Integrating outdoor environments into health service delivery at residential care facilities for older adults.
5 affiliations
- 1Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, House 1, Box 457, Gothenburg, 405 30, Sweden. [email protected].
- 2Division of Construction Management and Engineering, Department of Architecture and Civil Engineering, Chalmers University of Technology, Sven Hultins Street 6, Gothenburg, 412 96, Sweden. [email protected].
- 3Department of People and Society, The Swedish University of Agricultural Sciences, Slottsvägen 5, Alnarp, 234 56, Sweden.
- 4Division of Construction Management and Engineering, Department of Architecture and Civil Engineering, Chalmers University of Technology, Sven Hultins Street 6, Gothenburg, 412 96, Sweden.
- 5Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, House 1, Box 457, Gothenburg, 405 30, Sweden.
Abstract
Background
Outdoor environments may support everyday activities, person-centred care and rehabilitation, and health and well-being among older adults in residential care facilities (RCFs). However, how they can be integrated into routine health service delivery remains underexplored. This study aimed to explore how outdoor environments can support everyday activities and person-centred care and rehabilitation in RCFs, and to identify perceived benefits and barriers to their use in routine health service delivery.Methods
A qualitative study was conducted using individual walking interviews with older adults and focus group walking interviews with care workers at three Swedish RCFs. Data were organised according to the model of four zones in contact with the outdoors: indoor environments with windows (Zone 1), transitional outdoor environments (Zone 2), gardens (Zone 3), and the surroundings (Zone 4). Everyday activities, care and rehabilitation were identified across the zones, together with perceived benefits and barriers. Practices were distinguished as either currently occurring or potential uses.Results
All four zones offered opportunities for everyday activities, care and rehabilitation, including social interaction, recreation, physical activity, contact with nature, health conversations, and assessments. Perceived benefits included stimulation, enjoyment, social interaction, sensory experiences, and contact with nature. However, use was limited by physical, seasonal, organisational, informational, and social barriers. The findings indicate a gap between the opportunities outdoor environments offer and their integration into everyday routines.Conclusion
Outdoor environments are a valuable but underutilized resource in RCFs. Their integration into routine health service delivery requires access to accessible environments, supportive organisational routines, and care workers with sufficient time, knowledge, and support. The identified practices across the four zones may provide practical inspiration for using outdoor environments in everyday activities and person-centred care and rehabilitation.
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BibTeX
@article{liljegren2026integrating,
title = {{Integrating outdoor environments into health service delivery at residential care facilities for older adults.}},
author = {Madeleine Liljegren and Anna Bengtsson and Göran Lindahl and Helle Wijk},
journal = {BMC health services research},
year = {2026},
month = oct,
doi = {10.1186/s12913-026-15852-w},
url = {https://europepmc.org/article/MED/42902269},
note = {CC BY},
}
RIS
TY - JOUR
TI - Integrating outdoor environments into health service delivery at residential care facilities for older adults.
AU - Madeleine Liljegren
AU - Anna Bengtsson
AU - Göran Lindahl
AU - Helle Wijk
PY - 2026
DA - 2026/10/14
JO - BMC health services research
DO - 10.1186/s12913-026-15852-w
UR - https://europepmc.org/article/MED/42902269
AB - Background Outdoor environments may support everyday activities, person-centred care and rehabilitation, and health and well-being among older adults in residential care facilities (RCFs). However, how they can be integrated into routine health service delivery remains underexplored. This study aimed to explore how outdoor environments can support everyday activities and person-centred care and rehabilitation in RCFs, and to identify perceived benefits and barriers to their use in routine health service delivery.Methods A qualitative study was conducted using individual walking interviews with older adults and focus group walking interviews with care workers at three Swedish RCFs. Data were organised according to the model of four zones in contact with the outdoors: indoor environments with windows (Zone 1), transitional outdoor environments (Zone 2), gardens (Zone 3), and the surroundings (Zone 4). Everyday activities, care and rehabilitation were identified across the zones, together with perceived benefits and barriers. Practices were distinguished as either currently occurring or potential uses.Results All four zones offered opportunities for everyday activities, care and rehabilitation, including social interaction, recreation, physical activity, contact with nature, health conversations, and assessments. Perceived benefits included stimulation, enjoyment, social interaction, sensory experiences, and contact with nature. However, use was limited by physical, seasonal, organisational, informational, and social barriers. The findings indicate a gap between the opportunities outdoor environments offer and their integration into everyday routines.Conclusion Outdoor environments are a valuable but underutilized resource in RCFs. Their integration into routine health service delivery requires access to accessible environments, supportive organisational routines, and care workers with sufficient time, knowledge, and support. The identified practices across the four zones may provide practical inspiration for using outdoor environments in everyday activities and person-centred care and rehabilitation.
SN - 1472-6963
ER -