Wandering
in the
Woods
A Visit Woods pilot
project July 2011
Neil Mapes
Wandering in the Woods
Dementia Adventure 2011
Wandering in the woods
1
Acknowledgements
We would like to extend our warmest thanks to all the people living with dementia, their family
carers, the care staff and volunteers from Caring Homes who took part in and made this
project possible.
We would also like to thank Tony Vale and Gail Graham for supporting the initial idea and
design of the partnership agreement for this pilot project. We would like to thank Jill
Attenborough, Shona Morton, and Jane Craven from the Woodland Trust who gave their time
to support each of the respective woodland visits.
We would like to thank Rachel Hine (University of Essex) and Garuth Chalfont (Chalfont
design) for their advice and support with this report.
Finally we would like to thank the staff at the three woodland locations who welcomed our
groups at Hylands House in Chelmsford (owned by Chelmsford Borough Council), Sheffield
Park National Trust and the Westonbirt Arboretum (owned by the Forestry Commission)
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1. Executive Summary
This report details a pilot project called „Wandering in the woods‟ which was
delivered by Dementia Adventure from April to June 2011. This project was
funded by the Woodland Trust as part of the Visit Woods project
(www.visitwoods.org.uk) and delivered in partnership with Caring Homes
(www.caringhomes.org) across three locations in Essex, East Sussex and
Wiltshire. This written project report is accompanied by three short films of
the woodland visits which are available at www.dementiaadventure.co.uk.
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Designing and delivering this project has been a pleasure and an inspiration.
The act of re-connecting people living with dementia in care homes with
nature, and in particular, with woodlands, is a simple idea yet one capable of
transforming how we understand and treat dementia. This pilot project has
shown that there are potentially very significant physical, emotional and social
benefits to people living with dementia visiting woods and being active out in
nature.
The findings in this report indicate that there is a compelling need for a larger,
more scientifically rigorous investigation into the specific benefits of
woodlands and other outdoor environments for people living with dementia in
care home settings. Specifically, the potential cost-benefits are huge,
primarily in helping to dramatically reduce use of anti-psychotic medication
and reducing the frequency and severity of anxiety, apathy, anger and
depression which all too commonly predominate in long term care settings.
These can occur with less frequency out in nature, and after exposure to
nature. At a time when we are trying to reduce the use of anti-psychotic
medication and unnecessary hospital admissions, getting people out into
nature is potentially a significant non-pharmacological treatment which is
accessible and readily available for all people living with dementia.
This pilot project has specifically contributed to the meeting of three outcomes
as identified by Access to Nature (see appendix 4), which are evidenced in
the benefits below and are:
 People experiencing social exclusion feeling better physically or
mentally through accessing woodlands
 Access to woodlands for leisure/recreation is improved through
investment in information and on line resources
 Key partner organisations have the requisite knowledge to support
target groups in accessing woodlands for leisure/recreation
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1.2 Physical benefits
We have captured a broad range of qualitative evidence from this pilot project
which indicates the potential physical benefits for people living with dementia,
these include:
 Improved sleep
 Improved dietary intake
 Improved activity and exercise levels
 Multi-sensory engagement and associated joy
 Increased verbal expression
 Improvement in memory
We also captured a range of quantitative data, the most significant finding of
which showed that only 1 participant rated exercise as „very important‟ before
the woodland day out and 12 participants rated exercise as „very important‟
after the day out, representing a 41% increase as a result of the woodland
visit.
“I would be happy to walk as much as is allowed”
“You start looking again don‟t you?”
“Listening to the birds was lovely”
“I don‟t care how cold it is, I like the fresh air”
(People living with dementia)
“I know she is taking it all in”
(Family carer)
“I am struck by how long people have been awake for…people have talked more as the
day went on…We were outside nearly three and a half hours and the concentration and
energy levels were amazing.”
“Having spent many afternoons visiting a relative in a care home conversation so quickly
ran out because there was nothing to talk about other than news we had stored up and
brought with us. Here there was stimulation all around us.”
“It was lovely to see at least some of the residents eating heartily, sharing in the picnic. The
laughter, talk and beautiful surroundings all meant that eating became just another nice
part of the experience rather than the sole focus and something they must do.”
(Woodland Trust Staff members)
“People sleep better when they‟ve been out…people talk more, eat more, it gives them an
appetite…and they live longer”
“Patricia (resident) the following day came out of her way to thank me for taking her out
saying what a lovely day she had. Patricia still recalls the day, only yesterday she
commented to her daughter about her day at the woods. The care staff who came along
also noticed how relaxed everyone was and how at peace the residents were during and
on return.” (Caring Homes Staff members)
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1.3 Emotional benefits
We have captured a broad range of qualitative evidence from this pilot project
which indicates the potential emotional benefits for people living with
dementia, these include:
 Mood enhancement
 Spiritual uplift
 Stronger sense of self
 Having more control
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“Amy cried with happiness upon welcoming her in the Willow circle outdoor
classroom”
(Dementia Adventure volunteer)
"I felt alive, wonderful day! I remember the arch way with all the flowers hanging
down, I cannot walk and need help from kind people to take me these places
and relieved that it can happen”
“The height of love and bliss, getting out”
“It is so peaceful”
“I don‟t like being told what to do I like being asked”
“I was in the Ramblers, always enjoyed walking”
(People living with dementia)
“Mum was always an outdoors person, a country girl, and loves to get out”
(Family carer)
“The delight on one lady‟s face who couldn‟t communicate much verbally was
wonderful. She reached out and touched and for a short time was in control of
what she wanted to do – she wanted to be amongst the flowers and delight in
them…”
“One lady became more independent as she walked along requiring less input
from her carer; another lady became less anxious and more relaxed as we
wandered along the tree lined paths.”
“…the visible lifting of spirits as people realised where they had come to and that
it wasn‟t going to be difficult or demanding or scary, just relaxing and stimulating
and outdoors”
(Woodland Trust staff)
“She (Rosie) has not stopped smiling and talking about the day since she came
home asking to go again she said „so much to see ducks , flowers , trees so
exciting and made me feel very happy.‟"
(Caring Homes staff)
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1.4 Social benefits
We have captured a broad range of qualitative evidence from this pilot project
which indicates the potential social benefits for people living with dementia,
these include:
 Sense of belonging
 Sense of friendship and kinship
 Community presence and activity
 Co-incidental positive social encounters
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“Lucky to have had a nice time in the sun walking with nice people”
“Lovely to have the children along”
“Part of the joy has been all ages”
“Lovely wandering around together…on the same wavelength…friendly”
“I like to be out…usually bunged up somewhere.”
“It is important to get out into the larger world and community so you don‟t get
shut away.”
“Got to come out into the world to see what is going on”
(People living with dementia)
“Even the changing temperature was a reason for people to be individuals – I am
a little chilly...do you like the direct sunshine?”
“I guess „normal‟ encounters with everyday folk are fairly few and far between for
most residents, a trip outside makes it possible. The wedding was an added
bonus and made us all feel part of something together”.
(Woodland Trust staff)
“This day, like the Hylands day, coincidentally finished with the group witnessing
a wedding congregation in the grounds. Being part of these community spaces
allows coincidences like this to happen naturally.”
“…many enjoyed staying out in the rain rather than retreating indoors (as can be
the case when residents go out in the garden of the home and it rains)”
(Dementia Adventure Staff)
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1.5 What we learned
We have learnt a lot about the importance of nature and of woodland settings
to people living with dementia in care settings. We learnt how important it is
simply to get out of the home and into nature. We learnt a lot about what
makes a good woodland visit and in conducting „light-touch‟ research. This
pilot phase has laid the foundations for a larger piece of work and research.
Specifically we have learnt:
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Venues and walking paths which are wheelchair friendly are not
automatically dementia friendly.
Venues which have natural resources and green environments have
not yet fully considered people living with dementia as potential
users/customers/partners and appear to lack dementia specific
knowledge and expertise to successfully engage people with dementia
in the way they have done with other groups.
A well designed circular walk is an essential element of a successful
woodland visit. The elements of this include: key
features/trees/landmarks along the route, choices of direction along the
route, stopping places to appreciate trees and share information,
access to facilities (such as toilets, cafe and wheelchairs) and
undercover space.
Outdoor „classrooms‟ with circular seating work better for group
dynamics than traditional picnic table seating.
Sharing food outside together worked well in establishing a positive
group dynamic.
Creative and entertaining information boards are an important element
of enabling people living with dementia to enjoy a woodland visit.
Special invitations to get out of the care home are important, as is
welcoming and appreciating people on arrival in the woodland setting.
Enabling people to get out into nature shows them that they matter.
It is important that people with dementia are visible active members of
our communities.
The simple and easy equality that is found in natural settings is helped
by a diverse group of ages.
The children brought another dimension to the day; it eased everyone
into a family atmosphere, bringing the group together as one: staff,
residents, family and friends.
Like nature, people blossomed and bloomed as the day progressed,
terror and anger being replaced by friendship and joy.
The activity out in woodland settings enabled people living with
dementia to positively re-frame their understanding of what „exercise‟
means.
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Finally, perhaps most importantly, we have learnt that family carers
play a crucial role in maintaining a regular connection with nature for
their loved ones which can preserve the emotional bonds they share.
“The most memorable part of the day was the gratitude of one of the relatives
who was genuinely appreciative of the day and what it had enabled his relative to
experience. He so wanted to tell his own daughter about the day, and get her to
see the video clips so that she could see her grandmother on this day out, being
a different person to how she was in the home. This sentiment was echoed by
