My personal motivation to choose to work with the elderly user group is the fact that my grandfather has developed dementia symptoms and has started to feel confused and lost once leaving the family house, for example to visit healthcare facilities, or simply to go out for shopping. Gaining new knowledge thanks to this course I realize how little understanding for his situation there is, even within the family. Because his disease has started many years ago with loss of hearing, considered at first as a professional side effect, the dementia itself has been left untreated
The combination of impaired hearing and memory loss has led my grandfather to lose his connection with the reality. As a consequence, the everyday life of both my grandfather and grandmother has filled with frustration, unsecurity and sadness
Searching in the literature for answers, as a part of the Vollsjö grupp I discover that there are ways to decrease the damage and bring positive experiences in the elderly’s lives in general
Four mechanisms for linking nature with health (in our background part) is a strong argument and foundation for us to develop the project, but also for any stakeholder at Vollsjö to understand the importance of the outdoor environment and why it is worth to invest in it.
In the literature review we found that social relations also promote mental health (Kawachi and Berkman, 2001 and that green space in the living environment is related to feeling less lonely and experiencing less shortage of social support (Maas et al, 2009). However, the authors (ibid.) did not find any correlation between green space and social support. van den Berg, Joye, and de Vries (2013) point out that the link between green space and social contact is unclear Because we did not find any clear connection between green spaces and social interaction, we had to ensure this tool of health promotion is not overlooked in our proposal. Social cohesion, mentioned also by Ulrich (1999) as a significant healing aspect of health promoting gardens in my opinion is not related to nature alone, but, rather, it must be incorporated in a specific design organisation
As our program aim points out, we focus both on the physical aspects of the environment and the use of it Although some elements regarding the use of the outdoors were mentioned in our SWOT analysis, our methods for investigation through QET and Four zones remain mainly focused on the physical environment Visiting the elderly home in winter/early spring prevented us to observe how the residents use the environment from first hand, with the exception of one participant with whom we performed a walking interview. The walking interview could not comprehend actual use of all the spaces, and also different groups of residents, like dementia suffering and physically hindered individuals
During the writing of this individual part of the assignment, I found a study by Shi, Tong & Marcus (2018) carried out in Hong Kong, specifically focused on the use of the environment in elderly homes which could be useful for the enhancement of the use of our proposal. Unfortunately, it was ongoing at the time of our method development What is made differently from our data collection process is that they tried not to get personal impressions of the gardens during the time of the interview The interviews were made indoors with no visual access with the gardens.
The gardens were explored later, in connection to usage observations The researchers were also able to measure frequency and duration of garden vistas and also the way the users reach to it walking, alone by wheelchair, assisted by a visitor or stuff (Shi, Tong & Marcus, 2018) A measurement of this kind before and after the design intervention in our case would be sufficient to assess the level of success of the proposal.
We, on the contrary, did our interviews in visual connection with and directly in the outdoors, and also did not gather good quality of usage observations I realize, it is very hard to put yourself into others place, especially, working with elderly people and it is easy to assume things from own perspective. That is why I think it is a good idea to distance yourself with the site as much as possible during the pilot study.
The participatory input in the group work was limited to interviews with some members of the stuff, extensive interview with the manager and a walk interview with one of the residents The latter was of those residents with minimal need for assistance and walked by herself with the help of a walker. We actually do not know how many of the residents have the need for enhancing of walking paths and how many are limited to use of just the immediate surrounding As a possible way to assess the current situation is to make a survey including information about the level of independency of the residents and in general what kind of capacity the home in fact has to include future situations as well.
The choice to work in the group work with Four Zones of Contact with the Outdoors (Bengtsson, 2015), Quality Evaluation Tool (Bengtsson & Grahn, 2014) and a modified SWOT analysis tool (Hay & Castilla 2006), in my opinion, were sufficient as tools to cover the most of the issues we met on site.
