The natural gift of caring: a reflection on environmental approaches to care and support.

I’ve mentioned quite a few times over the years about how restorative and important nature is for me, whether that be the countryside or hills, or more recently having the privilege of living by the sea. Sometimes simply walking renews but at other times listening to a podcast adds to the experience.

Earlier this week I listened to what is becoming one of my favourite podcasts. I must confess that I was a late arrival to the world of podcasts but now I appreciate the sheer ease and benefit of getting entertainment, inspiration and knowledge through such an accessible media, whether I am relaxing, travelling or avoiding! One of my favourites has become the BBC’s science podcast ‘Instant Genius.’

My latest one was focussed on the work of Prof Kathy Willis who is the Professor of Biodiversity in the Department of Biology and Pro-Vice-Chancellor at the University of Oxford. I found it inspiring! She was talking about her new book which was published a few weeks ago, entitled ‘Good Nature: The New Science of How Nature Improves Our Health.’ In it she explores the powerful connection between nature and human well-being, drawing on scientific evidence to argue that our interaction with nature has profoundly positive effects on our physical and mental health.

It is a fascinating book full of insights and it started me off thinking about experiences in care homes and in communities. Put simply I think there is very real physiological and neurological benefit in us all becoming more aware of the role that the natural world plays in enhancing our health and wellbeing and I consider that such insights have a lot to teach us about how we have to develop the care and support of older people in the years to come.

I’ll use Kathy Willis’ work to illustrate some of this not least because her work is grounded in robust scientific evidence that demonstrates the impact of nature on human health. I think there are four areas which her work demonstrates which are applicable to care home and homecare provision.

The first is improving mental health. Willis highlights the growing body of research that shows how exposure to nature can reduce stress, anxiety, and depression. She notes work from the University of Exeter Medical School where researchers have shown that living near green spaces or spending time in nature is associated with lower levels of depression, anxiety, and stress. Their study highlights the mental health benefits of access to natural environments in urban settings. She also refers to a study published in The Lancet Planetary Health. This large-scale study, which linked exposure to green spaces with reduced mental health medication use, showed a tangible connection between nature access and improved mental well-being.

I suspect many of us have known the instinctive truth that spending time in green spaces, such as parks and forests, has health benefits but it is really positive to have respected international research to show evidence of lowered cortisol levels (a marker of stress), improved mood, and enhanced cognitive function. In her book Willis delves into the mechanisms behind this, such as how natural environments can restore attention, promote relaxation, and provide a break from the overstimulation of urban life.

For care home providers, this suggests the importance of integrating nature into the daily lives of residents. This could ideally be achieved by creating outdoor spaces with accessible gardens, utilising colour and sensory differentiation for those living with dementia and planted beds at a height which would enable people to continue gardening. Many care homes already have such spaces but if outdoor space isn’t possible then even small indoor areas with plants and trees can offer a calming environment that promotes relaxation and reduces anxiety. Those living in their own homes can be encouraged (or supported) to spend time in nearby parks or outdoor areas and they will evidentially achieve similar benefits from the therapeutic effects of fresh air and greenery.

A related theme in Willis’s work is the physical health benefits of nature. One of the book’s key arguments is that regular exposure to nature can improve physical health. This includes lowering blood pressure, reducing the risk of cardiovascular disease, improving immune function, and promoting physical activity. She shares the insights of ‘Forest Bathing’ (Shinrin-yoku) in describing the research of Dr Qing Li  from Japan, which demonstrates how spending time in forests can lower stress levels, reduce cortisol concentrations, and boost immune function by increasing natural killer cells in the body. This work highlights the physiological and psychological benefits of immersion in natural environments.  She also references studies on phytoncides, organic compounds released by trees, which have been shown to lower blood pressure and improve overall cardiovascular health when inhaled during time spent in forests.

A further study from the University of East Anglia reviewed data from over 140 studies involving more than 290 million people and found that spending time in green spaces was associated with reduced risk of cardiovascular disease, lower heart rates, and lower rates of premature death.

