Title: Extending active life for older people with cognitive impairment through innovation in the visitor economy of the natural environment (ENLIVEN)
Funder: Economic and Social Research Council

Abstract: To address the programme goal of adding 5 years of healthy active life by 2035 , ENLIVEN will enable older people with cognitive impairment to be active, independent and socially connected, and to experience good quality of life, through increasing or initiating engagement with nature-based outdoor activity. We will achieve this outcome by developing innovative models of practice that enable businesses, social enterprises and third sector organisations to address the barriers that currently limit access to nature-based outdoor activity for this population. Active engagement with our key stakeholders will ensure that the needs, preferences and aspirations of this group underpin our project and reflect the different contexts and diverse characteristics which contextualise how people with cognitive impairment experience ageing. We will address the programme goal of reducing inequalities in healthy ageing by including in our study those with established structural disadvantages including people from minority ethnic groups and socio-economically disadvantaged areas. Key aims are to: 1. Integrate the perspectives of older people with cognitive impairment and their families, and businesses and other organisations providing nature-based outdoor activity, with available evidence in order to co-design innovative and sustainable initiatives and reduce barriers to participation. 2. Support businesses and provider organisations to implement and sustain effective initiatives to encourage increased participation by diverse groups of older people with cognitive impairment and their carers/supporters across a range of contexts and environments. 3. Meaningfully engage older people and other stakeholders in these processes, through a Knowledge Exchange Forum, a dedicated involvement network, and other methods including arts-based outreach. Specific objectives are to: 1. Understand the views, experiences, aspirations and preferences of older people with cognitive impairment, and their families and supporters, with regard to engaging with nature-based outdoor activity, and how this kind of activity can be promoted in an inclusive manner irrespective of area, income or ethnicity. 2. Explore the perspectives of managers and staff in businesses and other organisations providing nature-based outdoor activity, including social enterprises, public sector bodies and charities, with regard to engaging this group. 3. Identify current evidence about which forms of nature-based outdoor activity for older people with cognitive impairment can enhance healthy active life expectancy. 4. Bring stakeholders together to co-design innovative solutions that encourage changes in provision of products and services to enhance the healthy active life of older people with cognitive impairment and address inequalities of access. 5. Assist businesses to implement sustainable initiatives to increase participation by older people with cognitive impairment and their families and supporters, and evaluate the success of these initiatives. 6. Understand how the nature and outcomes of these initiatives differ across contexts and environments, indicating which types of enabling initiatives in which contexts are most effective for users and providers, both financially and socially. 7. Create evidence-based resources that support a process of continuing development leading to long-term change, including a toolkit of online and printed resources for businesses and other provider organisations, and resources for older people with cognitive impairment and their families. 8. Widely disseminate the knowledge gained through a range of pathways to influence behaviour and support innovation, ensuring the legacy of the project has lasting impact. 9. Work across disciplines incorporating a range of perspectives. 10. Take account of the potential impact of COVID-19. 11. Facilitate capacity building and support researcher career development.

Lay abstract: Getting out and about in nature is good for us. It helps us stay healthy and active, stimulates our brains, keeps us in contact with other people, and brings pleasure and joy to our lives. During the COVID-19 pandemic, spending time in the garden or watching nature from the doorstep has helped people cope and feel connected. Older people living with cognitive impairment, and people with young-onset dementia, say that nature helps them in lots of ways. They feel more engaged, more enthusiastic, more hopeful, more resilient and better able to deal with challenges. Their family members agree that getting out and about in nature is helpful. This could be as simple as spending time in a nearby park or garden, or it could be a visit or organised outing to a special place or beauty spot that rekindles past memories. They also say there are things that get in the way and stop them enjoying nature as much as they would like. These include lack of facilities such as seats where you can have a rest, features like awkward steps that make it hard to get around, fear of getting lost due to lack of signs, staff seeming unhelpful, or a sense that older people are unwelcome. We need to remove these barriers and change attitudes. The places where people go to enjoy nature are usually managed by businesses, local councils, social enterprises and charities. We will call them 'providers'. Many providers want to make it easier for older people living with cognitive impairments and their families to access the places they manage, but do not know how. There is little guidance available for providers, because the amount of research so far has been small. Providers need to know how to respond to a growing market. If people are more satisfied with their visit to a particular place, they will tell others and more people will come. This will generate new business. The provider can then add better facilities. It is important that more research is done to help make these changes. A good number of providers and other organisations are keen to work with us on this project. Our research project will ask: What can be done to make outdoor places easier for older people living with cognitive impairment (including people with young-onset dementia) and their family members of all ages to visit? We will do this in 4 stages. We will involve older people (for the purposes of this project, this means older people living with cognitive impairment, including people with young-onset dementia) and their families in all of the stages. We will involve provider organisations in all of the stages as well. Stage 1 We will invite a wide range of people, providers and other organisations to send us information. We will talk to older people about their experiences of getting out and about in nature and what would make this easier. We will talk to providers to find out what works well and what could be improved. We will learn from the research that has already been done. Stage 2 We will work with older people and their families, and with managers and staff from provider organisations, to find ways to help people enjoy getting out and about in nature more. We will come up with a variety of ideas, to allow for different preferences and abilities. Stage 3 We will test these ideas out. We will work with different kinds of providers in different areas to find ways of making the places they run more accessible and welcoming. We will help them make changes. We will find out how well these changes work by talking with the older people who visit and with managers and staff. Stage 4 When we have finished we will pull together everything we have learned and share it with as many people as possible. We will work with older people and providers to develop resources such as guidelines and toolkits, and networks for sharing information. This will allow more people to use the results of our research.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH;NEUROLOGICAL