title: Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Health and Occupational Studies, University of Gävle, Sweden.|Department of Health and Medicine, Örebro University, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Dahlkvist
authors.affiliation: Institute for Housing and Urban Research, Uppsala University, Sweden.
authors.forename: Terry
authors.initials: T
authors.lastname: Hartig
authors.affiliation: Faculty of Health and Occupational Studies, University of Gävle, Sweden.|Department of Public Health and Caring Sciences, Uppsala University, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Nilsson
authors.affiliation: Faculty of Health and Occupational Studies, University of Gävle, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Högberg
authors.affiliation: Faculty of Health Sciences, Buskerud University College, Tønsberg, Norway.
authors.forename: Kirsti
authors.initials: K
authors.lastname: Skovdahl
authors.affiliation: Faculty of Health and Occupational Studies, University of Gävle, Sweden.|Department of Public Health and Caring Sciences, Uppsala University, Sweden.
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0002-9912-5350
authors.initials: M
authors.lastname: Engström
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D003430:Cross-Sectional Studies; D004779:Environment Design; D005260:Female; D000072506:Gardens; D006304:Health Status; D006801:Humans; D008297:Male; D008602:Mental Healing; D012112:Residential Facilities; D011795:Surveys and Questionnaires
keywords: health; nurses; nursing; outdoor environment; residential facilities; serial mediation