Anyone care to hazard a guess about how much time Americans, on average, spend indoors? Most will respond between 60 and 80 percent, however, the actual number is closer to 90 percent. As we age, this percentage inevitably increases. Approximately, 10,000 Americans turn 65 every day and by the year 2030, one in five Americans will be 65 or older. Needless to say, we are a population that is increasingly spending its time indoors, regardless of evidence based research supporting the numerous benefits of the contrary. These sobering trends have commanded the attention of those who manage, design and invest in senior living communities. Therefore it is no surprise that a large majority of award-winning senior living design projects are those that encourage greater outdoor engagement. What follows is a discussion of the benefits and methods for reversing this trend and increasing the health and wellness of our senior population.
• Benefits. The health benefits of connection and exposure to the elements is as old as the practice of medicine. Hundreds of years ago, medieval hospitals combined treatment, prayer and access to the elements for recovering patients. Today, a wide variety of research institutions are conducting controlled studies to illustrate specific benefits. PMC Canada published a study in 2012 to illustrate the benefits of sunlight for recovery, sleep quality and decreased hospitalization for bipolar depression. Numerous studies have shown that sunlight increases Vitamin D, which fights inflammation, improves the immune system, increases bone health and decreases depression – all of which are common in seniors.
In 2005, the University of Pittsburgh conducted a study of spinal surgery recovery times with relation to the outward views of recovery rooms. Patients with natural, scenic views recovered more rapidly and required less medication than those with views to an alley or brick wall. This illustrates a particularly important concept for seniors – even the views themselves have benefits. Further studies of outdoor activities by the University of Michigan in 2014 demonstrated that outdoor nature walks improved depression and stress levels, both of which are all too common for seniors.
Aside from local studies, the field has interested researchers in medical communities and institutions all over the globe. A 2014 study by the Nippon Medical School in Japan demonstrated increased white blood cells in subjects after six hours of exposure to a wooded environment. Regardless of age, location or circumstance, the benefits of outdoor engagement remain a growing interest for research publications and medical journals throughout the industry; especially with regard to senior care.
• Methods. It’s no surprise that outdoor amenity spaces in senior living communities must be safe to enter, occupy and travel through, however, the appearance of safety also plays a key role in the success of encouraging outdoor engagement. Architectural and technologically based security features incorporated to improve surveillance, lighting, visibility, privacy and protection from intruders are all necessary features, but if the tenants don’t perceive the area as safe, the engagement diminishes. Privacy fencing, walls and other methods to visually enclose outdoor space in aesthetically pleasing ways are fundamental in getting seniors outdoors.
Walking surfaces must be designed to reduce fall risks, and handrails must be available in cases where acuity levels require them. Ideally, indoor public spaces such as living, dining or activity rooms are located immediately adjacent, or open directly, to the outdoor space with direct visibility throughout the day. Keeping outdoor spaces visible from communal indoor spaces not only reinforces the sense of safety but also fosters familiarity and encourages engagement.
Transitions from indoor environments to outdoor environments also must be carefully considered. Spaces immediately adjacent to the exterior should provide ample glazing to help equalize light level differences between natural sunlight and indoor lighting. Doorways should include roofs and overhangs designed to provide shade and weather protection. In warmer climates, seniors simply will not leave cooler, indoor climates for hot, exterior climates unless shade structures are directly visible and easily accessible. The same rule applies for heating elements and sunny areas in cooler climates.
In addition to climate and transition considerations, outdoor spaces designed with specific functions can drastically improve outdoor engagement. Walking paths in senior living communities are ubiquitous and provide numerous benefits to physical, mental and spiritual health – only reinforcing why walking remains the most common exercise among seniors. Looping paths that return the traveler to their starting point encourage use, as do paths with interesting features such as lookouts, gazebos and surface material variety. Like indoor to outdoor transitions, it’s important to incorporate visually shaded and sunny paths in their respective climates. Structures that promote interaction such as barbeques, picnic tables and fire pits also increase outdoor engagement while encouraging important social opportunities. Exercise- and game-related activities like yoga, aerobics, tai chi, bocce ball, pickle ball, horseshoe pits and shuffleboard lanes also can be incorporated to establish specific outdoor functions. To enable a wide variety of active uses, turf lawns are relatively easy to maintain, more forgiving to falls and even can help to reduce noise pollution.
Seating in outdoor areas should be plentiful, accessible and comfortable. Movable options allow seniors to form groups, generate privacy and alter the space’s function. Chairs and benches should have sturdy arms to assist occupants in lowering and raising themselves, and all seating should maintain climate and weather protection considerations. Seating materials shouldn’t just be comfortable, they should appear comfortable, which is why concrete and metal should be avoided when possible.
Plants and landscaping used in senior outdoor spaces are other contributing factors in increasing outdoor engagement. In general, plants should be widely varied and adaptable to multiple seasons. Plants that flower and annual and perennial flowers that change throughout the year keep the grounds attractive and interesting. Vegetable and flower gardens also are an excellent way to provide variety while encouraging seniors to get outdoors. Bird feeders, nesting boxes and ponds can attract birds, which can promote both active engagement and passive observation. Taking care of other living beings, whether they are plants or animals, reaps physical and emotional benefits for seniors.
We are irrevocably linked to the natural world just outside our doors. As design professionals in the senior living industry, we are bound to strengthen these links and further the mission of the institutions we shape and build – to open our buildings, both literally and figuratively, to the many benefits of the world outside. Today’s senior living environments go beyond simple accommodation to environments where seniors thrive as they benefit from features that promote healthy living. Buildings that encourage and provide easy access to a variety of outdoor spaces further the mission of the institutions as a whole by promoting health, happiness and wellbeing.