Creative Spaces - evidence of need
The need for people living with dementia to be reconnected with the outside world
The Creative Spaces project was created in response to feedback and information gathered through consultation on the use and connection (or lack of connection) with the outdoors by older people living with dementia.
Those findings highlighted a need for older people with dementia to be re-connected with their community and to have greater opportunity to use outdoor environments.
Creative engagement activities carried out with residents from nursing care homes indicated that increasing the connection between older people with dementia and the outdoor environment had a positive effect on those involved, including the care home staff and greenspace management staff who were involved in the activities.
The importance of community
Between April and June 2007 the Sensory Trust consulted with local community groups to explore people’s views on the meaning and value of community. We explored views on communities past and present; how connected people feel with their local community, what they value, what changes they have seen within their communities and how these changes have affected them.
We explored what people understand by community. Have communities changed for better or worse? What influences have altered the feel of the community? The consultation included sessions with a wide range of community groups including people with a range of disabilities.
The consultation sessions highlighted some common themes; the value of being involved in your community; a sense of fear resulting from a lack of connection within a diverse and changing community; an overall feeling that people have less time to spend with one another; the importance of respect, consideration and understanding in a community.
Another key finding was the self-esteem that people felt from being involved in the consultation process itself. Many people said they enjoyed being part of the conversation and having an opportunity to participate with others, and wished they could do it more.
Feeling part of your community, enjoying all that it offers – local services, friendships, a sense of belonging and ownership – is denied to many people with dementia, whether living in residential care or at home. A lack of dementia awareness and understanding leads to a diminished social life and less participation in community life in general.
These are all factors that can reduce a person’s access and willingness to go outside, leading to less social interaction and an increase in feelings of loneliness and isolation.
Benefits of nature-based activities in dementia care
The consultation also demonstrated that by involving older people with dementia in group activities they became more communicative and alert. Activities such as visits to a public garden or making collages based on garden landscapes triggered conversations, memories, stories, laughter, questions and the sharing of their knowledge and experiences. The most powerful moments involved older people with dementia who rarely spoke other than to say “yes” or “no” to care staff who were suddenly engaged in conversation with people who were strangers to them.
These consultations and engagement sessions demonstrated how much this group of people benefit from,
- being able to get outside more and,
- sharing more of their time and creative skills and knowledge with other people in their community.
Nature-based activities not only increase communication and social interaction but help reduce feelings of anxiety, depression and levels of high blood pressure. Spending more time outside also helps to regulate our Circadian Rhythm - our inner body ‘clock’ and helps us to have a normal night’s sleep. Studies show that the more people with dementia experience reduced access to strong bright light, social interaction and physical activity the more likely they are to experience disturbance in their day/night rhythms ( www.ncbi.nlm.nih.gov/pmc/articles/PMC2413196/#b32).
These benefits have a ‘knock-on’ effect for dementia carers; caring for someone who is happier, more relaxed, communicative and sleeping well makes life much easier and enjoyable for all.
Importance of the residential home environment
Over the past 40 years or so, residential care has gone through a series of life-style changes. Old people’s homes – a term once used – provided older people living alone with the option of living somewhere where they felt safer and had more social interaction. As residential care has become increasingly associated with medical and nursing care, homes have adapted through staff training, the provision of supportive equipment and larger rooms to cope with that. More and more care homes are gaining nursing home status to provide the medical support.
If you look at the outdoor spaces of those nursing homes born from original residential homes, many remain just as they were originally designed. Whilst interior spaces support the care of older people with more complex needs, the exterior areas remain untouched and unable to support those current needs. As a result these spaces are lacking in sensory stimulation and under-used and neglected as a result. They could be vibrant, sensory-rich environments where people are able to choose how and when they want to interact with the outside environment and have more opportunities to socialise with the wider community.
Using creative engagement approaches such as nature-based activities, residents with dementia can play an equal role in enhancing these outdoor environments. They can become:
- opportunities for independent exploration by residents
- year-round sensory stimulation
- inviting plantings and spaces to entice people outside
- connection with internal communal spaces
- features that promote outdoor use and encourage extended time outside
- opportunities to re-connect with memories, places and people
- opportunities to engage with the wider community through activities and events
- character that reflects the local culture and heritage of St. Austell (most of the residents are Cornish and have lived in the area all their lives)
The value of intergenerational work
By involving young people and other members from the local community in the process it is possible to, not only create an outdoor space that fits the needs of the residents and staff but to begin to form strong positive relationships with the local community and help raise dementia awareness and local support.
Inter-generational work is particularly effective in creating social opportunities for residents and increasing the level of awareness and understanding in the community. Young people, after all, are our future generations.