the care staff who also stated that they could see the residents come out of
themselves and acting differently.
A positive and thoroughly enjoyable day for everyone.”
(Woodland Trust staff)
2. Project Background
2.1 Why Woods?
Woods are a fantastic, low cost resource for leisure and health but they‟re
sometimes overlooked when we‟re planning a day out. Over half of us live
within 4 km of a wood. There are nearly 14,000 woods in the UK which
welcome visitors, and www.visitwoods.org.uk makes it easier than ever to find
somewhere new to explore.
Woods have something for everyone. No two places are the same and
visiting the woods is a real breath of fresh air if you usually meet indoors.
Spending time outdoors together is a great way to get your group talking or
sharing experiences and memories. Visiting together can also help group
members gain the confidence to enjoy the great outdoors independently.
Research shows1 spending time in green spaces is great for our physical and
mental health. Woods specifically offer us space to:
• relax away from noise and stress
• spend time with friends or family
• exercise at our own pace
• connect with nature
• try new activities
• indulge all of our senses
• enjoy our hobbies somewhere new
• be ourselves
1 A collection
of the most up to date research on the general benefits of ‘green exercise’ can be found at
www.greenexercise.org
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Woods are different every time we visit. Each season brings different wildlife,
plants, sounds, and sensations - a real feast for the senses. For a shady spot
on a hot day or a scenic trail for a winter stroll woods are ideal.
For people looking to try something new, www.visitwoods.org.uk helps groups
of all kinds to find places ideally suited to their needs. .
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2.2 Pilot Project
Wandering in the Woods is the title of this pilot project which was designed
and delivered collaboratively between three partner organisations: the
Woodland Trust (as part of the Visit Woods project), Dementia Adventure CIC
and Caring Homes respectively.
This paper reports back on the pilot project delivery which took place between
April and July 2011. It shares resources, evidence, information and case
studies to inspire and inform people living with dementia (and the families and
staff in care settings who support them) of the benefits of visiting woods and
of getting out and connecting with nature.
This project builds on the author‟s previous research (Mapes 2011), titled
Living with Dementia and connecting with nature which explored the benefits
of green exercise for people living with dementia. This research highlighted
the need for a green exercise project in care homes. The University of Essex
defines green exercise as "engaging in physical activity whilst simultaneously
being exposed to nature."
This pilot project also uniquely combines the substantial experience Caring
Homes staff has in supporting their residents to enjoy outings away from the
home, the expertise Dementia Adventure has in assessing, designing and
delivering adventures, and the national reach and focus of the Visit Woods
project.
“The partnership between Visit Woods, Dementia Adventure and Caring Homes
is so important in demonstrating that accessing green space can significantly
improve the quality of life of people with dementia. This pilot project has
demonstrated how vital it is to provide access to the outdoors for all.
VisitWoods.org.uk is designed to inspire people to visit their local woods and
provides information to enable them to do so more easily. This is crucial for
helping people with specific needs ensure they have the confidence to go ahead
and enjoy their visit.”
Gail Graham, Project Manager, Visit Woods.
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2.3 Visit Woods and the Woodland Trust
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VisitWoods.org.uk is the only UK website where you can find almost all of the
woods in the UK you are welcome to visit, no matter who owns them. This
website is part of a wider Visit Woods project which aims to inspire people to
discover woods and the many benefits they have to offer. Visit Woods is a
partnership project, led by the Woodland Trust which receives funding from
Natural England (through their Access to Nature programme, part of the Big
Lottery Fund Changing Spaces programme).
The Woodland Trust is the UK‟s leading woodland conservation charity with a
vision to see a country rich in native woods and trees enjoyed and valued
enjoyed by everyone. It aims to:
 plant more native trees
 protect native woods, trees and their wildlife
 inspire everyone to enjoy and value woods and trees.
2.4 Neil Mapes
The author of this report has a background in Clinical Psychology and has
volunteered and worked in a wide variety of health and social care positions
since 1994. He has led and established a variety of innovative projects and
initiatives including one of the first Alzheimer's cafés in the UK, a specialist
outreach service for younger people with dementia, new qualifications in
mental health, mental capacity advocacy, and multi media research into the
social exclusion of older people. He was also a consultant on Dementia
Choices (a recent Mental Health Foundation project exploring self-directed
support). Neil co-founded Dementia Adventure and is a 2010 Clore Social
Fellow, an UnLtd Fellow and a Visiting Fellow at the University of Essex.
2.5 Dementia Adventure Community Interest Company (CIC)
Dementia Adventure provides adventure travel and short breaks for people
living with dementia. It is also a leading voice in a social movement which is
positively re-framing dementia. Dementia Adventure has a vision of society in
which people live well with dementia, are connected to nature, and enjoy a
sense of adventure. A society where people enjoy a full range of activities,
have strong relationships with people in their communities and have access to
places connected to their interests, passions and dreams. In addition to
providing a range of local, national and international adventures Dementia
Adventure also provides training, consultancy and research with individuals
and organisations who wish to enable people to live well with dementia.
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Dementia Adventure is a community interest company, which means it
operates for the benefit of the community rather than for the personal gain of
those involved. For more information on Dementia Adventure CIC, please call
01245 269 769 or visit the website www.dementiaadventure.co.uk.
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2.6 Caring Homes
Caring Homes is one of the UK‟s largest and well respected independent care
homes group. Founded in 1994 by Helena Jeffery, with the purchase of
Bradbury House in Essex, the Caring Homes Group now owns and runs more
than 100 care homes in England and Scotland. Caring Homes is an award
winning quality accredited provider of personalised professional nursing care,
social care and specialist dementia care to older people who would benefit
from a period of short term respite care through to a tailored long-term care
solution. A number of Caring Homes provide specific care for people living
with dementia. For more information on Caring Homes please visit
www.caringhomes.org
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3. Introduction
There is a fundamental need and desire for all of us to have contact with and
connection with nature. Our connection with trees and woodlands is ancient,
emotional and practical. Yet our many native woodlands are under threat,
need conservation and individuals find it difficult to access or fully benefit from
being in woodlands and around trees. There is an increasing bank of
scientific evidence that confirms what we already know - that the natural
environment, including woodlands, is good for us (Mayer et al, 2009). Kaplan
said that the natural world satisfies our need for contemplation, escape,
restoration and distraction (Kaplan 1995). People living with dementia in care
settings could perhaps be one of the groups in our society most in need of
contemplation, escape, restoration and distraction. This pilot project has
enabled three groups of care home residents living with dementia, (with
support from staff, volunteers and family carers) to get out of the care home,
to re-connect with nature and to enjoy the many benefits of woodlands. What
do we know about the benefits of nature, exercise and activity outdoors for
people living with dementia?
3.1 Benefits of Nature
It is well known that exposure to natural places leads to better mental health
whether it be a view from a window (Ulrich, 1984), being in nature (Pretty et
al, 2005), or exercising in these spaces (Pretty et al, 2007). There are clear
benefits to green exercise for a wide variety of people, these benefits include
improved self-esteem and improved mood, and often these benefits can be
experienced from as little as five minutes in nature (Barton and Pretty, 2010).
The Mental Health Foundation's report "Moving on up" identifies the following
advantages of exercise - exercise is cost effective, is available, there are coincidental benefits (e.g. healthier muscles and joints), is sustainable, promotes
social inclusion and is popular (Mental Health Foundation, 2009). The
Government have recently outlined an extensive range of commitments to
valuing the natural environment in a white paper called “The Natural Choice
securing the value of nature.” Chapter 4 of the white paper specifically details
reconnecting people and recognises the health benefits of spending time in
the natural environment. The executive summary tells us:
“Nature is sometimes taken for granted and undervalued. But people cannot
flourish without the benefits and services our natural environment provides. Nature
is a complex, interconnected system. A healthy, properly functioning natural
environment is the foundation of sustained economic growth, prospering
communities and personal wellbeing.”
(HM Government, 2011, page 3.)
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3.2 Accessing Woods and Walks
Visit Woods estimates that 33 million people in the UK live within 4km of a
large wood that welcomes visitors2. Often these spaces are cost free and
don't have opening and closing times. Increasingly, organisations such as
Natural England with Walking for Health3 and their campaign Our Natural
Health Service4 are encouraging everyone to make use of their local green
space and the benefits this brings. Walking for Health are volunteer
supported walks which people can join bringing the additional benefit of
meeting and talking to new people, re-establishing community connections
and people‟s ability to support one another outside of formal service provision.
Dementia Adventure CIC similarly has successfully designed green exercise
programmes specifically aimed at people living with dementia (Mapes 2010).
3.3 Dementia and Nature
Dr. Garuth Chalfont found that nature based experiences are, perhaps
unsurprisingly, therapeutic for people living with dementia. Chalfont states in
his prosentia hypothesis “that if a person with dementia has a sensory
connection to nature in a supportive relationship with another person, then
interaction within this triangular dynamic can help the person to maintain a
sense of self,” (Chalfont, 2006). Fundamentally this pilot project brought
people living with dementia together with the people who support them to
connect with nature and so supports this hypothesis. But often we forget that
nature is a valuable non-pharmacological therapy. Nature based experiences
can be restorative or healing, contributing to the emotional, psychological and
spiritual intangibles of well-being (Chalfont, 2006). Edward Wilson used the
term biophilia (literally a love of living things) and proposed the possibility that
the deep affiliations humans have with nature are rooted in our biology
(Wilson, 1984). More recently, Professor John Zeisel says in his groundbreaking book on Alzheimer‟s disease:
"It is likely that the need for contact with the natural environment and the feelings
