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Book Review: The Role of the Outdoors in Residential Environments for Aging and Outdoor Environments for People with Dementia

The Role of the Outdoors in Residential Environments for Aging, 2005, Susan Rodiek and Benyamin Schwarz (Eds.), Haworth Press, Binghamton, NY (Copublished simultaneously as Journal of Housing for the Elderly, 19(3/4).Outdoor Environments for People With Dementia, 2007, Susan Rodiek and Benyamin Schwarz (Eds.), Haworth Press, Binghamton, NY (Copublished simultaneously as Journal of Housing for the Elderly, 21(1/2, 3/4).When I was doing work in the area of outdoor environments for older adults back in the mid-1980s, there was very little research to draw upon that gave landscape architects and architects advice about how to approach this topic. Of course the seminal work of Powell Lawton and Roger Ulrich (Ulrich, 1984) had us all thinking about the possibilities. It wasn't until later that books by Carstens (1985), Cooper-Marcus and Barnes (1999), and Tyson (1998), as well as videos by Rodiek (2008), provided good professional advice and varying perspectives on the design and use of outdoor landscapes, gardens, and patio spaces.The two volumes reviewed are further proof of how far we have come. Chock full of advice and wisdom, compelling theory, and empiricism, they outline a range of promising ideas and interventions for the design of outdoor spaces in dementia settings and housing for the elderly. Collectively, there are 25 chapters and slightly more than 550 pages of text and illustrations that describe studies ranging from large sample surveys focused on basic policies and place-making inventories to intimate case studies. They explore the details associated with dysfunctional environments and the improvements necessary to make outdoor landscapes more appealing and useful.There are a number of common themes reflected in these volumes. Some are new, but many were identified decades ago. I personally found the research volume that addresses the needs of the cognitively impaired the more interesting and comprehensive of the two. Perhaps this is because the nature of this disease, which robs one of memory and recall, sets up environmental conditions that are easier to define for this population. The argument for intervention is also more compelling, given the psychological nature of the disease and the fact that many residents have a penchant for walking (or wandering). Closely coupled outdoor garden areas address these conditions.The main difficulty with the first volume, which addresses the use of outdoor space for older, nondemented populations, is that use patterns vary greatly depending on whether a person is a spry independent 70-year-old in a continuing care retirement community or a wheelchair-bound resident in a skilled nursing facility. Both of these people could benefit from high-quality outdoor environments, but their ability to interact and their expectations for meaningful activity vary greatly. Given such differences, it is surprising how easy it is to identify common themes, although younger, more active older adults are definitely under-represented in this collection of research studies.The most powerful common themes and takeaways presented in both volumes include:* An exterior garden design must be an extension of interior plan layout.* Clear visibility from the inside to the outside must be maintained.* Accessibility to and within the garden is very important.* Staff training, motivation, and commitment to use outdoor spaces is essential.* Exercise in outdoor spaces also benefits sleep comfort.* Garden design must address furniture comfort, plant selection and placement, circulation, and support for activities.* Glare and shade control are primary environmental factors that affect use.* Resident safety and security must focus on elopement and walking surfaces.* Resident activities and social opportunities increase engagement.* Circulation pathways that are easy to understand and follow encourage walking and orient residents to place. …