Provision of Outdoor Nature-Based Activity for Older People with Cognitive Impairment: A Scoping Review from the ENLIVEN Project

The health and well-being benefits of outdoor nature-based activity are increasingly recognised, but older people with cognitive impairment face significant barriers to access. The ENLIVEN project aims to promote access by gathering evidence and coproducing guidance for activity providers. As part of this project, we conducted a scoping review to characterise the types of outdoor nature-based activity for older people with dementia and other forms of cognitive impairment for which research evidence is available and the range of outcomes is examined. The protocol is available online. We systematically searched relevant databases from 1st January, 2009, to 20th October, 2022, and screened articles against the following criteria: participants were older people aged 65 and above with cognitive impairment arising from dementia or another health condition. The study described the formal provision of outdoor nature-based activity away from the person’s usual place of residence, and at least one outcome of participation in the activity was evaluated. Twenty-eight articles met inclusion criteria, all focused on people with dementia. In most cases, participants were attending day care or living in residential care, and sample sizes ranged from 4 to 136. Activities fell into three groups: green day care (fifteen articles), equine-assisted interventions (seven articles), and community nature-based activities (six articles). Outcome domains explored were connection with nature, activity engagement, impacts on clinical symptoms, functional ability, physical, psychological and social health,, and quality of life. Outdoor nature-based activity can be offered as an opportunity for meaningful occupation to enrich daily life, as a framework for day care provision, or as an intervention to address clinical needs. The evidence base for green day care is relatively established, but the potential for addressing specific clinical needs remains to be explored. The paucity of evidence regarding community provision, especially for those not attending formal care settings, suggests the need for effective knowledge exchange to stimulate initiatives in this area.