Nature as Medicine

Engaging with the outdoors, in both a rural and urban setting, is good for everyone

Connecting with the great outdoors has a profound effect on human health. Studies show that a daily walk around the block can slow the progression of cognition decline. Sowing the ground that grows our food can influence and improve our eating habits. The babble of a running brook, the colours of a sunrise and other soothing scenes of nature are shown to reduce anger, fear and stress.

The concept that engaging with nature benefits our physical, psychological and social well-being is hardly groundbreaking — bridging the gap between our natural and built environments has been a principle of good public policy for decades. With the proper access to it, a “prescription for nature” makes our communities healthier and people happier.

For people living with dementia, however, there are barriers to engaging with the outdoors in a safe and purposeful way. For example, pedestrian aids like crosswalks, which are designed to keep us safe, operate with the underlying assumption that everyone interprets the lights, buttons, signals and timers in the same way. In reality, crossing a busy intersection can be a dizzying and disorienting experience for someone living with dementia. While at an adult care centre, a vegetable garden may allow us to dip our fingertips in soil, but it can lack the purpose and productivity that really stimulates us and helps feed the human desire to fully engage.

Researchers are learning that improved and diverse opportunities for people living with dementia to engage with the natural environment can lead to better outcomes for individuals and their caregivers. But, providing these opportunities requires an understanding of how people living with dementia access the outdoors, what motivates a meaningful engagement with nature, and how health structures and policies in Canada can embrace alternative
models of care to accommodate a population of our neighbours who are on the inside looking out.

Rural Connection

Rebekah Churchyard fondly remembers her grandfather’s Christmas tree farm in Belwood, Ont. The rhythm of rural life was a familiar one to Churchyard and her family, who are still involved in the agriculture sector in southwest Ontario.

When her grandfather began experiencing signs of dementia in his mid-sixties, the disruption to his lifestyle and his sense of self was palpable. Churchyard and her grandmother, who was his primary care provider, quickly learned that the programs available for respite were concentrated in urban areas, hours away from the crops and silos that dotted her grandparents’ familiar landscape. Churchyard also noticed that the programming was narrowly focused. Her grandfather struggled to derive meaning and enjoyment just (or solely) from activities like cards and bowling.

“There was very, very little programming with engagement with the outdoors,” says Churchyard, who was studying social development at the time, specializing in gerontology and psychology. “He was very capable of working. It just wasn’t safe for him to be operating [farm equipment]. But he could if he were supported.”

Sadly, Churchyard’s grandfather passed away at the age of 77. That sense of “something missing” in his care options inspired her volunteer work in social planning and project management. It also led her to research alternative concepts of care that would meet the needs of individuals like her grandfather, such as Green Care Farms (GCF).

GCF is a care model that uses farming practices and a connection with the earth to promote health and provide skill-building in diverse populations. Participants include people living with intellectual and developmental disabilities, people who are in recovery or transitioning back to community living, and — as piloted in places like the Netherlands — people living with dementia.

Currently, there are no such farms for people living with dementia in Canada, but Churchyard is dedicated to changing this. For the past few years, she has been working through the financial, legal and logistical complexities of bringing GCF for those living with dementia to Ontario. More important, Churchyard says, is to establish a sustainable, scalable system for GCFs in Canada.

“Access to the outdoors is a human right,” says Churchyard. “It seems counterproductive that people living with dementia in an institutional setting or otherwise are not allowed to access the outdoors under the auspice of their safety.”

Like Churchyard, Wim VanBeek and his wife, Anja, were inspired to open their own GCF when they discovered that much of the support for Albertans living with dementia was offered through institutions. Anja is a nurse with more than 25 years experience in home care as well as hospital settings and together, the VanBeeks are committed to improving the quality of life for people with dementia and disabiilties. The couple, who migrated to Canada from the Netherlands 12 years ago and have roots in farming, were already familiar with alternative care models like GCFs and identified that different options weren’t available.

“How can we offer alternative care for the elderly and people with dementia so they can live longer in their current environment?” Wim says.

The VanBeeks eventually purchased a six-acre farmstead near their Northern Alberta community, and are currently in the process of converting their property to a GCF. While they’re still in the “proof of concept” phase, Wim imagines a typical day on the farm beginning with morning drop off, when clients and staff would gather to drink coffee and tea and prepare for the duties of the day. Tasks would then be divvied up: harvesting vegetables, weeding and planting, feeding the animals and more.

“Inspired by the dedication of caregivers, and our passion for economic development, our vision is to develop our hobby farm into a care-farm,” says VanBeek. “It’s about being exposed to nature, being active, eating healthy and adding value to the wellness of the client as well as the caregiver.”

Urban Connection

Whether we live in a remote community or an inner city, humans are equipped with a genetic need to connect with nature. Toronto-based urban planner Samantha Biglieri completed her PhD in Planning at the University of Waterloo in 2019. Her doctoral research focused on the importance of creating fully accessible, inclusive and meaningful spaces for people living with dementia. It included hours spent interviewing people with early-onset dementia on how they experienced their suburban neighbourhoods. Biglieri used GPS tracking to map the routes used by her volunteers. She accompanied them on “go alongs” to witness both the barriers they faced and the strategies they developed to overcome them. She was prepared to be surprised but was also impressed.

“They problem-solved,” says Biglieri. “For instance, participants used landmarks in different ways. ‘I turn right at the church’ or ‘I get off the bus when I see this bungalow.’”

These anchor points were sometimes distinct, like a brightly painted house or a garden of gnomes, or were common destinations, such as a hardware store or public library. Others held some sort of social connection: their children’s house, a recreation centre, or a coffee shop where the staff greets them by name. Even in older suburban communities that had similarly coloured homes, participants would still pick up tiny things in an environment of sameness, like a house with a leprechaun chair or a big red RV.

Participants would also go out of their way to avoid challenging experiences. During one “go along,” Biglieri recalled approaching a busy intersection with one of her participants and he explained why he didn’t use the controlled crossing: “He said, ‘There’s too much going on. I can’t deal with it,’” she says.

Instead, he crossed the road a few metres down from the flashing and beeping. To pay attention to one thing at a time, he crossed one direction of traffic, paused on the grassy median, and then crossed the other. Biglieri says participants would purposefully walk further, or on less direct side streets, to avoid too many inputs or startling sounds. Unfortunately, in some cases for people living with dementia, the solution eventually becomes to stay inside.

As an urban planner, Biglieri does see solutions in how we build and retrofit our communities in order to make them more accessible. For example, planning a grocery store within walking distance, building higher and denser instead of
single and detached, slowing down arterial roads, creating commercial nodes within neighbourhoods and providing signs that lead to parks, shade and paths.

“There is a sense of independence and a sense of dignity that comes with being able to access your neighbourhood,” she says. “People deserve to be able to go outside.”

Better Urban Design

Here’s how cities can evolve to better support people living with Dementia.

• Widen sidewalks.

• Paint raised sidewalks and level changes.

• Create shade canopies and rest stations with trees and frequent seating.

• Create easy-to-read signage with photos.

• Simplify intersections and plan pedestrian islands.

• Create unique designs for decision points, such has intersections, pathways and corners.

• Incorporate diverse age, ability and cultural groups in the planning and retrofitting of neighbourhoods.

• Revise land use plans and zoning to incorporate “dementia-inclusive” design. [ ]