However, these methods did not help us to find the ideal situation for an outdoor environment That is why I visited two reference places to see if there are better examples of what we were trying to achieve Comparing Vollsjö elderly home with two other places, I was able to prove to myself that the tools we were using should include a deeper dimension and a holistic approach
For example, in the QET analysis, sometimes the presence of a given quality was questioned within the group, simply because it was not showing its full potential An answer to this issue could be adding scores for each quality present to assess to which level it is present. In that connection I suggest a graphic representation of the results. Here (see fig.1), just to exemplify, I give for each quality a score from one to three, visualized in the diagram through different thicknesses of the connecting lines The numbers show in how many zones each of the quality is appearing
Fig.1: Infographic QET analysis. Source: Own production.
Individually, I also worked with a QET mapping on the site, which is to be used for analyzing purpose but also later, as an input for the design process (see fig.2). Not all of the eight user areas visible from the QET map, have actually been observed to be visited by residents or staff (confirmed in the interviews some of them were really never used) but rather some of them (for instance area I, II, III, VI and VII) were picked as potential spaces to be included in design process because of their qualities present This means we did not made a separation between areas that are used by the residents and those which are not. Non of the tools we used was able to help us to detect this lapse but the QET map is immediately showing higher concentrations of qualities in those areas which were actually used
Closeness and easy access
Enclosure and entrance
Safety and security
Familiarity
Orientation and wayfinding
Different options in different kinds of weather
Joyful and meaningful activities
Contact with surrounding life
Social opportunities
Culture and connection
Symbolism/Reflection
Prospect
Space
Rich in species
Sensual pleasures of nature
Seasonal change in nature
Serene
Wild nature
Refuge
Our methods do not provide either a study of the movement through the outdoors and in and out of the building except for the circular path around the building, as well Johansson, Hartig &Staats (2011) inform us however, that the walks are mentally and psychologically beneficial
Fig.2: QET mapping. User areas with roman numbers I-VIII. Source: Own production. Abbreviations as following:
for people in general and effects like mental performance and stress reducing can be enhanced by an according social context and qualities of the outdoor environment such as greenery and water From the interview with our walking participant, we know that today, very few of the residents use the circular path around the building One of the reasons I can think of is that the path lacks lots of qualities and it is clearly not designed for the elderly to use in their everyday life
Grahn & Stigsdotter (2003) inform us, on the other hand, that the general user is very sensitive to distans to green open space The study also discovers that after only 50m of distance the visits drastically decline (Ibid.) For our user group this distance may even be shorter. That is why the authors (ibid.) mean that we need to incorporate more valuable qualities in order to attract visitors from further away In the Vollsjö case we did not find physical elements which support a little bit longer walks That is why I think the cross graphic analysis of QET and the Four zones of contact (fig 3) is very important: it clearly shows that we have less qualities the further away we move from the building.
Fig.3: QET analysis of the user areas in relation to Four zones of contact. Source: Own production
However, we did not pay enough attention to this obvious finding and that is why the logistics of the walking paths as a feature to be included in design process was not captured Another conclusion from this infographic intended is that somehow, we have more nature elements further away from the house (many old trees, wild animals, natural shadows, closer to the surrounding life, etc.) but unfortunately not accessible for the user group and thus, zone 3 and 4 appear with less qualities comparing to the “boring”(according to interviews) immediate environment
We also did not include zone 1 in the QET evaluation, so we lack a comparison of the views from inside the building versus the environment outside, although we have the data This means that we did not draw a conclusion if the outdoor environment is attractive enough from the inside of the building so that there are sufficient stimuli to make a person to take the next step towards the outdoors.
Shi, Tong & Marcus (2018), in their usage focused study, found that factors like scale of the facility and the garden, the location of the garden, as well as residents’ attitudes towards the garden and support from staff are critical in determining if an elderly home garden will be well used (Shi, Tong & Marcus, 2018, p.7). For example in a smaller gardens it is more likely to meet others which supports the social interaction(Shi, Tong & Marcus, 2018, p.8). In general, more home-like and adjustable settings appear more inviting for older people than clearly defined or highly controlled ones “These would encourage more spontaneous and active garden usage among older people, compared to the sporadic and passive activities…”(Shi, Tong & Marcus, 2018, p.11).
