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Realist approach to explain outdoor activities and mobility in care homes

What we are doing:

The study was conducted in three East Midlands care homes over a six-month period. Environment and resident descriptive information was collected using questionnaires. Observations of 50 residents and 36 care workers were conducted using Dementia Care Mapping, a recognised observational tool that seeks to understand the viewpoints of people with dementia. The data was combined to develop ideas, or theories, about which residents do and don't get outside, and the potential reasons for either outcome. Following this, focus groups were conducted with care workers from each care home to test out these theories.  

Why we are doing it:

In care homes for older people, engagement in meaningful activities is recognised as a marker of high-quality, person-centred care. While outdoor activities and mobility are believed to have health-related benefits for residents, UK best practice recommendations are based on expert consensus. There is a lack of robust evaluations in this field and it is not clear what sort of outdoor programme might work, given how varied UK care home environments are in terms of size, registration, ownership, culture, resources and resident characteristics. While 70 to 80% of residents have some form of cognitive impairment and, or, dementia, their health states, abilities and individual needs vary significantly. Therefore, the ROAM study aimed to understand the circumstances under which residents used the outdoor spaces, how, why and to what extent. 

What the benefits will be:

There is a lack of research about residents’ outdoor use in UK settings and as far as we know, this was the first study to provide theory-driven explanations about how outdoor practices work in care homes. The study provided pragmatic recommendations about how a more robust outdoor culture might be developed at micro, meso and macro levels with a range of care home stakeholders. 

Who we are working with:

As well as the three participating care homes, we worked with a range of stakeholders. A draft study protocol was sent to the Patient and Public Partner’s Council at NIHR CLAHRC EM and feedback was received. In addition, the Dementia Patient and Public Involvement Group, a Division of Rehabilitation and Ageing, University of Nottingham, was consulted for one hour about the study leaflet and protocol. Amendments were made on the basis of both sets of feedback. 

A Stakeholder Advisory Group of experts in horticultural therapy, outdoor activities; geriatric medicine and Dementia Care Mapping, research were recruited. They provided ongoing study guidance regarding theory development recruitment and data collection. 


Amanda King  


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