What is the theoretical background to our research?
Designed inclusively, outdoor environments have the potential to benefit older people in a number of ways. This section of our website begins by summarising the established ‘environment-behaviour’ evidence base on the positive impact of getting outdoors on independence and quality of life, including all aspects of personal wellbeing: physical; social; and emotional. We then examine the meaning of quality of life (QoL): recognising that health is not a sufficient and all-encompassing measure for QoL in older age; that human beings have the power to adapt - and adapt to - their environment; and that people’s motivation and needs (both basic and higher) are important. Such a transactional approach is crucial when the aim of the research is to propose inclusive policy and environmental interventions.
Also in this section on theoretical background, we explain that the framework we have developed to understand how supportive outdoor environments can enhance older people’s QoL is based on a conceptualisation of ‘environmental support’ which integrates three complementary factors: personal projects; environmental attributes; and unmet needs. Much emphasis is placed on the individual and how they perceive supportiveness, based on their own physical and mental capabilities, as well as desires.
I'DGO (Inclusive Design for Getting Outdoors) draws on an established ‘environment-behaviour’ evidence base which suggests that being outdoors impacts positively on independence, quality of life and all aspects of personal wellbeing. It acknowledges that any approach to measuring these outcomes must take into account the emotional and psychological, as well as physical, impacts and obstacles in the landscape that affect quality of life (Price and Stoneham, 2001).
Despite abundant scientific evidence on the multiple health benefits of physical activity - and national and local level strategies to promote an active lifestyle - more than 80 percent of UK residents aged 65+ do not meet the recommended level of physical activity (Joint Health Survey Unit, 2004; Scottish Executive, 2005) and are thus at risk of developing certain diseases and disabilities (WHO, 2003). Getting outdoors can assist with addressing this shortfall, as it contributes to a more active life-style and is correlated with life satisfaction and health (Sugiyama and Ward Thompson, 2006; Sugiyama and Ward Thompson, 2007).
Activities in open spaces are associated with greater social integration and stronger social networks among neighbours (Kuo, Sullivan, Coley and Brunson, 1998), as well as reduced fear of crime (Kweon, Sullivan, and Wiley, 1998). The social benefits of getting outdoors also extend to practical considerations, such as being able to access local services (including shops, post offices and libraries).
As for the psychological benefits, contact with nature has been shown to reduce mental fatigue, thus aiding in the restoration of people’s attentional resources (Kaplan and Kaplan, 1989; Kaplan, 1995). It helps reduce stress by leading to positively-toned emotional states (Ulrich, 1983; Ulrich et al 1991) and aids reflection. Many people’s favourite places are natural environments (Korpela and Hartig, 1996).
Quality of life is a key concept in this research project. We have followed a social model that views the individual as an active being; capable of coping successfully with major life changes if personal and environmental contexts are appropriate. Further, our theoretical approach is based on the Needs Satisfaction Model proposed by Hyde, Wiggins, Higgs & Blane (2003), which gives value to older people’s agency in appraising, changing and adapting to what the environment has to offer (in terms of constraints and opportunities). This is consistent with Peace et al (2005), who suggest that a “life of quality” is one where mastery can be exercised in relation to the social and material fabric of one’s life.
Building on Maslow’s Motivational Model (Maslow, 1968), the Needs Satisfaction Model emphasises that human beings are “needs satisfiers”, with ‘needs’ not limited to what could be called ‘the basics’, but higher requirements such as control, autonomy, self-realization, and pleasure. The model places people in context, so it evaluates the “quality” of their lives in terms of the satisfaction of their personal needs and goals (both basic and higher), which they fulfil through a range of activities. A transactional approach to quality of life leads to the consideration of how an environment facilitates or hinders such activities; what it affords in terms of engagement and action (Gibson, 1979) and how these affordances are perceived by individuals. Differences between people are thus of utmost importance; recognising that the same environment may offer different opportunities to different individuals, that what people want to do may change from time to time and that personal quality of life is dynamic.
According to Lawton (1986), the environment offers three vital functions to older people: maintenance; stimulation; and support. Support is especially important in helping older people remain active and independent and, for us, a supportive built environment is one that makes it easy and enjoyable for an older person to get outdoors.
The concept of enjoyment is closely related to ‘personal projects’ (Little, 1983); the activities that individuals are motivated to do and that are meaningful to them. In an outdoor environment, such activities might include tending to the garden, going for a daily walk in a local park or posting a letter.
The concept of ‘personal projects’ is important to I'DGO in that it proposes an ecological view of people’s interaction with their environment. It is therefore closely linked to a transactional approach to quality of life (Peace et al, 2005). In turn, the way in which an environment facilitates or hinders ‘personal projects’ can be understood in terms of two ecological concepts: affordances (Gibson, 1979) touched on above; and behaviour settings (Barker, 1968).
Behaviour settings are the physical and social-cultural contexts within which ‘personal projects’ - and related outdoor actions and activities - take place. In terms of environmental or physical features, they are designed to encourage or restrict certain kinds of behaviours; a sports pitch encourages and enables physical activity, for example, while a theatre restricts it. In the context of older people, outdoor activities and behaviour settings, a group of older people taking a morning walk in a park can be defined as “ecological units”; a composite of environmental and behavioural factors.