Willis emphasises that access to nature encourages people to be more active, whether through walking, hiking, or other outdoor activities, which directly benefits physical health. Her research and that of others would suggest that for care home residents, particularly those with limited mobility, even moderate interaction with nature can have significant health benefits.

But it is perhaps when we move into a cognitive and neurological realm that nature comes into its own according to Willis. Many of the studies she quotes relate to children, but I would suggest there is a potential benefit in similar research for older adults. For children she cites work from the Barcelona Institute for Global Health which shows that children who have regular exposure to green spaces perform better on cognitive tests, have better attention spans, and show fewer signs of attention deficit hyperactivity disorder (ADHD). This research supports the idea that natural environments enhance children’s cognitive development and mental well-being.

In addition, studies from the US and Scandinavia show outdoor play in natural settings, like school gardens or green play areas, helps foster creativity, problem-solving skills, and social cohesion among children. Why would there not be similar cognitive benefit for older adults?

Indeed, Willis suggests that exposure to nature, particularly for older adults can help improve attention, memory, and cognitive function, making it a valuable resource for those living with dementia or other cognitive impairments. As many practitioners in care home and community care know this can be achieved through cognitive memory activities or using the natural world to manage agitation and confusion. Providing access to outdoor areas, with calming elements like water features or gentle landscaping, can and does reduce anxiety and restlessness.

Fourthly, as a leading advocate of bio-diversity Willis has a lot to say on this subject as it relates to immunology, which is one of our major challenges in residential care and support environments as well as care and support for older persons in the community. She explores the “biodiversity hypothesis,” which suggests that exposure to biodiverse environments can improve immune system functioning. She cites research from the University of Helsinki’s Immunological Department indicating that people who spend time in biodiverse green spaces have stronger immune responses, in all likelihood because they are exposed to a wider range of microbes, which helps “train” the immune system to be more adaptive and less prone to inflammatory diseases like allergies and asthma. She quotes research from Finland that showed children who attended daycare facilities with biodiverse outdoor play areas had significantly higher immune system activity and fewer incidences of inflammatory conditions compared to those in urban, less biodiverse settings.

Willis’s work has many insights but also contains no little challenge especially for urban designers and architects. Her challenge is as valid for care home and residential support developers as any others. In her study she addresses the issue of unequal access to nature, noting that disadvantaged communities often have less access to green spaces, which can exacerbate health inequalities. She advocates for better urban planning and policy changes to ensure that everyone, regardless of socioeconomic background, can benefit from nature’s health-boosting effects.

I found Willis’s work stimulating and thought-provoking – in many senses it portrays nature and the natural world as a prescription for wellbeing. Indeed, she explores the concept of “nature prescriptions”, where she cites some of the work of NHS Scotland which has explored the potential of nature-based interventions to reduce healthcare costs, with preliminary findings showing that patients who engage in nature-based activities, such as walking in parks, have better health outcomes, reducing their reliance on medication for conditions like depression, anxiety, and cardiovascular disease. Willis presents this as a growing trend backed by scientific evidence and discusses how it could become an integral part of preventive health and social care.

In Good Nature, Kathy Willis makes a compelling case for the vital role that nature plays in enhancing both mental and physical health. She calls for more research, better access to nature, and policy changes that recognise nature as a fundamental element of human well-being. Her work argues that reconnecting with nature is not just a luxury but an essential part of a healthy life, advocating for integrating green spaces into everyday environments to benefit all.

The challenge for care home and homecare providers is self-evident – how do we grasp it and make the natural world an ally in our care and support? How do we put nature into the heart of our care planning and support, our service offer and pattern of care? How do we maximise the potential of nature as therapy, incorporating elements of “green therapy” or “horticultural therapy” into care programmes to enhance both physical and emotional well-being, allowing residents or home care clients to benefit from hands-on engagement with nature?

Nature should not be seen as an optional or secondary consideration but as an essential part of promoting well-being. Whether through creating accessible green spaces, encouraging outdoor activities, or using nature-based therapies, care providers have the opportunity to transform the care and support experience by reconnecting residents, those who live in our communities and the care and support workforce with the natural world.

Donald Macaskill

Photo by v2osk on Unsplash