In connection with different weather conditions from the study in Hong Kong I believe we could better take advantage of observations if we had conducted the study in warmer months because the residents were very inactive at the moment of our visit due to cold weather. At the same time, the observed passiveness turned out to be useful, because we are now familiarized with the constraints existing in the cold season.
A personal condition I experience is that in many situations I could relate to the elderly’s unease to go out Mainly, because I was raised in a warmer climate, I often struggle with myself when I need to go out in a harsh and cold wind Also, I feel depressed when the spring does not seem to come when my inner calender says it should come
As a mother of a 2 year old child, on the other hand, I also could relate to the stuff working in the elderly homes I visited, because I recognise the moment of trying to persuade into changing clothes and shoes to warmer/more heavy ones before going out in the cold weather
Coming first from an architecture school and continuing my master’s education within the field of landscape architecture I am increasingly starting to pay attention to the importance of the transition zones between indoors and outdoors in order to encourage people to spend more time outside Especially in cold climates, like in Sweden, the built indoor and the open environment is very different from each other so for more sensitive people the change could be a huge challenge
Another issue for the project I see is the attitude towards dementia patients Talking with the elderly home manager I got the impression that the intention is to restrict them spatially Considering that many of them maybe are only mentally impaired, they also should have the opportunity to longer walks by their own initiative If the open courtyard become closed, as wished, this will contradict with the manager intention to provide more possibilities for unassisted outdoor vistas
My first impressions of the site of Vollsjö elderly home were rather positive. I visited it very early in the process because I wanted to get personal impressions as soon as possible. Coming from the field of architecture as another reason, I am used to visit the site as many times as possible As said earlier, this was maybe not the best approach in this case
During my first visit the place seemed as a very peaceful facility, where there was a need for stimulation, rather than stress reduction. Stress was very extensively discussed in the group as a possible aspect to study but since we assessed that stress was not the most important issue for this project we decided to drop the topic However, I stayed open for the topic and later on, my opinion was changed, thinking about the effort needed to adjust mentally for changing the environment from indoors to outdoors, especially in colder weather. The energy required for going out could vary from very little for the residents without health issues to very high for the residents who suffered from different physical and mental difficulties Analysing spatially the reference location in Köpingebro, I understood that the physical environment itself could influence a great deal of how the attitude towards the outdoors is
Visual graphic representations of study results were my methods to make sense of the data for myself and the rest of the group and, thus to help drawing conclusions of what the numbers meant for our project
Because of my background, I was mostly interested in the physical aspects of the environment existing and in the proposal (structure part). I also contributed to the group work by visiting other reference elderly homes to find out how they use the outdoors and to gather observation materials and interviews This brought a lot of inspiration for our proposal part In Vigavägen, located in Köpingebro, they have an inspiration stuff who has the task to find proper activities for the residents in order to awaken their senses and evoke positive emotions. This also includes guiding the elderly outdoors and finding activities to be performed in fresh air. It turned out, both Byavången in Tomelilla (the first visited reference place) and Vigavägen in Köpingebro (the second one) are managed by the same (private) company but the places were very different from one another When I asked the manager Annika Sjöstedt why it works better in Vigavägen when considering the use of the outdoor environment she said the reason was that their elderly home had a special profile from the
moment of establishment and when their company applied for the competition to run it for the next period, they were obligated to follow this profile in order to win the competition
Through visiting reference locations I came to value highly the importance of the connection with the surrounding life (the pleasure of playground sounds); the importance of experience of wild nature; the fact that the outdoors starts in the body of the building I also saw examples of how the maintenance of the outdoor is handled in different places After each visit I start to ask myself: What is the ideal situation? This was my re evaluating process through which I recognised that things can be executed differently than initially planned
Stepping into the landscape field for the first time this year, I came to realize that with vegetation material we can, just like within architecture, form rooms and spaces to encourage social interactions. I think also that this is the missing link between green spaces and health promotion through social activities. I now strongly believe, that while taking in the maximum effect of nature healing one needs to be alone, on the contrary to absorb a maximum benefit of socializing in green setting it is important to be in a room/space which is culturally constructed as a concept
