Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study.

AIMS To test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden. BACKGROUND Many older people in residential facilities suffer from complex health problems. Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health. DESIGN A multi-level, cross-sectional, correlational design. METHODS Questionnaires were administered June-August, 2011 to convenience samples of residents at 72 facilities for older people with complex healthcare needs. One to 10 eligible residents were sampled during self-motivated garden visits at each facility (n = 290). They reported on their garden experiences and health. Facility staff reported on objective garden characteristics and barriers to access. A serial mediation model was tested with multiple linear regression analysis. RESULTS The total indirect effect of greenery on self-perceived health was positive and significant. Garden greenery appears to affect health by enhancing a sense of being away, affording possibilities to experience the outdoor environment as interesting and encouraging visitation. Among residents in homes with multiple barriers, only fascination mediated the relationship between greenery and self-perceived health. CONCLUSION Ample greenery in outdoor space at residential facilities for older people appears to promote experiences of being away and fascination, more frequent visitation and better health.