A study has been carried out by the University of Warwick on over 50 care homes in the UK. The study aimed to examine the possible physical structural causes of increasing incidence of depression among people living in care homes. Approximately 50% of people living in care homes are thought to have some degree of depression.
The study found that a major cause was the failure to have independent access to outdoor areas, or to have easy facilities to associate informally with others. The overall design of the building was less important than providing the ability to be outdoors and to freely interact with others.
Although access may well be available, restrictions could have a negative effect on the person’s mood, with a danger of depression as a result. For example, a person’s physical ability may reduce their ability to go outdoors, or may mean that they must be accompanied to do so. Staffing levels may reduce these opportunities. Other barriers might include physical restrictions, or the requirements of procedures. Overall, the decor and other factors were not as important as the ability to freely socialise and to have independent access to outdoors.
Benefits of outdoors
This study is consistent with other recent research on how the environment affects our wellbeing. A study in the Netherlands found that brighter lighting levels led to reduced probability of developing depression. Research in healthcare has shown that people in hospital who were in rooms overlooking outdoor areas had shorter stays. Also, people who lived in areas close to trees and other greenery had reduced recovery times when discharged after surgery in hospitals.
Since outdoor independent access and socialising is important in keeping depression at bay, and in promoting health, then I think we have a duty to consider how to enable these benefits.
Obviously, the location and structure of the building is important and should be considered at the design stage. I once managed a care home owned by the local authority, which was situated actually within a public park. There was little risk from traffic, and a voluntary organisation held frequent social events and a dance in another building in the park. These events were well attended, often independently, by the people living in the care home. There was a feeling of openness and confidence about the care home which tends to confirm all the research above.
Procedures and perceived barriers need to be monitored carefully to ensure that staff are aware of the importance of, and encourage, safe outdoor access. There is a tendency to be over-protective, and this can affect people’s self-esteem and mood.
Other factors to consider are setting aside staff time to promote social interaction and outdoor walls, etc. Previous hobbies and interest can help here, for example, gardening and other outdoor pursuits. Volunteers and local community groups may help in this.
It is important that we consider these wider yet vital aspects of people’s day to day care, to ensure that we promote their happiness, wellbeing and health in as many ways as possible.