title: Green Care Farms as Innovative Nursing Homes, Promoting Activities and Social Interaction for People With Dementia.
abstract: Innovative care environments are developed for people with dementia to encourage person-centered care. This study aims to investigate whether residents of green care farms that provide 24-hour nursing care participate more in (physical) activities and social interaction compared with residents of other nursing homes.
  
  
  
  Longitudinal observation study.
  
  
  
  Nursing homes in the Netherlands (green care farms, traditional nursing homes, and regular small-scale living facilities).
  
  
  
  A total of 115 nursing home residents at baseline, 100 at follow-up.
  
  
  
  Ecological momentary assessments (n = 16,860) were conducted using the Maastricht Electronic Daily Life Observation Tool. Residents living at green care farms were compared with residents living in traditional nursing homes and regular small-scale living facilities. The following aspects were collected for this study: the activity performed by the participant or occurring in his or her vicinity, the engagement in the activity, the level of physical activity during the activity, the physical environment (location where the activity occurred), and the level of social interaction during the activity.
  
  
  
  In total, 9660 baseline observations and 7200 follow-up observations were conducted. Analyses showed that residents of green care farms significantly more often participated in domestic activities (P = .004, SE = 1.6) and outdoor/nature-related activities (P = .003, SE = 0.9), and significantly less often engaged in passive/purposeless activities (P < .001, SE = 1.7) compared with residents of traditional nursing homes. Furthermore, residents of green care farms had significantly more active engagement (P = .014, SE = 0.9), more social interaction (P = .006, SE = 1.1), and came outside significantly more (P = .010, SE = 1.1) than residents of traditional nursing homes. Residents of green care farms were significantly more physically active (P = .013, SE = 0.8) than were residents of regular small-scale living facilities. No other significant differences were found.
  
  
  
  Green care farms can be a valuable alternative to traditional nursing homes. They provide an attractive, homelike environment and activities that positively influence engagement and social interaction. Research is needed to study how successful elements of green care farms can be implemented in existing nursing homes.
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. Electronic address: b.deboer@maastrichtuniversity.nl.
authors.forename: Bram
authors.initials: B
authors.lastname: de Boer
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jan P H
authors.initials: JP
authors.lastname: Hamers
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Sandra M G
authors.initials: SM
authors.lastname: Zwakhalen
authors.affiliation: Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Frans E S
authors.initials: FE
authors.lastname: Tan
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Hanneke C
authors.initials: HC
authors.lastname: Beerens
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Hilde
authors.initials: H
authors.lastname: Verbeek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia; D000072480:Farms; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands; D009735:Nursing Homes
keywords: Dementia; activities; daily life; green care farm; nursing home; social interaction