In connection with the Triangle of supporting environments (Bengtsson & Grahn, 2014) I could add that sometimes people who are mentally exhausted may need instead some level of social interaction, supported by less solitude in wild nature and more cultivated physical environment While studying Vollsjö, we had a discussion if the elderly actually need the quality of wild nature, as it is totally lacking at the site. Some of us favoured in no need for wild nature, because it is in general not accessible for this user group. Others, including me, agreed on that elderly maybe are not able to climb mountains but they need the experience of wild nature Also, reflecting on the findings and information I gained during the project, I came to the conclusion that for many old people it is important to be able to share those experiences in order to feel a part of the surrounding life, or to train their memory by discussing the experience with somebody who was present. So the combination of strong positive emotion/fascination and recall could be used as a design technique in my future work
Understanding user’s own situation is essential for any physical design but working with the user group of elderly helped me to step beyond the basic human needs and also to critically analyze landscapes through the eyes of an older adult An important lesson I learned was that it is not enough for a space to be attractive but also accessible, and nevertheless, it should be rewarding for the energy given while getting there
To the date of finishing our program there were only one financial resource secured, and that is the donation of 100 000 SEK, which in Swedish context is not enough money to make a comprehensive outdoor environment design However, at the end of our journey we succeed to get the attention of the municipality who seem interested and engaged to help for the
development That is why I think that if we had this information earlier, we could make concept proposal differently
Additionally, searching for resources maybe has some answers in the architecture field For a garden environment, various materials can be found free in the nature, or donated from construction companies who would otherwise through remains of their activities. Here follows a list with materials that can be found for free or at a very low cost:
Willow is a tree found in abundance in Skania and can be found as a free material to design a garden with. It can be used for fences, privacy screens, edges of different elements for example between paths and seed/flower beds. This kind of design also introduce the qualities of familiarity and culture.
Big stones are available after ploughing, material that farmers are not happy with. As the Vollsjö elderly home is surrounded by farming fields, it is not a difficult task to find and use stones for garden elements.
Sleepers can be found as a waste material within the railway industry. They can be used for raised beds, edges, path cover, etc. An important condition is to be careful if they were treated and when. If they are very old they may be treated with poisonous substances against insects, which may cause pollution of the soil and the plants.
Wire mesh is a cheap material, which can be easily used as an anti-slip solution for wooden ramps and paths. It can be also used as a part of structure to provide support for a climbing vegetation and thus to create living walls or shadow providing roofs.
Various bricks, concrete and stone plates can be found for free or very cheap as waste in major building projects or online.
Fig
Fig
Fig
(left) Source:
com/diy crafts/g2416/repurposed broken china/?slide=3
design (middle) Source: https://i pinimg com/originals/ac/71/35/ac71355c5f7a9dd17f3bde4e1eabc5bd
Source: http://fantasticmaterials blogspot com/2013/11/pvc pipe html
Broken pottery and china can be used for decorative features like water fountains or birdbath, and also for path designs. Such colourful features can be even made during an art workshop by the residents themselves.
Fig
pinterest se/pin/332633122450581694/
PVC tubes can be find as waste material as well and they can be used for vertical gardening, for example planting hanging flowers or strawberries. Vertical gardens are very useful for the elderly user group as they do not require body bending while attending.
Fig 14: Lamps made of jars Source: https://www decoist com/2013 11 12/diy jar lamps project ideas/ Empty jars from the elderly home’s kitchen can be used for lighting features it the garden. Alternatively, old industrial lamps also can be found cheap or even for free.
Fig 15: Raised flower beds made of branches Source: https://www thegardenglove com/more garden edging 9 creative ideas/ Fig 16: Sculptures and trellis made of branches (right) Source: http://robotonholiday blogspot com/2011/06/garden structures html
Fallen branches as an absolutely free material can be found at the estate and used for garden structures or decorative sculptures.
Enhanced path system for the residents without serious physical or mental impairment This will include small challenges, points of interests, stimulations of the senses on the way of the paths The existing path around the building can be used but the it can be deflected to the open lawn (area II in the proposal) and there can be created some points of interest with sitting possibilities, flower arrangements, or a garden activity.