we have about nature and being outdoors are hardwired, partly because this is a
source of food. Sunshine, flowers, shade, moonlight and trees are all so much a
part of our basic nature that no one has to be taught to respond appropriately to
such stimuli. Again not surprisingly, gardens and nature are much appreciated by
those with the illness."
(Zeisel, 2009, page 62)
Connection to nature can enhance verbal expression in people living with
dementia (Chalfont, 2006). Chalfont identified in the same research that
2
3
www.visitwoods.org.uk
www.whi.org.uk
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www.naturalengland.org.uk/ourwork/enjoying/health/ournaturalhealthservice/default.aspx
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nature based activities for people living with dementia can bring joy and
sensory stimulation. He also found that family and professional carers play an
important role in enabling a person living with dementia to maintain a
connection to nature by overcoming obstacles (Chalfont, 2006). Family
carers and professional carers were a fundamental part of this pilot project.
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3.4 Dementia and Exercise
Green exercise can enable individuals living with dementia to feel well and
experience a “dampening down” or absence of their dementia related
symptoms (Mapes, 2011). The simple act of walking is important in enabling
us to feel well, forget about our illnesses and remain active. Exercise is one
of five factors which have a strong evidence base for reducing the risk of
dementia (Bradley, 2010). This year the work of Dr. Erickson and colleagues
showed that regular walking can increase the size of the hippocampus region
of the brain and improve memory, their work was widely covered by the
world‟s media (New York Times, 2011). Studies which have concentrated on
green exercise or activity with people living with dementia have shown that
there have been improvements for people living with dementia in terms of
better sleep patterns (Brooker et al, 2007), longer sleep duration (Connell,
2007), better continence and mobility (Brooker et al 2007) and eating patterns
(De Bruin et al, 2010). Whilst the benefits of nature are at times intuitive and
have been widely evidenced we don't yet have a strong sense of how these
benefits might apply to the wide range of people living with dementia,
particularly those living in care settings.
"While progress has been made in terms of our understanding about the
importance of outside spaces for people with dementia and of the benefits
of being outside in terms of mobility, sleep patterns and well being, there
is still much to be done"
(Moriarty, 2006)
This project aimed to bring together people living with dementia from care
settings, the staff which support them and their family carers and for them all
to enjoy a woodland walk out in nature. We set out to make each woodland
walk enjoyable and successful whilst at the same time capturing information
that could inform and inspire others of the benefits of this approach.
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4. Methodology
We used the „participation appraisal‟ method, which is further explained below
but was chosen because of the four common principles of participatory
methods as highlighted by Pretty and Hine (Pretty and Hine 1999):
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1. It is a systemic and group learning process – we wanted to inquire
together as a group, interacting with each other and nature
2. Multiple perspectives of stakeholders – we wanted to seek a diversity
of views of residents, relatives, staff and volunteers
3. Facilitation leads to transformation – we wanted to transform existing
activities offered to people living with dementia
4. Learning leads to sustained action – by learning together in this way
future action is more likely
4.1 Caring Home pilot site selection
Initially the design of this project allowed for one pilot location to be chosen
and for a walk to be designed and delivered in a woodland in May (one of the
best months of the year for woodlands), with the possibility of two further pilot
locations being selected later in the year to take advantage of autumnal
colours. However, interest in the project quickly grew and three Caring
Homes locations were identified both by Caring Home head office and by selfselection as those who:
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Had a successful track record of providing outings from the home
Had recent experience of nature based outings with residents
Had an experienced activity co-ordinator willing to be the local lead
Were located within a short drive (up to 45 minutes) of a potentially
suitable woodland(s)
Wanted to be part of new pilot project
The three Caring Home pilot locations were selected as:
1. Bradbury House in Essex (also the first home owned by Caring
Homes)
2. Heffle Court in East Sussex
3. Ferfoot in Wiltshire
4.2 Woodland venue selection
Once the Caring Homes pilot sites were selected the Visit Woods team
quickly identified the best local woodlands using the following criteria:
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The woodland was listed on the VisitWoods.org.uk website
Within a 45 minute minibus journey from the Caring Home
Disabled parking
Accessible toilets
Accessible (wheelchair-friendly) paths
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Inside spaces
Woodland and green spaces
Catering or café facilities
Beautiful locations to spend a day out in nature
The three Woodlands chosen met all these criteria. In choosing the three
woodland locations we also wanted to visit woodlands which were not owned
by one single organisation, thus increasing the scope for learning. The three
woodlands chosen were:
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1. Hylands park in Essex (owned by Chelmsford Borough Council)
2. Sheffield Park in East Sussex (owned by the National Trust)
3. Westonbirt Arboretum in Gloucestershire (owned by the Forestry
Commission)
4.3 Participant appraisal question and data gathering
The participant appraisal questionnaire was designed to gather the following
data:
 Age
 Gender
 Status (resident, relative, staff or volunteer)
 Responses to the statement “I can enjoy life” - this being one of the
National Dementia Strategy Quality Outcomes (Department of Health,
2010)
 Responses to the statement “I get the treatment and support which are
best for me” - this also being a National Dementia Strategy Quality
Outcome (Department of Health, 2010).
 Responses to how important different aspects of a woodland visit were
to people including: scenery, wildlife, being part of a group, being on
my own, exercise, fresh air, getting out of the home, independence and
self-identity.
This data was gathered twice for each pilot location. Both before the
woodland walk had taken place on the Caring Home pre-planning visit (see
below), and secondly during (towards the end) of the woodland walk itself.
The data gathering itself was done by pictorially drawing charts and boxes on
large flip charts and individuals being shown and supported to put stickers in
the relevant boxes. Individuals were given post-it notes to stick on the charts
recording their comments and staff collected and recorded post it note quotes
on the charts too. This process was carried out both with individuals and
small groups at the Caring Home locations and again at the Woodland
locations. Participant appraisal flip chart examples are shown below:
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4.4 Assessment and design visits
Dementia Adventure visited each woodland location ahead of the group‟s visit
to the woodland. The purpose of this visit was to:
 Gather details about the specific features and benefits of the venues
and woodlands
 Take photographic imagery to share with the residents, families and
staff at the homes
 Design and plan different options for the entire day and for a „dementia
friendly‟ walk to be discussed and agreed with the Homes
 Carry out a risk/benefit assessment of the visit to the woodland
4.5 Pre-planning and design with Caring Homes
A pre-planning visit was also undertaken by Dementia Adventure to each of
the Caring Homes taking part in the pilot project. The purpose of these visits
was to:
 Inform and inspire residents, families and staff about the Visit Woods
project and about the planned day out itself (including sharing
photographic imagery and walk route information)
 Gather interest in the day, share information and discuss the pilot
project and complete consent forms for all participants
 Build upon the home‟s previous experiences in planning and delivering
days out in nature for residents
 Co-design an overall plan for the visit to the woodland including
timings, transport, entry fees, lunch and walking routes
 Inform the risk/benefit assessment process (see below)
 Gather data for the participatory appraisal process
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4.6 Conducting the Walks
Each of the three visits to the woodlands was conducted to a broadly similar
time framework which involved:
 1130 – arrival at the woodland location
 1145 – welcome, appreciation and information provision
 1200 – picnic lunch
 1300 – 1500 woodland walk
 1500 – data capture
 1530 – depart the woodland location
Timings for each walk differed slightly across each location, but the central
themes which were common in the delivery of the walks were:
 At least a 1:1 ratio of people living with dementia to supporters
 Minibus transport to and from the venue
 Dementia Adventure led the day and the walk itself
 A circular walk in the woodland starting and finishing at the central
facilities
5. Results
5.1 Participant data
Participants in this pilot project (excluding Dementia Adventure staff and
volunteers who were present at all three events) totalled 52. A full breakdown
of participants and related data is below.
NB: Sums do not total in all cases as some people did not answer all
questions and before and after groups varied in their composition.
5.2 Pre-planning Visit Woods visits
Across the three pre-planning visits, to each of the Caring Homes, we
gathered participatory appraisal data from:
Males
Females
Age range: <60
Age range: 60-69
Age range: 70-79
Age range: 80-89
Age range: 90-99
Number of residents
Number of family carers
Number of staff
Total number of participants
4
24
3
3
2
14
2
15
9
4
28
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5.3 Visit Woods days out
Three woodland days out were held during May and June 2011 with the
following numbers of attendees:
18
Day out
Residents
Family carers
CH staff and
volunteers
WT
DA staff and
volunteers
TOTALS
Hylands
7
2
8
Sheffield park
9
5
6
Westonbirt
8
2
2
1
3
1
3
1
4
21
24
17
CH: Caring Homes
DA: Dementia Adventure
WT: Woodland Trust
There were 7 people using wheelchairs (for some or all of the time) on the
Hylands day out, 4 people on the Sheffield park day and 5 people on the
Westonbirt day respectively.
On the Sheffield park day there were three children part of the group (ages 16
months, 5 years and 10 years). On the Westonbirt day there were two
children (ages 16 months and 5 years) part of the group.
5.4 After (during) the VisitWoods day out
Across the three visits to the Woodlands we gathered participatory appraisal
data from:
Males
Females
Age range: <60
Age range: 60-69
Age range: 70-79
Age range: 80-89
Age range: 90-99
Number of residents
Number of family carers
Number of staff
Total number of participants
6
21
10
4
4
5
2
12
6
9
27
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Dementia Adventure 2011
NB. The total number of participants on the day out differs from the total
numbers of participants involved in the pre-planning visits because these
groups were not strictly set and tracked.
5.5 Question breakdown
We used the following rating scale for question 1 and 2:
19
1: None of the time
2: Rarely
3: Some of the time
4: Often
5 All of the time
We asked participants to rate two statements with the following breakdown of
results.
5.5.1 Question 1: I can enjoy my life
Before
Rating 3
Rating 4
Rating 5
Total
No.
3
11
12
26
%
12
42
46
100
After
Rating 3
Rating 4
Rating 5
Total
No.
2
5
6
13
%
15
38
46
100
NB. No scores given for rating 1 or 2.
Comments from question 1:

