“Sit in my chair in that sunshine and look at my tree—it’s medicine,” my 97-year-old mother said, just days before she died. I knew she was right.
Almost two years prior, before I had moved her to this sunny room, she had nearly given up on life. The first assisted living facility I had found for her had been attractive, but in its architectural design, no thought had been given to connection with nature. Its windows looked onto poorly landscaped gravel courtyards, paved parking lots and parallel wings of the building. My Florida-native mother, as her first Wisconsin winter approached, grew sad and lethargic. Was death stalking her? No, I finally realized—it was a dearth of nature.
It has become accepted science that spending time in nature is beneficial. Thirty years ago, a Swedish architect studied patients recovering from gallbladder surgery; those placed in hospital rooms with windows facing a cluster of deciduous trees healed faster than those whose windows opened onto a brick wall. More than a century before that, Florence Nightingale proved that natural light in patients’ rooms promoted healing. More recently, Richard Louv coined the term Nature Deficit Disorder to describe the deficient relationship of children to the natural world today that is leading to a number of physical and emotional disorders. Research suggests that older adults can experience nature deprivation as well.
Enriching Life for Well Elders
My mother’s mood improved once she moved from that nature-deficient facility to one laid out on a narrow lot flanked by trees. Her mobility was limited and her eyesight terrible; even so, she could stroll a path that passed bird feeders and stands of evergreens. The birdsong and the rustle of breezes through branches seemed to nourish her.
‘Was death stalking her? No, I finally realized—it was a dearth of nature.’
My mother had been suffering from thwarted biophilia. The naturalist E.O. Wilson defined biophilia as "the urge to affiliate with other forms of life.” Biophilic design principles are increasingly being incorporated into places where older adults are housed or treated. A few of these design patterns include:
- Visual connection with nature,
- Sensory stimuli,
- The presence of water,
- Dynamic and diffuse light,
- Biomorphic forms and
- Natural materials.
Four aspects characterize biophilic spaces: Prospects (unimpeded views), refuge (places for withdrawal), mystery (partially obscured views that entice), and—surprisingly—risk. Risk refers to the interplay of a perceived threat and a rational knowledge of safety, as you might find in an infinity pool. Feelings of apparent risk have been connected with dopamine bursts, which can stimulate motivation and memory.
The first facility where my mother lived offered none of these aspects. Her second (and last) had not been intentionally designed along biophilic principles, but even so, it offered enough of these patterns to make a meaningful difference. If only I had known about this when I was facility-shopping!
Solving for a Better Life for the Unwell
I was lucky in that my mother was cognitively sharp, despite her limitations. Thanks to her trusty rollator, we were able to make excursions to Madison’s many parks. But even the “unlucky”—those among us who cannot safely access the outdoors—can benefit from nature’s medicine. This is a crucial argument for incorporating biophilic patterns into the interior design of institutions that serve older adults. (Not to mention that doing so improves conditions for the staff and visitors as well.)
Older adults often experience reduced mobility; this is frequently the reason behind the decision to move from independent to congregate living. When the wide world outside is no longer accessible, even a view out a window can be beneficial. Seeing the wind move through a tree, or the light change as a day progresses, is significant. Psychology Professor Dr. Charles Musselwhite interviewed 42 older people in the UK on the importance of having a room with a view. He said, “Those I spoke to—all aged over 65, who go outside less than once a week—valued their window so much that many spent a while setting up their space to get a good outlook.” My mother certainly did.
For people with memory issues, access to nature—through biophilic facility design if not actual excursions—is helpful. Nature-inspired design elements can provide spatial cues that assist wayfinding and orientation. Light also can help with temporal orientation.
“Exposure to natural light helps to regulate circadian rhythms, which can alleviate sleep disorders, sundowning, and seasonal depression,” wrote Emily Chmielewski, an industry leader in environment-behavior research.
‘Nature-inspired design elements can provide spatial cues that assist wayfinding and orientation.’
At end of life, some find nature a comforting reminder that all of life has its seasons. Hospice care, with its emphasis on relieving suffering and living as comfortably as possible, calls out for a biophilic approach. I knew that when my mother reached the end of her road, I wanted her to have the experience offered at the nearby Anderson Inpatient Unit for Agrace Hospice in Fitchburg, Wis.
Connection with nature had been a top priority when Agrace hired the architecture firm Potter Lawson to plan an expansion. “We recognize that the exterior experience, whether you walk through it, or wheel through it, or just see it through a window, is really important to the quality of life for people there,” said Mike Gordon, project manager. “Nature has an inherent beauty,” Jason Hill, a chaplain with Agrace Hospice said. “When we see it, stand in it, smell it, touch it, our senses are inspired. How could we not be more aware of a larger peace within us?”
Saiki Design, a landscape architecture firm located in Madison, designed the site and plantings for Agrace Hospice’s expanded facility. Rebecca de Boer, Landscape Architect with Saiki Design, confirmed that biophilic design principles were incorporated throughout its extensive gardens. However, unlike buildings, which tend to be constructed and then remain somewhat static, “Landscapes are dynamic, because they have biophilic qualities,” she noted. “Plantings require ongoing maintenance, which facilities can find challenging. The cycle of birth, life, and death is always there as the plantings evolve. But what makes gardens amazing is also what makes them costly.” Higher-end privately owned care facilities invest in ongoing regenerative landscape maintenance. But even modest facilities have started including garden elements that invite and welcome wildlife, feature plants with scents, and offer horticulture activities for residents.
The Medicinal Nature of the Outdoors
It is time we recognized nature’s importance as medicine. More funding needs to flow toward research into nature’s benefits and executing projects based on biophilic design, serving every level of affordability. Healthier people and healthier profits are not mutually exclusive; current research has already proven that. Investors in the field of aging need to take note.
I hunger for a world where biophilic design is incorporated into how we care for each other as we age, at every economic level. Each one of us deserves a sunbeam, a bird’s song and a view to something more than the crushed rock of an interior courtyard.
Sarah White is a freelance writer and personal historian. She helps people write about their lives and work from her home base in Madison, Wis.
Photo: The grounds of Agrace Hospice in full bloom in July.
Photo courtesy Agrace Hospice.