Path system for the dementia patients, stimulating physical activities, less challenging mentally, easy wayfinding, privacy but also easy access to social gatherings and elements for observation for example precipitation measuring instruments, or birdfeeders The terrain on south is sloping down towards the fields so it can be used/developed as a place for solitude and meeting visitors in private with its prospect/refuge setting.
The inner courtyard is used for socializing, gardening and walking rounds during winter/bad weather The walking path should be enhanced for shorter walks in bad weather
Designing an attractive space for meeting visitors outdoors socially encouraging spaces away from disturbances like air conditioners and also children friendly features
Today in Vollsjö, many of the apartments have spaces for own little garden, but they are not used optimally. The majority of the residents don’t have physical abilities to keep this as a permanent and frequent activity because the gardening space is low on the ground
Gardening can be, however, shared/scheduled and most importantly adjusted towards less physically demanding environment Example for adjustments towards elderly users are the vertical gardens and raised beds. Vertical garden can be created in spatial connection to the kitchen so the users can understand that their effort is beneficial for everybody.
a
the
During the interviews, there was expressed a desire to make something about the both courtyards as they seemed have the highest significance for the users Considering the difficulties with the open courtyard I would suggest some ideas of combining environments for dementia residents and those without this mental disease.
The courtyard should not be closed with a fence as such intention was revealed during the conversations with the manager It should give an opportunity for the dementia patients to perform longer walks and be physically active outdoors. The Eastern part can extend to south where some meaningful activity can be performed (see fig.21).
Fig 20 Location of the winter garden: Enclosed courtyard (West) Image: Own production
References:
Bengtsson, A , 2015 From experiences of the outdoors to the design of healthcare environments Doctoral Thesis No 66 Acta Universitatis Agriculturae Sueciae Swedish University of Agricultural Science, pp. 21 26, available at: http://pub.epsilon.slu.se/12192/
Bengtsson & Grahn, 2014 Outdoor environments in healthcare settings: A quality evaluation tool for use in designing healthcare gardens Urban Forestry & Urban Greening, 13(4), pp.878 891.
Grahn, P & Stigsdotter, U 2003 Landscape Planning and Stress Urban Forestry & Urban Greening 2, 1 18
Hay, G., & Castilla, G. (2006). Object Based Image Analysis: Strengths, Weaknesses, Opportunities and Threats (SWOT) ISPRS Archives Volume XXXVI-4/C42, 2006 36
Johansson M, Hartig T, Staats H 2011 Psychological benefits of walking: moderation by company and outdoor environment. Appl. Psychol. Health Well Being 3:261 80
Kawachi, I , & Berkman, L F (2001) Social Ties and Mental Health Journal of Urban Health: Bulletin of the New York Academy of Medicine, 78(3) Retrieved from https:// www ncbi nlm nih gov/pmc/articles/PMC3455910/pdf/11524 2006 Article 44 pdf
Maas, J , van Dillen, S M E , Verheij, R A , & Groenewegen, P P (2009) Social contacts as a possible mechanism behind the relation between green space and health Health and Place, 15(2), 586 595 https://doi org/10 1016/j healthplace 2008 09 006
Shi, S.L., Tong, C.M. & Cooper Marcus, C., 2018. What makes a garden in the elderly care facility well used? Landscape Research, pp 1 14
Ulrich, R S (1999) Effects of gardens on health outcomes theory and research In C Cooper Marcus & M. Barnes (Eds.), Healing Gardens: Therapeutic Benefits and Design Recommendations (pp. 27 86). John Wiley & Sons. Retrieved from http:// www google com hk/books?hl=zh-TW&lr=&id=YRY1WejQok8C&pgis=1
van den Berg, A E , Joye, Y , & de Vries, S (2013) Health benefits of nature In L Steg, A. E. van den Berg, & J. I. M. de Groot (Eds.), Environmental psychology: an introduction (pp 47 56) British Psychological Society and John Wiley & Sons, Ltd
Images:
Own production if not other mentioned