Just be happy where you are
5.5.2 Question 2: I get the treatment and support which are best for me
Before
Rating 3
Rating 4
Rating 5
Total
No.
2
5
8
15
%
13
33
53
99
After
Rating 3
Rating 4
Rating 5
Total
No.
0
0
10
10
%
0
0
100
100
NB. No scores given for rating 1 or 2.
Comments from question 2:


I have to rely on other people because I can‟t walk, people are so kind. If you
get asked to go you don‟t have to ask, and you can say no
I want to get out to the seaside
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Dementia Adventure 2011

People were lovely and kind
5.5.3 Question 3: How important is each of the following about visiting
woods/getting out into nature?
We used the following rating scale for question 3:
20
1: Not very Important
2: Not important
3: Neutral
4: Important
5: Very important
5.5.4 SUMMARY DATA
Before
Rating
After
1
Scenery
Wildlife
Being part of
a group
Being on my
own
Exercise
Fresh air
Getting out of
the home
Independence
Self-identity
2
3
3
1
4
5
2
13
9
8
2
3
5
2
3
1
1
12
9
%change
in 5
rating
1
2
3
4
5
2
12
12
10
-2
+12
+8
1
6
+4
1
12
11
13
+41
-1
+16
9
11
+15
+27
1
1
2
1
5
4
NB. Sample size before: 28, sample size after: 27. Not all participants
completed all ratings for question 3.
Scenery
13 participants rated scenery as very important to them before the day out,
with 12 participants after the day out, representing a 2% drop in participants
rating scenery as very important.
Comments before:


It is important to get out for a change…a change of scenery
I love all those [the trees]
Comments after:
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21














You wouldn‟t find many places like this…beautiful
I like the life of the trees and gardens
I‟d like to come again, I don‟t mind how many times because I love it here
I know she is taking it all in
A lot to see so many colours
It‟s been a good morning for everybody, I enjoyed the plants
You start looking again don‟t you
All green up there [tree canopy]
Lovely flowers aren‟t they?
She just kept mentioning all the colours and the beautiful flowers
It‟s lovely isn‟t it
It‟s lovely coming here I want to come back
It‟s a privilege to get out to places like this
It‟s certainly a great place
Wildlife
9 participants rated wildlife as very important before the day out with 12 rating
it as very important after the day out, representing a 12% increase in
participants rating wildlife as very important.
Comments before: None
Comments after:




Enjoyed all the animals we‟ve seen – ducks, coots, the rabbit and lots of
flowers weren‟t they beautiful
Tame ducks
You are my honeysuckle I am the bee
Listening to the birds was lovely
Being part of a group
8 participants rated being part of a group as very important before the day out
and 10 participants after the day out, representing an 8% increase in
participants rating being part of a group as very important.
Comments before:



If you are on the same wavelength then it is nice to be part of a group…it
depends on who you are with
Not necessarily any group…a person who you are in sympathy with
In places I do not know I want people with me
Comments after:




