Quarantine restrictions due to COVID-19 and the resultant isolation have caused a myriad of negative effects, especially on the elderly who are dependent on others for both mental and physical support.

The year 2020 brought about not only a staggering death toll across the world due to COVID-19, but also “a year of accelerated unraveling” for fragile older adults living with dementia, according to a Feb. 21 report in the New York Times Sunday Review.

Quarantine restrictions limiting family visits except through windows, social distancing prohibiting congregate meals and physical contact, a lack of re-orienting routines such as physical and mental exercises and exposure to the arts, in addition to keeping people locked in their rooms, likely caused an uptick of emotional and physical problems, including agitation, depression, de-conditioning, and overall failure to thrive.

Tanya Carey, education and Eden coordinator at the Windsor Elms Village in Falmouth, Nova Scotia, observed an increase in challenging behaviors in residents when the home was in strict lockdown at the beginning of the pandemic. “Residents were not able to walk throughout the home and burn off energy,” she said. “There was little spontaneity.”

The residents missed their families and pet therapy. Previous group activities became one-on-one visits with little to no interaction among residents. The garden was no longer used for fun or a place of solace.” Stacey Flint, Montessori community relations coordinator of WindSong Memory Care Communities in Oregon, Washington, and Colorado, noted “significant challenges to adhering to strict lockdown, including more dehydration and weight loss in residents.”

Mental and physical problems also can occur in socially isolated adults living in their homes. The U.S. Centers for Disease Control and Prevention website cites evidence that isolation is associated with a 50 percent increased risk of dementia and other serious medical conditions in community-dwelling older adults.

Antidotes to loneliness and isolation and strategies to increase resilience during the current pandemic have been challenging for adults of all ages, regardless of where they live. Researchers from Spain, Saudi Arabia, the United Kingdom, Norway, and Austria recently revealed evidence for a powerful mental health intervention that is free and readily available to most: contact with nature.

The study found that increasing contact with blue-green spaces in nature was associated with mitigating the negative impacts of COVID isolation, increasing individuals’ resilience, and maintaining positive mental health. Access to private outdoor spaces such as a garden or patio were perceived as most beneficial. The results, published in the November Science of the Total Environment journal, were based on more than 5,000 responses from adults age 26 to over 65 in nine countries during lockdown from the pandemic.

Scientific evidence that spending time outdoors can improve wellbeing is not new. In an email interview, Richard Louv, author of books such as The Nature Principle, Vitamin N, and Our Wild Calling, said there was a paucity of solid studies 15 years ago about the benefits of nature. But the Children & Nature Network that he co-founded in 2006 has compiled a library with summaries of more than 1,000 studies and reports on nature’s impact on children and adults.

Architect Margaret Calkins, PhD, EDAC, FGSA, a nationally recognized trainer and researcher in the field of environments for elders, recently wrote a white paper, Designing Gardens to Attract Activity, to convince administrators, healthcare providers, family members and older adults living in residential homes of the benefits of spaces that help residents get outside regularly.

She cited evidence that individuals in residential settings who go outdoors regularly exhibit less depression. Time spent outdoors reduces stress in nursing home staff as well. Calkins reviewed a horticulture study of older adults in a three-month program of passive and active gardening activities. Depression was reduced and remained lower three months after the program ended. Additional improvements included quality of sleep and ability to concentrate.

Marsha Stamm Gayl, a registered horticultural therapist with a private practice north of Philadelphia, said she conducted nature-based activities for the past nine years in 20 long-term care facilities, working with approximately 200 individuals per month. Beginning in March 2020, she was not allowed into the facilities. “Most long-term care facilities are not allowing their residents to even leave their rooms at this time, let alone be outside in a secure location,” Gayl said. “A lot of it has to do with staffing and the idea that lockdown is interpreted as isolation from the outside, including the outdoors even on their own campus.”

According to Calkins, “There is clear evidence that people are at lower risk of infection when spending time outdoors, practicing social distancing and wearing masks than when following the same precautions indoors. The movement of fresh air dramatically dissipates the density of the number of particles, reducing the risk of infection.”

Susan Rebillet, PhD, who provides psychotherapy for long-term care patients in Dallas, said nature exposure is not encouraged in the facility where she works. “All of the rooms have a view of some sort but because the home is in an urban area, few trees are visible. There is a courtyard with plantings which residents can view but not spend time there due to COVID.”

Pivoting During the Pandemic

Some residential homes have found creative ways to encourage contact with nature during the pandemic, including the Montessori-based communities where Flint works. Residents received individual bucket gardens to tend. For those unable to go outdoors, the buckets are brought to their rooms so they can smell, touch, and feel the plants. The facilities also have enclosed courtyards with planter beds, with two people assigned per planter, and held balance classes in the courtyards in good weather.

Last spring, residents planted flowers in ceramic pots they painted to sell in a drive-through event as a fundraiser. Daily outdoor walking groups are allowed, with social distancing enforced, as well as occasional food truck meals outdoors. The facilities also had outdoor seating for art activities and residents could build snowmen in the winter. Visits to parks and pet therapy still are not allowed, but staff brought their own dogs into the facility for visits.

The Windsor Elms Village in Nova Scotia brought nature indoors prior to the pandemic, with live plants placed throughout the home and a cat and budgie bird (aka parakeet) taking up residence in different homes. Therapy pets still are not allowed, but the home allows family pets during visits.

Resources for Increasing Access to Nature

Susan Rodiek, PhD, professor emerita in the Department of Architecture at Texas A&M University and an expert in therapeutic design for senior living facilities, said three factors make it more likely older adults will access nature:

1. An outdoor area with easy-to-open doors and thresholds that are easy to cross.
2. Comfortable seating.
3. Heaters in winter and devices to reduce humidity in hot weather.

Rodiek created a three-DVD set, Access to Nature, Planning Outdoor Space for Aging, to help providers, policymakers, designers, and advocates create healthy, inviting outdoor environments for seniors in residential settings. She recommends the Seniors’ Outdoor Survey tool as an easy way to evaluate outdoor areas. Based on residents’ preferences and usage, it can help residential care home staff decide what to install or improve. It is free to download through the website: http://accesstonature.org/resources.html

Nature’s Healing Impact

Widow Virginia Davis, who moved from her Ohio home to a retirement community in New Mexico nine months before the pandemic, participated in a virtual expressive writing workshop last fall. On Zoom, she described severe loneliness because she could not visit with new friends due to lockdowns. But, she said, nature got her through. “I coped with the COVID isolation by going out on my balcony every evening to watch the Albuquerque sunset followed by the starry night sky. Without the beauty and constancy of nature, I could not have managed,” she said.

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