Extending active life for older people with cognitive impairment through innovation in the visitor economy of the natural environment (ENLIVEN)

Lead Research Organisation: University of Exeter
Department Name: Institute of Health Research

Abstract

Getting out and about in nature is good for us. It helps us stay healthy and active, stimulates our brains, keeps us in contact with other people, and brings pleasure and joy to our lives. During the COVID-19 pandemic, spending time in the garden or watching nature from the doorstep has helped people cope and feel connected.

Older people living with cognitive impairment, and people with young-onset dementia, say that nature helps them in lots of ways. They feel more engaged, more enthusiastic, more hopeful, more resilient and better able to deal with challenges. Their family members agree that getting out and about in nature is helpful. This could be as simple as spending time in a nearby park or garden, or it could be a visit or organised outing to a special place or beauty spot that rekindles past memories.

They also say there are things that get in the way and stop them enjoying nature as much as they would like. These include lack of facilities such as seats where you can have a rest, features like awkward steps that make it hard to get around, fear of getting lost due to lack of signs, staff seeming unhelpful, or a sense that older people are unwelcome. We need to remove these barriers and change attitudes.

The places where people go to enjoy nature are usually managed by businesses, local councils, social enterprises and charities. We will call them 'providers'. Many providers want to make it easier for older people living with cognitive impairments and their families to access the places they manage, but do not know how.

There is little guidance available for providers, because the amount of research so far has been small. Providers need to know how to respond to a growing market. If people are more satisfied with their visit to a particular place, they will tell others and more people will come. This will generate new business. The provider can then add better facilities. It is important that more research is done to help make these changes. A good number of providers and other organisations are keen to work with us on this project.

Our research project will ask: What can be done to make outdoor places easier for older people living with cognitive impairment (including people with young-onset dementia) and their family members of all ages to visit?

We will do this in 4 stages.

We will involve older people (for the purposes of this project, this means older people living with cognitive impairment, including people with young-onset dementia) and their families in all of the stages. We will involve provider organisations in all of the stages as well.

Stage 1
We will invite a wide range of people, providers and other organisations to send us information. We will talk to older people about their experiences of getting out and about in nature and what would make this easier. We will talk to providers to find out what works well and what could be improved. We will learn from the research that has already been done.

Stage 2
We will work with older people and their families, and with managers and staff from provider organisations, to find ways to help people enjoy getting out and about in nature more. We will come up with a variety of ideas, to allow for different preferences and abilities.

Stage 3
We will test these ideas out. We will work with different kinds of providers in different areas to find ways of making the places they run more accessible and welcoming. We will help them make changes. We will find out how well these changes work by talking with the older people who visit and with managers and staff.

Stage 4
When we have finished we will pull together everything we have learned and share it with as many people as possible. We will work with older people and providers to develop resources such as guidelines and toolkits, and networks for sharing information. This will allow more people to use the results of our research.

Publications

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Title Action plan template 
Description Action plan template designed to highlight key features of small grant scheme project plans to extend active life of older people living with cognitive impairment to facilitate innovation in the visitor economy of the natural environment. 
Type Of Material Improvements to research infrastructure 
Year Produced 2023 
Provided To Others? No  
Impact ENLIVEN's action plan template has highlighted focus points for further work to progress projects aimed at improving outdoor provision for people living with dementia, their families and carers. 
 
Title Qualitative interview schedules 
Description Qualitative interview schedules designed to elicit a unique data set to support the extension of active life of older people living with cognitive impairment and their families through innovation in the visitor economy of the natural environment. 
Type Of Material Improvements to research infrastructure 
Year Produced 2021 
Provided To Others? No  
Impact ENLIVEN's qualitative interview schedules have provided a window onto the intersection between cognitive impairment and innovation in the visitor economy. This is an area where there is currently a knowledge gap. 
 
Title Site audit template 
Description Site audit template designed to guide researchers' attention to key features of visitor attractions that are factors in the extension of active life of older people living with cognitive impairment to facilitate innovation in the visitor economy of the natural environment. 
Type Of Material Improvements to research infrastructure 
Year Produced 2022 
Provided To Others? No  
Impact ENLIVEN's site audit template has highlights the extent and variety of provision and challenges to provision for visitors living with dementia to outdoor visitor attractions. 
 