Lucky to have had a nice time in the sun walking with nice people
Lovely to have the children along
Part of the joy has been all ages
Lovely wandering around together…on the same wavelength…friendly
Being on my own
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Dementia Adventure 2011
5 participants said being on their own was important before the day out and 6
participants after the day out, representing a 4 % increase in participants
rating being on my own as very important.
Comments before:

I‟m fed up going out on my own that is one thing I get depressed about
Comments after: None
22
Exercise
1 participant rated exercise as very important before the day out and 12 after
the day out representing a 41% increase in participants scoring exercise as
very important.
Comments before:




I enjoy exercise if it is not too far
I would be happy to walk as much as is allowed
I like to keep my joints going
I like it but I know I can‟t do very much
Comments after:


Enjoyed it
When you go out sometimes and walk around and see all the flowers it‟s so
beautiful
Fresh air
12 participants rated fresh air as very important before the day out and 11
participants after the day out, representing a 1 % decrease in participants
rating fresh air as very important.
Comments before:

I don‟t care how cold it is I like the fresh air
Comments after:





I like the fresh air from always living at the seaside
Quite enjoyed it quite cold
I like to be out in the air
I am struck by how long people have been awake for…people have talked
more as the day went on
I don‟t mind it so cold
Getting out of the home
9 participants rated getting out of the home as very important before the day
out and 13 after the day out, representing a 16% increase in participants
rating getting out of the home as very important.
Comments before:



The height of love and bliss, getting out
I like to be out…usually bunged up somewhere
It is important to get out into the larger world and community so you don‟t get
shut away
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
I like to get to the beach
A retreat that‟s different sometime










Getting out in the winter is lovely
We need more days like this, can‟t get enough of getting out
It‟s been a fantastic day out, just seeing their faces, they‟ve loved it.
Better than four walls
Lovely thank you very much
Getting out…fantastic idea…develop in a big way
Got to come out into the world to see what is going on
Enjoyed every minute of it, lovely day
Most people just like getting out it is important for well-being
Very helpful to have the facilities…when you are bringing a group out prices
are important
It is so peaceful
People sleep better when they‟ve been out…people talk more, eat more, it
gives them an appetite…and they live longer

Comments after:
23


Independence
5 participants said that independence was very important before the day out
and 9 participants after the day out, representing a 15% increase in the
participants rating independence as very important.
Comments before:

I like being outside certainly…if you are going to be outside it is important to
make the most of it.
Comments after:

I don‟t like being told what to do I like being asked
Self-identity
4 participants rated self-identity as very important before the day out and 11
participants after the day out, representing a 27% increase in the participants
rating self-identity as very important.
Comments before:


Vital
I was in the Ramblers, always enjoyed walking
Comments after:




