Outdoor environments are increasingly recognised as fundamental for the health and quality of life of people living with dementia. However, little is known about their availability, accessibility, and actual use in residential care facilities in Southern Europe. This study explores these dimensions in Portugal through a nationwide cross-sectional survey of 423 residential care facilities, completed by their directors in 2024. Logistic regression models were applied to examine organisational, institutional, spatial, and environmental factors associated with three outcomes: (i) autonomy to access outdoor spaces, (ii) frequency of residents going outdoors, and (iii) organisation of outdoor activities. Results show that nearly all facilities reported having outdoor areas (98.6%), most of them vegetated (93%). Nevertheless, only one-third allowed people living with dementia unrestricted access outdoors, while two-thirds required accompaniment or supervision. Autonomy was more likely in facilities located in the Lisbon Metropolitan Area (around the capital city) or Algarve (Southern Portugal) and in those facilities with orchards or vegetable gardens. Person-centred care practices, staff training, pavement accessibility, and the possibility of easy supervision significantly increased the frequency of outdoor use and the organisation of activities. Walking, conversation, and resting dominated outdoor activities, whereas gardening and structured interventions remained less common. These findings reveal a paradox: although outdoor areas are almost universal in Portuguese residential care facilities, their accessibility and effective use remain uneven and shaped by socio-spatial inequalities, organisational culture, and environmental design. Policies and practices must move beyond safety-driven restrictions to recognise outdoor life as a central dimension of dementia care.

Authors:
Liliana Sousa, University of Aveiro, Portugal
Miguel Padeiro, Universidade de Coimbra, Portugal
Flávia Machado, Universidade de Aveiro, Portugal
Oscar Ribeiro, Universidade de Aveiro, Portugal
Paula Santana, Universidade de Coimbra, Portugal
Clarissa Giebel, University of Liverpool, United Kingdom

About the Presenter(s)
Liliana Sousa, full professor at the University of Aveiro, Portugal. She is a psychologist with expertise in psychogerontology.

See this presentation on the full schedule – Tuesday Schedule

Bookmark