Research into the environmental factors which influence people’s outdoor activities tends to use either audit type instruments for gathering objective data or self-reported, subjective measures. A review by Moudon and Lee (2003) identified 31 instruments for measuring environmental support objectively while several subjective instruments have been proposed to assess the perceived adequacy of a neighbourhood area for walking. These include: the Neighborhood Environmental Walkability Scale (NEWS) developed by Saelens et al (2003) to assesses residential density, land-use mix, access to services, street pattern, availability of facilities for walking, aesthetics and safety; and a similar ecological scale developed by Humpel et al (2004) to evaluate the quality of neighbourhood as a place to walk.
Subjective measures are advantageous in that they take into account individual differences and preferences. This is especially important for older people, for whom the same environmental attributes may have different implications depending on their physical and mental capabilities, as well as personal needs and goals.
With regards to one specific feature of quality of life - physical health - there is a growing body of research exploring links with environmental factors, from the aesthetic qualities of streetscapes and open spaces, to crowdedness, air pollution and noise and the condition of housing and amenities (Blafour & Kaplan, 2002; Cummins, Stafford, Macintyre, Marmot & Ellaway, 2005; Halpern, 1995; Wright & Fisher, 2003). Wen, Hawkley, & Cacioppo (2006), for example, have examined the relationship between perceived ideas about the quality of neighbourhood environments (including physical, social and service aspects) and the health of participating older adults aged between 50 and 67 years. The environmental attributes we focus on in Inclusive Design for Getting Outdoors similarly relate to perceived ideas about the quality and supportiveness of outdoor spaces and places, picking up on other studies on physical activity and external environments. There is evidence, for example, that aesthetically pleasing and tree-lined walking paths are more likely to stimulate physical pursuits than monotonous or unattractive streets and footways, that having good quality footways (Newton and Ormerod 2008), shops and other accessible facilities nearby is encouragement to walk in a neighbourhood (Corti, Donovan, & Holman, 1997) and that it is not only the provision of space for physical activity that is important for people’s perceptions and usage, but how such amenities are both designed and maintained (Hahn & Craythorn, 1994).
Inevitably, studies on the perception of outdoor environments - particularly those concerning their quality and supportiveness - will demonstrate that many behaviour settings do not allow ‘personal projects’ to be accomplished. This may be because they do not physically facilitate a particular activity (such as tennis), or because they have been evaluated, by the user, in a negative way. Since the process of ageing often involves a gradual decline in various functions and challenges self-efficacy, what an older person cannot do in a given situation may be as significant as what they can. Unmet needs are therefore an important part of Inclusive Design for Getting Outdoors.
We define an unmet need as the discrepancy between what a person would like to do in a setting and what the setting allows the person to do, taking into account that it is the user’s perception of the space (and how it matches both their needs and capabilities) that makes it either supportive or unsupportive. The concept helps to focus on individual differences and on understanding adaptation to outdoor spaces in diverse environments, such as neighbourhoods, private homes and nursing homes. It is important to remember that, as people age, they often experience a loss of resources, productive roles and access to opportunities and challenges. Sometimes, then, unmet needs are simply activities associated with daily living; those essential to maintaining an independent life-style.
In summary, ‘personal projects’ and unmet needs are concepts that account for the individual’s agency in the use of the outdoor environment. These processes of agency help understand the “experiential” aspect of environmental support by focusing on the active role of the older person.
|Potential benefit/Aspect of QoL||Scope/examples||Related category from focus group findings||Related category from literature review findings|
|Perceived safety||From attack/assault/robbery; fear of groups of young people||experience of crime||Fear of crime; safety & perceived safety; crime prevention through environmental design|
|Safety and comfort||Not falling or having accidents and safety from traffic||Being able to successfully navigate the environment; fear of crime and actual experience of crime||Safety & perceived safety|
|Physical health||Opportunities for exercise and access to fresh air||Being healthy and independent||Health & wellbeing; health related QoL; physical activity|
|Emotional wellbeing||Mental health and opportunities for relaxation||Keeping active in mind||Emotional wellbeing; satisfaction; purpose in life; depression|
|Mobility||Ease of access to facilities, amenities & open space (inc. with assistive technology); wayfinding ability and ability to go out||Being able to successfully navigate the environment to successfully reach the destination and autonomy||Mobility & access; compatibility with assistive technology|
|Sense of community||Belonging and social support networks||Sense of community/sense of belonging and support mechanisms||Social support|
|Satisfaction with neighbourhood||Attractiveness, cleanliness, lack of noise, safety, and security||Having an outdoor environment that affords engagement and aesthetic quality||Satisfaction; traffic; anti-social behaviour; management|
|Social interaction||Extent of interaction with others in the neighbourhood||Variety and purpose in daily activities and infrastructure to support socializing||Social interaction and mobility|
|Enjoyment||Going out, feeling good and relaxed||Social interaction and mobility||Activity and relaxation|
|Stimulation||Variety/purpose||Keeping active cognitively and variety and purpose in daily activities||Enjoyment and satisfaction|
|Autonomy and control||Independence, self-actualisation, self-esteem, and self-efficacy||Independence, health, and mobility||Autonomy, independence, self-actualisation, self-esteem|
|Care and support||Need to be looked after by staff and family; ease of care-giving||Not included||Not included|
I'DGO - Inclusive Design for Getting Outdoors. Last updated 30 Nov 2012