I want to come back here as soon as possible, when are we coming back?
Would love to do it again
I was practically born in the sea
Mum was always an outdoors person, a country girl, and loves to get out
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6. Discussion
This pilot project represents a second important step for Dementia Adventure
in building the evidence base for people living with dementia connecting with
nature for the benefits this brings. This report follows on the author‟s previous
research into Green Exercise and Dementia (Mapes, 2011) - in this research
an expert panel identified three priorities for future research for people living
with dementia and green exercise, one being the impact of green exercise
programmes in care homes.
24
This pilot project has had an intentionally broad approach incorporating two of
the National Dementia Strategy outcomes, recording photographic and video
evidence and conducting light-touch research gathering a range of qualitative
and quantitative data both before and after the group‟s visit to the woodland
settings. In addition to the design and delivery of the woodland visits
themselves. We encountered a range of challenges in conducting this pilot
project but the successes significantly outweighed these challenges, many of
which can be overcome with dedicated funding. We are now looking for
individuals and organisations to supporting and become partners in a larger
more robust investigation.
6.1 Challenges
Two of the national dementia strategy outcomes were selected as questions
for this research (Question 1 and 2, see section 4) and answers were
gathered in the homes and woodland settings as a group. This presented a
range of challenges in that people living with dementia are perhaps under
subtle unintentional pressure to say they are enjoying their life and get the
treatment and support which is best for them even though this may not be the
case. In a larger future research project we would conduct personal one-one
interviews. Nonetheless people enjoyed this group format for gathering
information which people found novel and engaging. People liked the flip
chart exercise and enjoyed sticking stars on the charts and many participants
kept a star for themselves as a small recognition of taking part.
Rating the elements of nature (Question 3, see section 4) often proved difficult
outside in the woodland setting and worked best where there was a circular
outdoor space where everyone could sit and take part. For many the
concepts of self-identity and independence were difficult topics that warranted
further explanation and again in future research we would change our
terminology focusing on one-one interviews
We set ourselves the additional challenge of capturing photo and video
footage of the walks. Ideally we would have had a dedicated team or
individual at each walk whose role it was to capture this media. In practice
this task was shared between the staff from the three partner organisations:
Dementia Adventure, Woodland Trust and Caring Homes. There were some
photo and video opportunities which were missed due to combining the tasks
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of capturing media and assisting and supporting participants on the walk.
However, people did particularly enjoy being on film and knowing that this
work was going to be shared publicly as well as with within the respective
care homes.
25
We experienced a range of challenges at the venues, many of which we
overcame by conducting a pre-planning visit to each venue and liaising with a
staff member at the location. Remaining challenges involved issues such as
key features or trees not being accessible by wheelchairs, no seating at key
features, raised bordered paths creating trip hazards for people with depthperception problems, and only one location of accessible toilets limiting how
far the group could explore together. We noted how welcoming staff at the
venues were but also found that they appear to have less knowledge about
dementia and have less experience of inviting and engaging people living with
dementia to enjoy their venues than they have for other groups, in particular
school groups.
6.2 Successes
Three Caring Homes quickly came forward to be part of this project when our
original plan was to conduct one woodland walk in May. The fact that we
were able to design and deliver three woodland walks is in itself a sign of the
interest and success of this pilot. We used the participatory appraisal method
of data collection which, although not without its challenges, did enable us to
capture some extremely important qualitative information in particular. The
participatory method shows that „every voice matters‟ hence collecting a
range of views, many of these are critical indicators for where this work might
go next and have therefore been included in the executive summary to
evidence the potential physical, emotional and social benefits of this work.
Interestingly the most noticeable difference in quantitative data gathered
before and after was in participants rating of exercise. This is perhaps
because in the care home many residents perhaps have a particular
understanding of exercise which may well be „chair-based‟ or bouncing balls
and other similar indoor exercise activities. The woodland walks helped
people to re-frame their understanding of exercise (within the context of green
exercise) and the importance of this to them.
The multi-media data capture was also a success and whilst the footage was
not of „professional‟ quality, it authentically brings to life the importance of the
woodland walks to the people who took part and supports the quotes in this
report. By capturing this information we can begin to challenge and change
the perception and understanding of what people living with dementia in care
settings are capable of doing.
In terms of venues‟ engagement with and support of this work it was
noticeable how supportive individual staff members were at all three locations.
The success of the delivery of the walks did in part rely on friendly non-
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Dementia Adventure 2011
intrusive support with our group members on the day. An extra wheelchair
was found on one location, a waterfall feature was left on for our group at
another. The interest and support of organisations like the Forestry
Commission and the National Trust as well as community owned natural
resources is something we would like to harness in the larger, national project
which is planned as the next step of the work.
26
But perhaps the clearest success of this pilot project has been the
transformation that was brought about by getting people out of the care home
and into the woodland settings. The personal impact both during and after the
day out was deeply emotional and was uplifting to witness the extreme
importance this simple act of connecting to nature was for all involved.
There are tangible physical benefits of nature based activities for people living
with dementia in care, many of which already have good evidence to support
them, including people eating and sleeping better. These could be easily
measured and monitored in a larger structured study. The social and
emotional benefits are also significant and present potential cost savings in
terms of reducing anti-psychotic medications and hospital admissions but
represent important quality of life issues. The next stage of this work must
include a rigorous exploration of the costs and the specific benefits of green
exercise in woodland settings and other natural environments for people living
with dementia in care settings.
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7. Conclusion
Dementia Adventure has learnt a lot during this successful research based
pilot project. Both in terms of the development and refinement of a successful
model of nature based day adventures for people living in care homes, but
also in using a participatory appraisal research method to begin to understand
the specific importance and benefits of woodland activities for people living
with dementia in care settings.
27
It is tempting to make far-reaching conclusions about a project which enabled
some profoundly moving and deeply personal connections with nature to
emerge. It is also hard to convey on paper the importance of the days out for
the participants themselves, hence the inclusion of the films which support
this research.
However, it is clear that this project has demonstrated that there are
significant potential physical, emotional and social benefits worthy of a larger
scale nationally funded research related project.
For the participants involved, their rightly insistent question remains “When
are we going out again?” This work, following this successful pilot phase,
must now become more focused and rigorous but also take place over a
larger scale in order to reach and impact on the lives of the many thousands
of people living with dementia in care settings across the UK who would
benefit from activity in and contact with woodlands and other natural
environments.
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8. References
28
•
Barton J and Pretty J (2010) What is the best dose of nature and green exercise for improving
mental health? A multi-study analysis. Environmental Science and Technology 44 (10)
•
Bradley C (2010) Risk factors for dementia. Living with dementia, pp.20-21.
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Brooker DJ, Woolley RJ and Lee D (2007) Enriching opportunities for people living with
dementia in nursing homes: an evaluation of a multi-level activity based model of care. Aging
and mental health, 11(4) 361-370.
•
Chalfont G (2006) Connection to Nature at the Building Edge: Towards a therapeutic
architecture for dementia care environments. PhD thesis. Sheffield: University of Sheffield
•
De Bruin SR, Oosting SJ, Tobi H, Blauw YH, Schols JMGA and De Groot CPGM (2010) Day
care at green care farms: a novel way to stimulate dietary intake of community dwelling older
people with dementia? Journal of nutrition, health and aging 14(5): 352-7.
•
Department of Health (2010) Quality outcomes for people with dementia: building on the work
of the National Dementia Strategy.
•
HM Government (2011) The Natural Choice: securing the value of nature.
•
Kaplan S (1995) The restorative benefits of nature: towards an integrative framework. Journal
of Environmental Psychology 15 (3) 169-182.
•
Mapes (2011) Living with dementia and connecting with nature - looking back and stepping
forwards. Essex: Dementia Adventure. Research available at: www.dementiaadventure.co.uk
•
Mapes N (2010) It's a walk in the park: exploring the benefits of green exercise and open
spaces for people living with dementia. Working with Older People, vol.14, issue 4,
Decemeber 2010
•
Mayer FS, McPherson Frantz C, Bruehlman-Senecal E, Dolliver K (2009) Why is nature
beneficial? The role of connectedness to nature. Environment and Behaviour vol.41, no.5,
pp607-643.
•
Mental Health Foundation (2009) Moving On Up. London: Mental Health Foundation.
•
Moriarty J (2006) Innovative practice. Dementia: the international journal of social research and
practice vol 5 no 1 pp. 137-139.
•
New York Times (2011) Paula Span: Walking down memory lane, 1.2.11.
•
Pretty J and Hine R (1999) Participatory appraisal for community assessment: principles and
methods. Centre for environment and society: University of Essex.
•
Pretty J, Peacock J, Hine R, Sellens M, South N, and Griffin M (2007) Green exercise in the
UK countryside: Effects on health and psychological well-being, and implications for policy and
planning. Journal of Environmental Planning and Management, Volume 50, Number 2, March
2007, pp.211-231 (21).
•
Pretty J, Peacock J, Sellens M, Griffin M (2005) The mental and physical health outcomes of
green exercise. International journal of environmental health research 15 (5) 319-337.
•
Ulrich RS (1984) View through a window may influence recovery from surgery. Science, 224:
420-421.
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Wilson EO (1984) Biophilia. Cambridge: Harvard University Press.
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•
Zeisel J (2009) I'm Still Here: A breakthrough approach to understanding someone living with
Alzheimer's. New York: Penguin.
9. Useful Websites
Here is a list of the websites referred to in this paper:
29
Access to Nature:
Big Lottery Fund:
Caring Homes:
Chalfont design
Dementia Adventure
Green Exercise
Hylands Park
Natural Health Service
Sheffield park
Visit Woods
Walking for Health
Woodland Trust
www.naturalengland.org.uk/accesstonature
www.biglotteryfund.org.uk
www.caringhomes.org
www.chalfontdesign.com
www.dementiaadventure.co.uk
www.greenexercise.org
www.chelmsford.gov.uk/hylands
www.naturalengland.org.uk
www.nationaltrust.org.uk/sheffieldpark
www.visitwoods.org.uk
www.whi.org.uk
www.woodlandtrust.org.uk
10. Appendices
Appendix 1 - Case study: VisitWoods at Hylands Park
A short film capturing the Visit Woods day at Hylands Park can be found at: Visit Woods film
at www.dementiaadventure.co.uk
A selected number of photos of the Hylands park visit can be seen on the Dementia
Adventure Facebook page via the following link:
http://www.facebook.com/DementiaAdventure
Observational data and feedback
We gathered data and feedback from staff and volunteers from all three organisations:
1. Dementia Adventure
2. Woodland Trust
3. Caring Homes (Bradbury House)
1. Dementia Adventure observational data:
 It was Joan's first day out of the home since the New Year, she is receiving end of life
care and has always loved flower arranging. She had a beautiful moment with a
buttercup with Jill
 Jim was excited to be in the woodland as he is fed up with the local scenery around
the home
 Jim really loved the beautiful surroundings, very animated and engaging as the day
proceeded
 Diana (upon seeing the horses) 'I used to ride ponies at my husband's work'
 Diana also spoke of her initial terror - of being on a quiet bus, not knowing what to
say, where they were going and not wanting to get things wrong. I asked Diana what
she enjoyed about being in nature and she quoted the entire poem of the „Owl and
the Pussycat.‟
 Amy cried with happiness upon welcoming her in the Willow circle outdoor classroom
 Trees spotted: Cedar Italica, Elm, Yew, Oak, Judas tree.
 Out in nature there is an easy equality between people
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




