title: What is the impact of using outdoor spaces such as gardens on the physical and mental well-being of those with dementia? A systematic review of quantitative and qualitative evidence.
abstract: OBJECTIVE
  To examine the impact of gardens and outdoor spaces on the mental and physical well-being of people with dementia who are resident in care homes and understand the views of people with dementia, their carers, and care home staff on the value of gardens and outdoor spaces.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Fourteen databases were searched from inception to February 2013. Forward and backward citation chasing of included articles was conducted; 38 relevant organizations were contacted to identify unpublished reports. Titles, abstracts, and full texts were screened independently by 2 reviewers in a 2-stage process and were discussed with a third reviewer where necessary. Results were synthesized narratively.
  
  
  RESULTS
  Seventeen studies were included: 9 quantitative, 7 qualitative, and 1 mixed methods. The quantitative studies were of poor quality but suggested decreased levels of agitation were associated with garden use. The views and experiences of the garden are discussed in relation to themes of how the garden was used, nature of interactions, impact/effect of the gardens, mechanisms/how the garden was thought to have an effect, and negatives (such as perception of the garden as a hazard and the limited staff time).
  
  
  CONCLUSIONS
  There are promising impacts on levels of agitation in care home residents with dementia who spend time in a garden. Future research would benefit from a focus on key outcomes measured in comparable ways with a separate focus on what lies behind limited accessibility to gardens within the residential care setting.
authors.affiliation: Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK. Electronic address: r.s.whear@exeter.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Whear
authors.affiliation: Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Jo Thompson
authors.initials: JT
authors.lastname: Coon
authors.affiliation: Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Bethel
authors.affiliation: Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Abbott
authors.affiliation: Peninsula Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Stein
authors.affiliation: European Centre for the Environment and Human Health and PenCLAHRC, University of Exeter Medical School, University of Exeter, Knowledge Spa, Truro, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Garside
mesh_terms: D003704:Dementia / Q000523:psychology*; D058611:Horticultural Therapy; D006801:Humans; D008603:Mental Health; D009735:Nursing Homes; D011595:Psychomotor Agitation / Q000517:prevention & control; D011788:Quality of Life
keywords: BPSD; Residential care; horticulture; mixed methods