The role of outdoor microclimatic features at long-term care facilities in advancing the health of its residents: An integrative review and future strategies.

Projections show that Earth's climate will continue to warm concurrent with increases in the percentage of the world's elderly population. With an understanding that the body's resilience to the heat degrades as it ages, these coupled phenomena point to serious concerns of heat-related mortality in growing elderly populations. As many of the people in this age cohort choose to live in managed long-term care facilities, it's imperative that outdoor spaces of these communities be made thermally comfortable so that connections with nature and the promotion of non-sedentary activities are maintained. Studies have shown that simply being outside has a positive impact on a broad range of the psychosocial well-being of older adults. However, these spaces must be designed to afford accessibility, safety, and aesthetically pleasing experiences so that they are taken full advantage of. Here, we employ an integrative review to link ideas from the disciplines of climate science, health and physiology, and landscape architecture to explain the connections between heat, increased morbidity and mortality in aging adults, existing gaps in thermal comfort models, and key strategies in the development of useable, comfortable outdoor spaces for older adults. Integrative reviews allow for new frameworks or perspectives on a subject to be introduced. Uncovering the synergy of these three knowledge bases can contribute to guiding microclimatic research, design practitioners, and care providers as they seek safe, comfortable and inviting outdoor spaces for aging adults.

The Seniors' Outdoor Survey: An Observational Tool for Assessing Outdoor Environments at Long-Term Care Settings.

PURPOSE OF THE STUDY: To describe the development and psychometric testing of the Seniors' Outdoor Survey (SOS), an instrument for evaluating how well the outdoor space in a long-term care setting supports the preferences and outdoor usage of residents. DESIGN AND METHODS: Content validity of the main SOS items initially was based on relevant literature and preliminary studies in diverse long-term care settings. After conducting a multiregional pilot study with 152 outdoor spaces at 68 assisted living facilities, the instrument was substantially revised and tested for interrater and test-retest reliability with 22 outdoor spaces at 12 long-term care settings, using 2 raters. Validity was examined using content analysis of resident survey responses (N = 1,128) from the multiregional study and specific item validation by subject matter experts (N = 53). RESULTS: The final instrument contains 60 ratable items organized in 5 domains: access to nature (14 items), outdoor comfort and safety (15 items), walking and outdoor activities (14 items), indoor-outdoor connection (11 items), and connection to the world (6 items). Intraclass correlation coefficient (ICC) estimates of interrater reliability were .91 for the overall instrument, ranging from .83 to .98 for the 5 domains. Interrater reliability (ICC) was above .70 for more than 79% of individual items. Test-retest reliability (ICC) was .92, ranging from .81 to .98 for domains. IMPLICATIONS: The SOS tool fills a gap in the available environmental assessment instruments, providing a reliable way for researchers, providers, and designers to evaluate and compare the supportive potential of outdoor spaces for long-term care residents.