30
Enabling people to get out into nature shows them they matter
Special invitations to get out are important as are welcoming and appreciating people
Smiling, laughing, talking all increased as the day went on
Rose was quiet and angry upon first arrival, having just woken up. By the middle of
the visit and through to the end she was smiling non-stop, a picture of joy.
Like nature, people blossomed and bloomed as the day progressed. Terror and
anger being replaced by friendship and joy.
2. Woodland Trust observational data and feedback:
So many reasons and opportunities to interact with the residents and for the residents to
interact with each other and staff. Things to point at, touch, talk about, things that provoked
memories (flower arranging, sea bathing, dogs they‟ve owned, books they‟d read, ponies
they‟d ridden, their love of wildlife etc). Having spent many afternoons visiting a relative in a
care home conversation so quickly ran out because there was nothing to talk about other than
news we had stored up and brought with us. Here there was stimulation all around us.
A particular moment for me was the response to the colour and wonder of the wisteria
pergola. The delight on one lady‟s face who couldn‟t communicate much verbally was
wonderful. She reached out and touched and for a short time was in control of what she
wanted to do – she wanted to be amongst the flowers and delight in them and through her
response was determining how her carer moved her around and so on. As someone with
limited communication I imagine what she does is normally very much controlled by others,
albeit sensitively and with the best intentions.
Staff and residents were able to share knowledge – tree names, what trees were used for –
yew for longbows came from one resident, yews in churchyards from a lady whose father and
husband were vicars, dutch elm disease from another.
We were outside nearly 3 and a half hours and the concentration and energy levels were
amazing – again from experience sleep seems to come quickly to care home residents but
with one exception (the lady who is very ill who had a quick nap at one point), everyone
seemed wide awake throughout. There was so much talk and laughter.
I would pay a lot of credit to the care home staff and to you Neil for the constant attention to
individuals to draw them in and involve them which definitely helped to keep everything so
lively but the environment undoubtedly played a major role. Even the changing temperature
was a reason for people to be individuals – I am a little chilly...do you like the direct sunshine
etc etc. Nicky was brilliant in the way she picked up bark and handed it round. Such a simple
thing but you could see how well residents responded and again it made me think how rare
such an encounter with something rough and natural must be. I talked to two residents about
buttercups and daisies and both suddenly lit up when we recalled „do you like butter‟ and
holding the buttercup under the chin, and making daisy chains, and the different techniques
for making them. Again this simply came from being outdoors and having the flowers to hand.
Joan in particular was quite moved by the buttercup – stroking it and talking with me about its
beauty in comparison with the daisy. I understand from her daughter that she was a top flower
arranger and you could almost see her mind working to remember.
It was quite something to hear that one seemingly very together lady had said she was
„terrified‟ on the way to the park, because it was going into the unknown. Neil, you and I talked
about the visible lifting of spirits as people realised where they had come to and that it wasn‟t
going to be difficult or demanding or scary, just relaxing and stimulating and outdoors. The
fact that loos were near by and anyone could go when they needed to was also a confidence
builder. As was the picnic and the cup of tea later on. It was lovely to see at least some of the
residents eating heartily, sharing in the picnic. The laughter, talk and beautiful surroundings all
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meant that eating became just another nice part of the experience rather than the sole focus
and something they must do.
It was clear that it was the diversity of the environment that was particularly successful –
flowers, ducks, dogs, a squirrel, the totem pole, encounters with other people, as well as the
trees. It would be very interesting to see the same group in a pure woodland setting to see if it
was as stimulating. Though there is such a range of woodland on VisitWoods that it is
probably hard to pick out a typical woodland. Lots of them would have „extras‟ – a stream, a
pond, a rockface, a sculpture and so on, and then of course there‟s the seasonal moments –
bluebells and autumn colours.
31
I thought having lots of other people around was a really good thing – although some people
were clearly embarrassed about their dogs running over and „disturbing‟ us actually it brought
the residents back into the world, not hidden away as a separate group. Like the encounter
with the bark I guess „normal‟ encounters with everyday folk are fairly few and far between for
most residents, a trip outside makes it possible. The wedding was an added bonus and made
us all feel part of something together.
I think my favourite moment was a lady who found it hard to communicate who had her
collection of leaves. When I asked her what she had she said very clearly „I couldn‟t resist
them‟. Then there was the lady who burst into tears with happiness at the start. Then of
course there was the fact that I couldn‟t tell who had dementia and who didn‟t. Everyone was
so ready to enter into conversation and respond. And the fact that from the very start people
were planning their next visit. The chat about grandchildren at the end was interesting.
Wouldn‟t it have been lovely to have them there too?
One last thought – when people are reliant on others to push them around I always wonder
whether they are actually doing what they want to do – moving at the right pace, facing the
right way, next to the person they want to be next to. I didn‟t see any evidence of anyone
getting this wrong and it may be that getting out – albeit under someone else‟s direction – is
liberating enough. I hope so – it certainly seemed to be so today!
3. Caring Homes (Bradbury House) observational data and feedback
A big thank you again for all your support and organisation in making the Dementia
Adventure at Hylands Park happen. The feedback from residents, families who came and
staff was wonderful as I will detail below.
Joan, who has been a resident at Bradbury since December 2010 and has vascular dementia
is very frail and has not been outside in the fresh air for 18 months due to her poor health.
"What a wonderful day, I have missed this, I love the fresh air, it was beautiful all of it the
trees, flowers." Joan's daughter, Jenny, who came for a while said this was wonderful to see
her mother out, she did not think she would be able due to her mother‟s health and it was
really important to her to have seen the look on her mother‟s face upon her first outing and
knowing that she is having some quality and dignity towards her end of life years. She feels
that this too helps with coping with her mother‟s decline in health because it is so important to
know that she has a good life right up to the end of life.
Rose is 93 years old and has dementia. She has been a resident at Bradbury for many years
and was quiet and withdrawn on morning of the trip. She has not stopped smiling and talking
about the day since she came home asking to go again she said "so much to see ducks ,
flowers , trees so exciting and made me feel very happy." Her daughter Pat who came said
"This is what keeps my mother going and love of life, we are so glad it is made possible and
so grateful people help make this happen, she has eaten more and not stopped smiling since
the came home "
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Diana 98 years old in early stages of Dementia said on her return to the home "I felt alive ,
wonderful day I remember the arch way with all the flowers hanging down , I cannot walk and
need help from kind people to take me these places and relived that it can happen "
I as the home manager feel that this day was truly enjoyable and so well organised by you
with the pre-planning, visits to home to talk to the resident prior to going on the day. This is a
vital part in the resident‟s emotional, social and general well-being enabling them to have a
really positive experience. Thank you again.
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Appendix 2 – Case study: Visit Woods at Sheffield Park
A short film capturing the Visit Woods day at Sheffield Park can be found at: Visit Woods film
at www.dementiaadventure.co.uk
A selected number of photos of the Sheffield park visit can be seen on the Dementia
Adventure Facebook page http://www.facebook.com/DementiaAdventure
Observational data and feedback
We gathered data and feedback from staff and volunteers from two organisations:
1. Dementia Adventure
2. Caring Homes (Heffle Court)
1. Dementia Adventure observational data and feedback
The group arrived at Sheffield Park shortly after the skies had turned black and a shower had
passed over. We started by welcoming everyone to take a seat and enjoy lunch together.
Some people were clearly anxious about what they were doing and why they were at the park
but the simple act of sharing food together and receiving a personal welcome worked well. It
did rain briefly towards the end of the picnic lunch and it was fascinating to see one lady
simply put on a rain mac and carry on eating her lunch whilst others took shelter under nearby
trees. The tables were unusual in that they were octagonal in design with two gaps left for
wheelchair users to be part of the tables.
Access to toilets, wheelchairs and motorised buggies at the start/end of the walk was helpful
as were the staff on hand to help with equipment, directions and advice.
The walk immediately brought out all the best of the park and of the people with conversation
easily turning to „nature in the moment‟ as people became fascinated at different trees and
marvelled at flowering shrubs. Following feedback from the first Visit Woods day we
incorporated three young children into the day with much positive effect for all concerned.
The residents loved the „normality‟ and „family friendly‟ atmosphere and when we asked
Charlie (who is five years old) what he thought of the people with dementia he said „they are
lovely and kind.‟
There were many special moments for the group as a whole, enjoying the waterfall which had
been left on longer for our group by the park staff. And there were many individual moments
of joy and pleasure as the sun blessed our group on the way round. One lady in particular
who was a new resident in the home, on her first outing, was clearly revelling in being out in
such a beautiful space and helped her feel part of this new group of people in her life. There
were many moments when she would be found dreamily taking in the scenery.
The changing temperature and the incline on the walk back all made the finish a slightly
taxing effort for some, although many enjoyed pushing on until the end and many enjoyed
staying out in the rain rather than retreating indoors (as can be the case when residents go
out in the garden of the home and it rains).
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On reflection, once again, special invitations and personal welcomes matter. As does a welldesigned, circular walk with key landmarks and stopping places to appreciate the beauty.
