Outdoor Wandering Parks for Persons with Dementia

The study yielded the following findings:
Facility characteristics:

• They were a mix of for-profit (61%), non-profit (17%), and religious/ government (7%) facilities.
• Locations were suburban (42%), rural (35%), and urban (23%).
• About 74% of the facilities had self-funded their outdoor spaces.
• The age of the outdoor spaces varied from a few months to 44 years.
• In terms of flexible hours for accessing outdoor spaces, 60% reported that their spaces were open 24/7.

Design features:

• Included were courtyards (76%), patios (52%), gardens (16%), and parks (11%) with a mean area of 1111.6 square yards.
• About 68% of the facilities had outdoor spaces that were separate for cognitively impaired and cognitively intact residents.
• All outdoor spaces were enclosed – by wooden fences (46%), buildings (37%), chain link fences (31%), shrubbery (12%), and few brick walls and plexiglass fences. Fences, plants, and camouflaged fences were various means used to restrict residents from leaving the premises.
• About half of outdoor spaces received sunshine throughout the day and 44% for half the day.
• The view from the outdoor space was usually a fence (41% of facilities). In other facilities the view included residential neighborhoods, other buildings, woods, streets, highways, interior courtyards, lawns, playgrounds, schools, parking lots, or farms.
• About 78% had walkways, 83% reported trees, 79% flowers, and 59% bird feeders.
• Seating included lawn furniture in 85%, picnic tables in 69%, and benches in 24% of the facilities.
• About 15% of the facilities had water features in their outdoor areas.
• Convenience features for the elderly were found in only few of the facilities – handrails, easy access to bathrooms, drinking fountains, coffee bar/ snack cart.
• About 41% had lights for the evenings.
• For protection against sunlight, umbrella tables were present in about 49% of the facilities, gazebos in about 28%, 15% had provided awnings, and 7% had trellises.
• Respondents considered the following to be essential features in outdoor spaces: lawn furniture, gazebo, trees, picnic tables, and flowers.
• Respondents considered the following to be desired features in outdoor spaces: raised garden for wheelchair access, lawn furniture, bird feeders, trees, and easy access to a drinking fountain.
• Respondents considered the following to be problematic features in outdoor spaces: concrete walkways, lawn furniture, fences, raised gardens, and flowers.
• In spite of safety features like alarm systems (26%), physical supports (17%), and television monitors (2%), being escorted by staff and visual contact were considered to be the key safety measures.

Utilization of outdoor areas:

• Residents used the outdoor spaces for eating and barbecues (86%), exercise (62%), private parties (55%), gardening - communal (46%)/ individual (44%), sports (42%), concerts (33%), reality orientation (29%), crafts (21%), and physical/ occupational therapy (18%). Reading, storytelling, and spending time with pets were other activities.
• About 85% of outdoor spaces had been designed specifically for cognitively impaired residents, 77% for wanderers, 37% for non-ambulatory, 22% for hearing impaired, and 20% for visually impaired residents. Only 12% had been designed for all resident types.
• Over 80% of the outdoor spaces were being used by residents with dementia and wanderers. Over 50% of the spaces were also used by cognitively intact and non-ambulatory residents.
• About 62% of these spaces were used by families and visitors.
• Close to 45% of the spaces were also used by staff and volunteers.
• Usage of these spaces was higher in summer than in winter. In summer, 77% were used daily and 98%, several times a week; in winter, 46% reported rare usage and 23% were used daily. During spring and fall, about half were used daily and over 90%, several times a week.
• Issues pertaining to weather, accessibility (inaccessible area, heavy doors, distance from facility), design (no walkways, no or small benches), and supervision limited a more frequent use of the spaces.
• Facilities (69%) considered these outdoor spaces to be extremely useful and 72-84% reported these as having a positive impact on their residents.

Perceived impact

• Activities like individual gardening and private parties and design features like fountains, storage features, raised gardens, rocky gardens, and pets were significantly related to perceived impact on cognitively intact residents (P value ranging from 0.000-0.002).
• Activities like sports, exercise, crafts, individual and communal gardening, and design features like gazebo, lights, trellis, playground equipment, lawn furniture, and easy access to bathrooms were significantly related to perceived impact on cognitively impaired residents (P value ranging from 0.000-0.009).
• Activities like sports, physical therapy, exercise, crafts, communal gardening, and reality orientation, and design features like gazebo, trellis, storage features, playground equipment, lawn furniture, and easy access to fountain were significantly related to perceived impact on wanderers (P value ranging from 0.000-0.009).