Description Chatathon interview participation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Two of the ENLIVEN Knowledge Exchange Officers were guests on the 2022 Dementia Research Charity Chatathon LIVE which was held on Friday 2nd December (a non-stop 12.5 hours livestream hosted by Adam Smith, interviewing 68 Dementia Researchers and Special Guests working across all areas of discovery to beat Alzheimer's disease and all forms of dementia). Their session was on the topic The Great Outdoors - Benefits of Nature in Dementia & Tech Help. The Chatathon was aimed at anyone with an interest in dementia (including healthcare professionals, clinicians, researchers, people living with dementia and their families).
Year(s) Of Engagement Activity 2022
 
Description Conference presentation - British Society of Gerontology conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presentation by Professor Jo Connell on 'Innovation in the Outdoor Visitor Economy: Towards inclusivity for older people living with cognitive impairment' at the British Society of Gerontology Conference 6th-8th July 2022
Year(s) Of Engagement Activity 2022
 
Description ENLIVEN Community of Practice meetings 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact ENLIVEN's community of practice meetings have provided a space for mutual learning amongst businesses and organisations. They have also facilitated the formation of new business connections.
Year(s) Of Engagement Activity 2021,2022
 
Description ENLIVEN Knowledge Exchange forum meetings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact The ENLIVEN Knowledge Exchange forum involves businesses and organisations from our Community of Practice network and people living with dementia from our advisory group. It is a unique opportunity for business and organisation representatives to meet and discuss their ideas and receive feedback directly from people living with dementia.
Year(s) Of Engagement Activity 2022,2023
 
Description ENLIVEN Webinar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact The ENLIVEN webinar is intended to provide a focus on a particular issue that has emerged as significant from previous project findings and discussions with partners. In the first webinar people discussed their experiences, problems and ideas around social prescribing, and shared resources for working in this area.
Year(s) Of Engagement Activity 2023
URL https://enlivenproject.co.uk/kef-webinar-connecting-with-social-prescribers/
 
Description ENLIVEN business/organisation meetings 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Discussions with a diverse range of businesses and organisations to raise awareness of innovation for dementia friendly experiences and spaces in the visitor economy of the natural environment.
Year(s) Of Engagement Activity 2021,2022,2023
 
Description ENLIVEN engagement with Lewy Body Society 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact This was an event consisting of a short presentation to attendees about the ENLIVEN project, describing opportunities to get involved. The short presentation was followed by a wider discussion about experiences of getting out into the nature, focusing on what helps and what gets in the way.
Year(s) Of Engagement Activity 2021
URL https://www.youtube.com/watch?v=-WekTW8OnxM
 
Description ENLIVEN newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact ENLIVEN's newsletter is co-produced with the research team and ENLIVEN's partner organisations and businesses. It raises awareness of dementia related issues and provision, 'spotlighting' the work of our partner businesses and organisations who are at various stages of their journey in becoming dementia-friendly.
Year(s) Of Engagement Activity 2021,2022,2023
URL https://enlivenproject.co.uk/newsletters/
 
Description ENLIVEN website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact The ENLIVEN website raises awareness of ENLIVEN, helps others to learn more about the project and highlights opportunities to get involved. It provides Community of Practice members and other visitors with a central point of contact for news about the project, including upcoming and past Community of Practice and Knowledge Exchange forum events.
Year(s) Of Engagement Activity 2021,2022,2023
URL https://enlivenproject.co.uk/
 
Description Meetings of ENLIVEN's PPI Advisory Group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact ENLIVEN's Advisory Group provides persons living with dementia as well as carers/supporters an opportunity for their voices to be heard and shape strategic decision making about the future trajectory of ENLIVEN. Over the last year, the advisory group has provided insights into early project findings, proposals for collaboration and their experience of social prescribing.
Year(s) Of Engagement Activity 2021,2022,2023
URL https://enlivenproject.co.uk/enliven-advisory-group/
 
Description Nature Health Network presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact An online presentation to a network of professionals interested in the role of nature in promoting health. The presentation was delivered to an audience of 42 on the topic of emerging findings of ENLIVEN's research, with the opportunity for audience members to ask questions.
Year(s) Of Engagement Activity 2023
 
Description PPI participation in ENLIVEN management meetings 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Study participants or study members
Results and Impact Participation of one person living with dementia and one carer in ENLIVEN management meetings, providing a space for PPI voices to become embedded at the heart of the ENLIVEN research project.
Year(s) Of Engagement Activity 2021,2022
 
Description RHS Bridgewater invited visit 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Patients, carers and/or patient groups
Results and Impact On 4th October 2021, ENLIVEN Co-Investigator Dr Carol Opdebeeck was invited to RHS Bridgewater to meet the Fabulous Forgetful Friends group. This helped to raise awareness of the project and ENLIVEN's work to make outdoor nature spaces in the visitor economy more accessible for all.
Year(s) Of Engagement Activity 2021
 
Description The Accessibility to coastal places for people living with Dementia workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Linda Clare gave a presentation as part of an online workshop, hosted by Dynamic Dunescapes Cymru team & Green Links Bridgend, with the aim of raising the awareness of accessibility to coastal spaces for people living with Dementia, and facilitating knowledge exchange and networking between staff from different sectors and organisations (particularly anyone working in the coastal land management sector, event planning or care & support sector).
Year(s) Of Engagement Activity 2022
 
Description Workshop for nursing students 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Presentation and discussion for level 3 nursing students as part of Managing complexity, holistic approaches course University of Exeter Academy of Nursing. ENLIVEN's Research Fellows summarized the project and its early findings and set up discussions to encourage students to consider how the ideas and issues raised might affect their work.
Year(s) Of Engagement Activity 2022