Meaningful activities outside of care homes can improve the wellbeing of people with dementia 

D'Cunha NM, Isbel S, McKune AJ, Kellett J, Naumovski N. Activities outside of the care setting for people with dementia: A systematic review BMJ Open. 2020 August; 10:e040753.

Review question

Can meaningful activities that allow people with dementia or cognitive impairment to leave their residential aged care facilities improve their wellbeing? 

Background

Meaningful activities are an important part of care for people with dementia and cognitive impairment. Previous studies have shown positive effects on mood and depressive symptoms for people living in residential aged care facilities (for example, long-term care homes, nursing homes, assisted-living facilities).  


These interventions usually occur indoors and include engagement with art and music, the use of assistive technology, life story work, or gardening. 


Although outdoor activities have been proven to reduce stress and anxiety and increase the sense of community in people with dementia, little is known about interventions outside of residential aged care facilities. This review aims to examine the effects of psychosocial interventions that enable people with dementia to participate in activities outside of their care setting. 


How the review was done

A detailed search of five electronic databases for literature published up to May 2020 was conducted. Studies that included residents of aged care facilities with dementia or cognitive impairment and evaluated the effects of interventions outside of their living quarters were included. 


A total of 6,453 studies were identified in the initial database search, and 11 were included in the final review. 


This review was funded by a research foundation PhD scholarship in Australia.


What the researchers found

The activities in these studies included wheelchair cycling, swimming, art gallery visits, intergenerational mentorship, horse riding, walking and outdoor gardening. Overall, these studies showed psychological, physical and physiological benefits in people with dementia. 


Positive psychological outcomes observed included improvements in wellbeing, quality of life, mood, cognition and reduction of depressive and behavioural symptoms. 


Facilitating activities outside the care setting was found to require additional planning and resources such as adequate staffing, transportation and assessment of the physical abilities of the participants. Some activities such as wheelchair cycling, walking and gardening do not require transportation into the community and can be both accessible and practical for people with dementia. 


Since each study focused on different outcomes, the authors of this review were not able to determine which activities were the most effective at improving wellbeing. 


Conclusion

Engaging in meaningful activities outside of residential aged care facilities has the potential to improve quality of life and potentially reduce behavioural symptoms. However, this review was not able to determine which activities were the most effective. While field trips and outings occur frequently at many facilities, more research is needed to identify the barriers to implementing such activities to increase participation for people with dementia.