With around 40% of residents in UK care homes having significant depressive symptoms, researchers have questioned whether the design of the physical environment of homes could be contributing to the problem, and how this could be addressed. New research led by the University of Warwick has found that although the physical environment alone is unlikely to negatively affect the mood of residents, poor access to gardens and outdoor spaces could. Procedural, staffing and physical barriers can prevent older people using outdoor spaces and the researchers at Warwick Medical School and WMG at the University of Warwick have found that access to the outdoors is significantly associated with depressive symptoms.
There has been a growing interest in the role of the physical environment on health. An early study found that hospital patients residing in rooms with windows looking at a natural scene had shorter hospital stays. Another study found that brighter lighting reduced depressive symptoms in residents in assisted living facilities in the Netherlands. However whether the physical environment of care homes directly affects depression in residents was not as well understood until now.
Researchers at WMG and Warwick Medical School at the University of Warwick examined the relationship between the design of care homes and depressive symptoms of older people living in care homes, and have now published their results in the journal The Gerontologist in a paper entitled "The Impact of the Physical Environment on Depressive Symptoms of Older Residents Living in Care Homes: A Mixed Methods Study."
The researchers assessed the physical environment of 50 care homes in Coventry and Warwickshire and northeast London and looked for any association with the depressive symptoms of 510 residents in the homes. They also carried out interviews with a small number of residents living in the care homes to explore what residents thought about the design of the homes they lived in. The researchers were surprised to find that the overall physical environment of care homes was not associated with depressive symptoms, and the interviews with residents supported this.
One of the researchers on the paper, Dr Rebecca Cain from WMG at the University of Warwick, said:
"Residents expressed little interest in the décor of the care homes; and appreciated features of the care home that increased opportunity for social interaction and promoted independence and function".
Even the physical presence of good quality outdoor space did not appear to have an impact – however access to outdoor space was the single environmental variable that did significantly predict depressive symptoms. Residents interviewed reported that access to outdoor space was restricted in many ways: locked doors, uneven foot paths, steep steps, and needing permission or assistance to go outside.
The Lead author Dr Rachel Potter from Warwick Medical School at the University of Warwick said:
"Residents may appear to have access to outdoor space but are prevented from using the outdoor space independently due to poor physical or cognitive function, or need the permission of staff to use the outdoors, reasons that may negatively affect residents' perception of autonomy and consequently their mood. The findings of the study suggest that interventions that increase access to outdoor spaces could positively affect depressive symptoms in older people."
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Rachel Potter et al. The Impact of the Physical Environment on Depressive Symptoms of Older Residents Living in Care Homes: A Mixed Methods Study, The Gerontologist (2017). DOI: 10.1093/geront/gnx041