The simple and easy equality that is found in natural settings is helped by a diverse group of
ages.
2. Caring Homes (Heffle Court) observational data and feedback
First of all I want to say a huge thank you from myself, the residents, their family and friends
of Heffle Court for giving us the opportunity to be involved in this adventure with you and the
Woodland trust.
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I was just having a look at all the photos that were taken during our visit to Sheffield Park. As I
gaze upon them I feel a real sense of warmth seeing just how very happy everyone looks,
knowing we made a real difference to the residents‟ day and helped to create a wonderful
memory for friends and family to take away.
Although the day was at times a little wet and cold you can still see their smiles shining
through. Particularly with Alison, Kay and Bridget, I feel that it truly touched them deep within,
something that can only be accessed by being in natural sunlight and the open natural
environment. You can see them engaging with their surroundings, relaxing and chatting
together as they went along their woodland walk. The children brought another dimension to
the day; it eased everyone into a family atmosphere bringing the group together as one staff,
residents, family and friends.
When we returned back to Heffle Court everyone was extremely relaxed and still smiling
happy to share their experiences of the day with others at the home. We sat for some time
after with a nice hot cup of tea and left over picnic cake, the day stimulating conversation
amongst everyone, even though they were tired and worn out. All stating how much they had
enjoyed themselves, „wasn‟t it a lovely day…weren‟t the children good…the colours were
beautiful…when can we go again?‟ They all commented on how pretty the waterfall was to
see.
The only negative comments were on the coldness of the day, but also remember to take into
account how warm the care home is daily and so they will feel the cold more.
Paula kept commenting on the beautiful colours in particular the red tree. Patricia (resident)
the following day came out of her way to thank me for taking her out saying what a lovely day
she had. Patricia still recalls the day, only yesterday she commented to her daughter about
her day at the woods. The care staff who came along also noticed how relaxed everyone was
and how at peace the residents were during and on return.
Appendix 3 – Case study: Visit Woods at Westonbirt
A short film capturing the Visit Woods day at Westonbirt can be found at: Visit Woods film at
www.dementiaadventure.co.uk
A selected number of photos of the Westonbirt visit can be seen on the Dementia Adventure
Facebook page http://www.facebook.com/DementiaAdventure
Observational data and feedback
We gathered data and feedback from staff and volunteers from two organisations:
1. Dementia Adventure
2. Woodland Trust
1. Dementia Adventure observational data and feedback
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Dementia Adventure 2011
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The group arrived at Westonbirt on one of the hottest days of the year, with shade, sun cream
and hydration being important in our delivery today. We started with welcoming the group in
the outdoor education space but the linear layout of the space did not work as well as the
circular outdoor space at Hylands because people were sitting farther away from each other
and could not see each other. We moved onto a picnic boxed lunch which some struggled to
open the packaging or to know what they were eating but regardless many people enjoyed
the novelty of eating in this way. Sitting in the sun became rather hot which many enjoyed but
it was a welcome relief for some to enter the shade of the trees on the walk. One resident in
particular was highly anxious upon starting the walk and found the lunch space a difficult one
in which to feel comfortable and spent most of her time on her feet. On the walk she
gradually became more settled and less anxious and towards the end was very much at ease
with the group and the activity and clearly was enjoying herself and the beauty of the
surroundings. There was quiet a transformation from how she was at the start of the day and
towards the end. Although the Care Home manager did report that her behaviour similarly
varies like this when she is in the home. Nonetheless the significance of the group activity out
in nature certainly was, I feel, a factor in her behaviour calming as the walk and the day
continued.
Children again flourished in the company of the group and many revelled in the children‟s
company with many group members choosing to support or engage with the children as the
walk continued. This gave a „family outing‟ feel to the day.
The signage at Westonbirt was both clear and informative with key trees given different and
entertaining information which captured the group at key points around the walk. Information
boards with „It‟s a matter of life and death‟ and „boiled sweets‟ gave the group unusual tree
related information. The group hugged a giant sequoia tree – it taking nine of the group
holding hands to reach around the tree. Two people with dementia walked on an elevated
balance beam activity designed for children which they took great pleasure in completing.
But the sheer stunning beauty of the variety of trees (both native and non-native) and
flowering shrubs combined with the sun and a positive outdoor experience made the day very
special. This day, like the Hylands day, coincidentally finished with the group witnessing a
wedding congregation in the grounds. Being part of these community spaces allows
coincidences like this to happen naturally.
Finally, two members of the public approached me at the end of the day as we were returning
wheelchairs. They were intrigued by our group and had seen us wandering around the
woods. Upon hearing of the identity of the group and of Dementia Adventure they were
amazed and heartened that such activities were happening as they had both had bad
experiences of relatives in care. It is so important that people with dementia are visible active
members of our communities.
2. Woodland Trust observational data and feedback
This was an opportunity for like-minded people (sharing an interest in the outdoors) to come
out together to share and enjoy the beautiful woodland surroundings of Westonbirt. Whilst this
may not have seemed anything out of the ordinary – for these people it was – it was a break
from the normal everyday routine of the care home in which they lived and were not able to
get away from often. It enabled them to share a different set of experiences alongside those
they live with on a daily basis, to stimulate conversations and experiences, and remember
songs and poems.
The day started tentatively with each person looking a little worried and concerned with the
change of scenery, but once out in the woodland people started to comment on the colours
(not just the flowers) but the changing greenery especially vivid on what turned out to be a
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Dementia Adventure 2011
gloriously sunny day. Rather than being a set of individuals on a day out, they became more
of a group. One gentleman took on the responsibility of pushing the wheel chair of one of his
fellow residents, and several people took part in „hugging a tree‟ by joining hands to work out
how big it was. One lady became more independent as she walked along requiring less input
from her carer; another lady became less anxious and more relaxed as we wandered along
the tree lined paths. Petals, pine cones, leaves were collected, comments of „isn‟t that lovely‟,
„wonderful‟, „look at the colour‟ could be heard regularly. The most poignant comment of the
day for me was from one lady who had been quite quiet throughout the day that came out
with the comment of „you have to get out into the world to see what is going on‟.
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The most memorable part of the day was the gratitude of one of the relatives who was
genuinely appreciative of the day and what it had enabled his relative to experience. He so
wanted to tell his own daughter about the day, and get her to see the video clips so that she
could see her grandmother on this day out, being a different person to how she was in the
home. This sentiment was echoed by the care staff who also stated that they could see the
residents come out of themselves and acting differently. A positive and thoroughly enjoyable
day for everyone.
Appendix 4 - About Visit Woods
Visit Woods is a partnership project, led by the Woodland Trust which receives funding from
Natural England (through their Access to Nature programme, part of the Big Lottery Fund
Changing Spaces Programme), Yell, People‟s Postcode Lottery, the Forestry Commission
England, the Forestry Commission Scotland, Scottish Natural Heritage and DoubleTree by
Hilton. The project has also been made possible with the support of the National Trust, RSPB,
The Wildlife Trusts, Action for Children, Walking for Health, Age UK, EcoMinds, The Scout
Association and DisabledGo.
Visit Woods will promote the use of local, publicly-accessible woodland for health, recreation
and enjoyment, to everyone. The project aims specifically to inspire children, older people,
disabled people and those experiencing social exclusion through economic disadvantage to
visit their local wood, giving them the confidence that the habitat is a viable leisure destination
for them. VisitWoods.org.uk provides information, knowledge and confidence to people using
their local woodland to improve their wellbeing. The project aims to:
•
Increase in awareness of woods as a viable leisure destination
•
Provide people not used to accessing the natural environment with opportunities to
learn about it.
•
Recruitment of Woodland Ambassadors representing beneficiaries
A sustainable and wide-reaching communications campaign will promote local woodland as a
relevant and exciting recreational destination.
VisitWoods.org.uk will become the main source of information for visiting woods, offering our
target beneficiaries (4.5 million people) the inspiration, knowledge and confidence to use their
local woodland to improve their wellbeing.
Access to Nature
1. Access to Nature is run by Natural England and is part of The Big Lottery Fund‟s Changing
Spaces programme launched in November 2005 to help communities enjoy and improve their
local environments.
2. Natural England manages this £28.75 million Lottery-funded programme on behalf of a
consortium of twelve national environmental organisations comprising BTCV, British
Waterways, Environment Agency, Forestry Commission, Greenspace, Groundwork UK, Land
Restoration Trust, The National Trust, Natural England, RSPB, The Wildlife Trusts and the
Woodland Trust.
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3. Through this programme, it is Natural England‟s ambition to create opportunities for people
from all backgrounds to have greater access to our natural environment and bring a lasting
change to their awareness and understanding as well as improved links to the natural world,
which many of us can take for granted.
4. Access to Nature closed to applications in May 2010 but for further information about the
programme visit www.naturalengland.org.uk/accesstonature
5. For further information about the Big Lottery Fund, its programmes and awards visit
www.biglotteryfund.org.uk
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