Associations Between Quality of Life and Outdoor Access in Nursing Homes: A Cross-Sectional Study

Associations between provision of independent access to outdoor areas and frequency of Australian nursing home (NH) residents going outdoors with health-related quality of life (HR-QoL, EQ-5D-5L) are examined in a cross-sectional study (541 participants, 17 homes, 84% with cognitive impairment) using multilevel models. After adjustments for potential confounders (including comorbidities and home location), independent access to outdoor areas was not associated with HR-QoL (β=-0.01, 95% CI, -0.09–0.07). Going outdoors daily (β=0.13, 95% CI 0.06–0.21), but not multiple times a week (β=0.03; 95% CI, -0.03–0.09), was associated with better HR-QoL. Residents living in small-scale, clustered, homelike facilities had greater odds of going outdoors daily (odds ratio 15.1; 95% CI, 6.3–36.2). Provision of independent access to outdoor areas alone may be insufficient to achieve HR-QoL benefits of NH residents venturing outdoors, in a pre-COVID era. Staffing structures, organizational attitudes, environmental design, and activities to support residents of NHs venturing outdoors frequently, despite any COVID-19-related restrictions, are needed.