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.
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.
Organisations
- UNIVERSITY OF EXETER (Lead Research Organisation)
- Manchester City Council (Project Partner)
- Parkinson's UK (Project Partner)
- Social Prescribing Network (Project Partner)
- Ramblers (Project Partner)
- Northern Roots (Project Partner)
- The Charles Causley Trust (Project Partner)
- Botanic Gardens Conservation Int (Project Partner)
- Treverbyn Community Trust (Project Partner)
- Mind for You (Project Partner)
- Potager Garden (Project Partner)
- Bus Users UK (Project Partner)
- The Bishop's Palace, Wells (Project Partner)
- Exeter Cathedral Church of St Peter (Project Partner)
- Alzheimer's Society (Project Partner)
- Dementia Alliance for Culture and Ethnic (Project Partner)
- Seaton Tramway (Project Partner)
- Devon Wildlife Trust (Project Partner)
- The Sensory Trust (Project Partner)
- Exmoor National Park Authority (Project Partner)
- Get Out More CIC (Project Partner)
- South West Heritage Trust (Project Partner)
- Together Dementia Support Manchester (Project Partner)
- Manchester Health and Care Commissioning (Project Partner)
- Age Cymru (Project Partner)
- UK National Parks (Project Partner)
- Active Devon (Project Partner)
- Greenwich Peninsula Ecology Park (Project Partner)
- Innovations in Dementia CIC (Project Partner)
- Wild East Devon (Project Partner)
- Dementia Adventure (Project Partner)
- Royal Botanic Gardens (Project Partner)
- The Panjabi Centre/Desi Radio (Project Partner)
- Age UK (Project Partner)
- Historic Royal Palaces (Project Partner)
- Westonbirt - The National Arboretum (Project Partner)
Publications
Collins R
(2023)
Provision of Outdoor Nature-Based Activity for Older People with Cognitive Impairment: A Scoping Review from the ENLIVEN Project
in Health & Social Care in the Community
Page S
(2023)
Operationalizing Transformative Tourism: Creating Dementia-Friendly Outdoor and Nature-Based Visitor Experiences
in Journal of Travel Research
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 |