Outdoor areas of Australian residential aged care facilities do not facilitate appropriate sun exposureSeeta Durvasula A F , Rebecca S. Mason B , Cindy Kok C , Monique Macara D , Trevor R. Parmenter A and Ian D. Cameron E
A Sydney Medical School Northern, University of Sydney, Kolling Building, Level 7, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia. Email: firstname.lastname@example.org
B Physiology and Bosch Institute for Medical Research, School of Medical Sciences, Building F13, University of Sydney, NSW 2006, Australia. Email: email@example.com
C Garvan Institute of Medical Research, Bone Biology Department, Darlinghurst, NSW, 2010, Australia. Email: firstname.lastname@example.org
D Institute of Bone and Joint Research, Department of Rheumatology, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia. Email: email@example.com
E The John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney Kolling Building, Level 7, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia. Email: firstname.lastname@example.org
F Corresponding author. Email: email@example.com
Australian Health Review 39(4) 406-410 https://doi.org/10.1071/AH14035
Submitted: 16 February 2014 Accepted: 2 December 2014 Published: 2 March 2015
Objective The aim of the present study was to assess whether the outdoor areas of residential aged care facilities used for a sunlight intervention trial had the design features that encouraged participants’ use of these spaces.
Methods The design principles recommended in the ‘Vitamin D and the Built Environment in Victoria’ guidelines were used to assess the outdoor spaces of residential aged care facilities that were used in a randomised controlled trial (RCT) of sunlight exposure. Attendance rates in the sunlight RCT were analysed in relation to global impression scores of the facilities using one-way analysis of variance.
Results Thirty-six outdoor areas of 31 facilities were assessed. The facilities met the guidelines for sun exposure, and were generally safe and accessible. However, many lacked privacy, security and aesthetic appeal. Most of the outdoor spaces were not used for regularly scheduled activities. Attendance rates were higher in those facilities with the highest global impression scores compared with those with the lowest scores (F(2,367) = 3.262, P = 0.039).
Conclusions The physical environment of the outdoor areas of residential aged care facilities was associated with their use for sunlight exposure. Suitably designed or modified spaces have the potential to encourage their greater use, and residential aged care facilities should also plan regular activities in those areas. These measures can facilitate safe sun exposure, as well as physical activity and social interaction in older people.
What is known about the topic? Older people living in aged care facilities have inadequate outdoor sun exposure and vitamin D deficiency. The outdoor spaces of aged care facilities are not well used by residents. Design features that encourage greater use of outdoor spaces have been identified.
What does this paper add? Participation rates in a trial of outdoor sun exposure in residents of aged care facilities were found to be higher in those facilities with better design features in their outdoor spaces. Most facilities do not schedule their regular activities outdoors.
What are the implications for practitioners? Suitable design or modification of outdoor spaces of residential aged care facilities can encourage their greater use. Regular scheduling of leisure and social activities can further promote their utilisation.
Additional keyword: accessibility.
References Jacobs JM, Cohen A, Hammerman-Rozenberg R, Azoulay D, Maaravi Y, Stessman J. Going outdoors daily predicts long-term functional and health benefits among ambulatory older people. J Aging Health 2008; 20 259–72.
| Going outdoors daily predicts long-term functional and health benefits among ambulatory older people.CrossRef | 18332184PubMed |
 Kono A, Kai I, Sakato C, Rubenstein LZ. Frequency of going outdoors: a predictor of functional and psychosocial change among ambulatory frail elders living at home. J Gerontol A Biol Sci Med Sci 2004; 59 M275–80.
| Frequency of going outdoors: a predictor of functional and psychosocial change among ambulatory frail elders living at home.CrossRef |
 Kent J, Thompson S. Health and the built environment: exploring foundations for a new interdisciplinary profession. J Environ Public Health 2012; 958175
| Health and the built environment: exploring foundations for a new interdisciplinary profession.CrossRef | 23028393PubMed |
 Australian Institute of Health and Welfare (AIHW). Residential aged care in Australia 2010–11: a statistical overview. Aged Care Statistics Series no. 36. Catalogue no. AGE 68. Canberra: AIHW; 2012.
 Flicker L, Mead K, MacInnis RJ, Nowson C, Scherer S, Stein MS, Thomasx J, Hopper JL, Wark JD. Serum vitamin D and falls in older women in residential care in Australia. J Am Geriatr Soc 2003; 51 1533–8.
| Serum vitamin D and falls in older women in residential care in Australia.CrossRef | 14687381PubMed |
 Nowson CA, McGrath JJ, Ebeling PR, Haikerwal A, Daly RM, Sanders KM, Seibel MJ, Mason RS. Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust 2012; 196 686–7.
| Vitamin D and health in adults in Australia and New Zealand: a position statement.CrossRef | 22708765PubMed |
 Cutler LJ, Kane RA. As great as all outdoors. J Hous Elder 2006; 19 29–48.
| As great as all outdoors.CrossRef |
 Department of Human Services Victoria. Vitamin D and the built environment in Victoria. A guideline for planners, engineers, architects and policy makers in local and state government. 2009. Available at: http://www.vitamindwiki.com/tiki-download_wiki_attachment.php?attId=1121 [verified 10 January 2014].
 Department of Health, Victoria. Vitamin D and sun exposure. Good practice for quality dementia care. An A–Z of strategies, checklists and tools. 2010. Available at: http://www.health.vic.gov.au/dementia/images/a2z/checklist40.pdf [verified 15 January 2014].
 Sambrook PN, Cameron ID, Chen JS, Cumming RG, Durvasula S, Herrmann M, Kok C, Lord SR, Macara M, March LM, Mason RS, Seibel MJ, Wilson N, Simpson JM. Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial. Osteoporos Int 2012; 23 615–24.
| Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial.CrossRef | 1:CAS:528:DC%2BC38XhtFeksr0%3D&md5=45abcb18d7d4b414aefbe2685c442b09CAS | 21369788PubMed |
 Durvasula S, Sambrook PN, Cameron ID. Factors influencing adherence with therapeutic sunlight exposure in older people in intermediate care facilities. Arch Gerontol Geriatr 2012; 54 e234–41.
| Factors influencing adherence with therapeutic sunlight exposure in older people in intermediate care facilities.CrossRef | 21924507PubMed |
 Rodiek S. Resident perceptions of physical environment features that influence outdoor usage at assisted living facilities. J Hous Elder 2006; 19 95–107.
| Resident perceptions of physical environment features that influence outdoor usage at assisted living facilities.CrossRef |
 Cranz G, Young C. The role of design in inhibiting or promoting use of common open space. J Hous Elder 2006; 19 71–93.
| The role of design in inhibiting or promoting use of common open space.CrossRef |
 Moore KJ, Hill KD, Robinson AL, Haines TP, Haralambous B, Nitz JC. The state of physical environments in Australian residential aged care facilities. Aust Health Rev 2011; 35 412–17.
| The state of physical environments in Australian residential aged care facilities.CrossRef | 22126942PubMed |
 Parker C, Barnes S, McKee K, Morgan K, Torrington J, Tregenza P. Quality of life and building design in residential and nursing homes for older people. Ageing Soc 2004; 24 941–6.
| Quality of life and building design in residential and nursing homes for older people.CrossRef |