Academic journal article Australian Health Review

Outdoor Areas of Australian Residential Aged Care Facilities Do Not Facilitate Appropriate Sun Exposure

Academic journal article Australian Health Review

Outdoor Areas of Australian Residential Aged Care Facilities Do Not Facilitate Appropriate Sun Exposure

Article excerpt


Being outdoors has health, functional and psychosocial benefits for older people.1,2 Suitably designed built environments have the capacity to promote health and improve the quality of life of individuals.3 This includes older people who live in aged care facilities. Due to the aging of the population, increasing numbers of older people are living in aged care facilities. In 2011, over 165 000 people were in permanent residential aged care in Australia and approximately 4000 people received respite care in these facilities. From 1999 to 2011, the number of permanent residents of aged care facilities increased by 25% and the number of those receiving respite care increased by 60%.4

This population of older people in residential aged care has a high prevalence of falls and fractures, with vitamin D deficiency being an important risk factor.5 In Australia, the main source of vitamin D is synthesis through sunlight-derived ultraviolet radiation, and inadequate sun exposure is an important contributing factor to vitamin D deficiency in many older people. The importance of safe sun exposure, particularly in older people and others at high risk of vitamin D deficiency, has been recognised.6 Thus, for older people in residential aged care, promoting safe sun exposure is one way of reducing the risk of vitamin D deficiency, and the design of the facilities' outdoor spaces has an important role in this regard.

However, outdoor areas of aged care facilities have been reported to be underutilised. Cutler and Kane7 assessed the indoor and outdoor amenities of 40 nursing homes and interviewed residents, families and staff about the residents' use of outdoor spaces. They found that one-third of physically able residents go out less than once a month. There was also very low involvement by residents in planned outdoor activities, with 48.1% not participating in any outdoor activities. The environment and accessibility of the outdoor spaces were felt to be factors in their inadequate use.

Few design guidelines for residential aged care facilities specifically address the need to provide appropriate sun exposure. 'Vitamin D and the Built Environment in Victoria. A Guideline for Planners, Engineers, Architects and Policy Makers in Local and State Government'8 was developed for the Victorian state government in Australia. It recommends design features that enable direct sunlight exposure in built environments and these include: adjustable shade devices or deciduous trees; accessibility for those with mobility impairments; safety, privacy and security; a pleasant and appealing environment; and the development of activities to encourage the use of areas with direct sun exposure. Similar recommendations have been made for dementia care facilities in Victoria.9

A cluster randomised controlled trial (RCT) of sun exposure in older people in residential aged care facilities in northern Sydney, Australia, aimed to assess whether short periods of daily sun exposure over 1 year would increase vitamin D levels and reduce falls in this population.10 The study showed no significant decrease in falls or increase in vitamin D levels in the intervention group. However, in the 17% of participants who attended more than half the available sessions, there was a signi fi cant reduction in falls and increase in vitamin D levels. This poor adherence to the sunlight intervention was likely to have been an important factor in its lack of success. A follow-up study investigating the reasons for the poor adherence found that, in addition to poor health, decreased mobility and outdoor temperature discomfort, the outdoor environment used for sun exposure was a factor in determining attendance.11

The purpose of the present study was to assess whether the outdoor areas of the residential aged care facilities used in the previous sunlight RCT had features that encouraged participants to go outdoors.


In the sunlight cluster RCT,10 602 participants were recruited from 51 residential aged care facilities in northern Sydney and the Central Coast of New South Wales (NSW). …

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