suit people with dementia. When choosing materials, think about people’s long-term mobility and independence.
Paths should suit ambulant and semi-ambulant people and people in wheelchairs. Changes in levels need to be carefully managed and ramps built only as needed (Bennett, 2006).
Paths and paving
Trees, shrubs and plants
Many different trees, shrubs and plants can be used in facilities. Local nurseries and landscape designers can advise on species and varieties.
- Choose non-toxic plants.
- Plant flowers close to walking paths.
- Choose plants that reflect seasonal changes, like fruit trees and vegetables, to help orient people in time and place.
- Choose plants for certain activities, such as picking fruit, pruning, growing vegetables or sitting in the shade in summer.
- Think about colour, scent, shape and feel of flowers and leaves when choosing plants.
- Do not plant trees that could be climbed close to fences.
- Choose low maintenance trees, shrubs and plants.
Example - a safe and attractive garden
The photo shows the boundary fence of a facility. The fence is metal, about 1.5 metres high with vertical bars about 10 cms apart, painted black. The fence is both attractive - allowing people to enjoy the view beyond - and functional, as it cannot be climbed.
A wide, smooth path runs along the fence. The garden bed between the path and fence is planted with drought-resistant, low-maintenance flowering plants of different heights. Along the path there is a wooden table and chairs, all with rounded edges.
The environment provides a safe and secure area for people to walk, sit and use wheelchairs, enjoy the view and colourful plants. The garden seat and table provide an attracting resting place and help with wayfinding. An umbrella can be inserted in the table for shade.
Recreational gardening can be social and private. Gardening spots of privacy and reflection are important in shared living environments.
People can do occasional gardening at any time of the day, and gardening sessions might be planned. People can be involved in choosing plants and may want to suggest gardening activities. Gardening may awaken long-term memories as it is a sensory experience involving touch, sight and smell.
People with different levels of physical impairment can easily reach raised garden beds and movable potting tables. People in wheelchairs, and others who cannot stand for long, can weed or plant while seated.
People may have tended a hobby patch in their backyard or a large garden to produce food for their families when younger. If so, gardens are likely to be important in their lives for enjoyment and meaningful activity. Think about vegetable gardens. Herbs and vegetables can be used in cooking at the facility.
Example - gardening made easy
The photo shows a garden with shrubs and a lawn. Behind the garden there is a warehouse. A high fence separates the warehouse and the garden. You can see through the fence but you can't climb over.
There is a raised garden bed set on concrete, which allows people to garden while standing or in wheelchairs.
Shade can be provided to reduce glare and prevent sunburn. The warehouse contains an old-style shed.
Adjustable umbrellas and shade-producing arches and arbours can help control sunlight. A sheltered pavilion can be a space for activities usually held inside and a place to sit with friends and family.
Example - shade and rest
The photo shows a gazebo in the middle of a garden between residential areas. The gazebo has a concrete path leading to it, and continuing on through to the other side. The gazebo has a 1.5 metre fence and contains bench seating around the internal perimeter. The gazebo acts as a wayfinding cue and a rest point, and offers privacy for residents and visitors. The path is wide and smooth, suitable for wheelchair access.
Outdoor furniture that is going to be outside for long periods of time should have:
- non-splintering and smooth surfaces
- rounded corners and edges
- materials that do not become hot or cold.
Outdoor furniture should look familiar and be sturdy, stable and suitably arranged. There should be dining style chairs and more comfortable chairs of different sizes and heights for different outside experiences.
Other outdoor seating types that create a home-like environment include park benches, porch swings and rocking chairs.
People need places to sit:
- along walking paths
- near garden beds
- under trees for hot days
- close to pets, bird baths or bird feeders
- near water features
- where there is a view
- in private and quiet spots.
Play equipment for children
Play areas and equipment for children encourage families to visit and can help make visits more enjoyable. They may be familiar to people with dementia as a garden feature. Think about putting in a sandpit, slide and swings.
Example - safe and shady play area
The photo shows a swing set located in a fenced area with a garden bench in the shade. The play equipment is on a safe surface to minimise injury in case of a fall. Providing play equipment encourages families to bring their children to visit aged care facilities, and the shaded bench provides a comfortable spot for people to rest and watch the children at play.
Garden features and memorabilia
Furnishing a garden with structures and memorabilia often seen in home gardens is valuable for people with dementia. Choice of items depends on facility location and people’s social and cultural backgrounds.
Sheds, greenhouses, pergolas, gates, mailboxes and other decorative landmarks may remind people of home and pleasurable times from the past. Think about using garden gnomes, bird baths, statues, water features, wheelbarrows, large pots and hanging baskets.
Sheds are useful as places for:
- fixing, repairing or tinkering with machinery, motors or other items
- socialising around recreational and work-related experiences
- being alone
- listening to the radio
- rummaging in drawers and cupboards.
Sheds can help self-esteem for those who have valued outdoor activity in the past. Some activities involving tools may need supervision.
Other outside structures include:
- greenhouses and potting sheds. Work benches and tables should allow for seated and wheelchair-bound people
- pergolas and trellises. These and other structural features break up large areas to create interesting smaller spaces. They should look familiar to people
- a garden gate with an easy-to-operate latch or self-closing mechanism
- a mail box
- a car under a carport, for sitting in, tinkering, washing and polishing, family activity and conversation
- a bus stop, so people can leave the building and walk down a path to a familiar looking bus stop. It can help meet some people’s wishes to leave, and give others a chance to socialise.
Example - an old car
The photo shows an old ute parked in a driveway that is surrounded by lawn. The ute acts as a topic of conversation, a prompt for memories, and provides an opportunity for activities such as cleaning, polishing and ‘tinkering’. Safety must be ensured at all times. For example, the car is parked in full sun and would be too hot to sit in during summer. Other features in the environment include:
- a high fence that allows a view but can't be climbed
- chairs for resting and socialising
- a wheelchair-accessible path
- garden beds with low maintenance plants.
Gardens and outdoor spaces checklist
New residential facilities
Vitamin D and sun exposure
Case study - Villa Maria Aged Care Residence
Villa Maria in Berwick has a sensory garden with raised garden beds, wheelchair access, rubber paths, bridges, gates, a music sensory board, bus stop, letter box and shed. This gives people points of interest and things to move and touch. The number of falls outside has reduced and people have meaningful activities. Alarms on the door are set off when a person goes outside, letting staff know someone is in the garden.
Research says ...
- For people with dementia, families and staff to enjoy outdoor spaces they have to see them as safe and secure.
- Carefully planned outdoor environments are valuable for people with dementia because they support independence and mobility, maximising abilities and wellbeing.
- Views of and access to enclosed outdoor areas can give people options for privacy and sociability.
- Gardens and outdoor environments have ready-made activities for staff to tap into. They make it easy to say, ‘Let’s go and look at the flowers’.
- Porches, patios and pergolas give wayfinding cues for entering and leaving garden spaces and have clearly marked areas for socialising.
- Because dining outside through the summer months is a common activity for many in Australia, placing tables and chairs outside for meals can be a familiar and enjoyable past time.