Step Outside! It Changes Everything

Image used under license from Canva

Most of us walk outside without thinking about it. A breath of fresh air, a coffee in the sun, a quick lap around the block. For older adults living in residential care, that simple act often disappears. Doors get locked, days get long, and the garden a few metres away might as well be a country away. A new Swedish study asks what happens when care workers start to see the outdoor environment as part of the job, not a break from it.

The Key Findings

Madeleine Liljegren and colleagues from the University of Gothenburg, Chalmers and the Swedish University of Agricultural Sciences ran focus group walking interviews with 11 care workers, nurses, activity leaders, occupational therapists and physiotherapists, across three Swedish residential care facilities of very different sizes and shapes. They walked through each setting together, zone by zone, from indoor windows out to the surrounding streets. Three themes came out. First, potential for health. Nature views and outdoor stays met basic human needs and lifted well-being, better appetite, brighter mood, less anxiety, and staff describing outdoor breaks as what kept them going through stressful shifts. Second, potential for enriched everyday life. Outdoors brought stimulating days, more movement, and, crucially, choice. Residents could decide where to be; at the window, on the balcony, in the garden, or out in the surroundings. Third, challenges for operational development. The outdoors was often underused. Some staff had never been into the garden of the facility they worked in. Planning, time, attitudes and habit all got in the way.

Going outside is not a leisure activity tacked onto care, it is care. For older adults, including those living with dementia or significant frailty, the outdoor environment can support health, identity and dignity in ways the indoor environment simply cannot match. But access alone is not enough. Without staff who see outdoor time as part of their role, beautiful gardens stay empty.

Implementation and Action

For people living with dementia, older adults and families: ask about the outdoors when choosing or visiting a care home. Can residents see green from their bed? Is there a balcony, patio or garden they can reach without help? Do staff actually use it with residents, for meals, walks, conversations, or just sitting together? For aged and dementia care workers: try shifting one routine task outside this week, a chat, a coffee, a follow-up assessment, a short walk. Even brief outdoor time generated alertness, calm and connection. For designers and architects: think in zones, the view from the window, the in-between spaces like balconies, the garden and the wider neighbourhood. Pay close attention to transitions: doors without thresholds, automatic openers, level surfaces, and sightlines so staff feel confident letting residents step out. For managers and policymakers: outdoor use needs to be planned, staffed and valued, not left to the goodwill of individual workers.

The Critical Messages