The year 2020 brought about not only a staggering death toll across the world due to COVID-19, but also “a year of accelerated unraveling” for fragile older adults living with dementia, according to a Feb. 21 report in the New York Times Sunday Review.

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Quarantine restrictions limiting family visits except through windows, social distancing prohibiting congregate meals and physical contact, a lack of re-orienting routines such as physical and mental exercises and exposure to the arts, in addition to keeping people locked in their rooms, likely caused an uptick of emotional and physical problems, including agitation, depression, de-conditioning and overall failure to thrive.

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Tanya Carey, education and Eden coordinator at the Windsor Elms Village in Falmouth, Nova Scotia, observed an increase in challenging behaviors in residents when the home was in strict lockdown at the beginning of the pandemic.

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“Residents were not able to walk throughout the home and burn off energy,” she said.

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“There was little spontaneity. The residents missed their families and pet therapy. Previous group activities became one-on-one visits with little to no interaction among residents. The garden was no longer used for fun or a place of solace.”

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Stacey Flint, Montessori community relations coordinator of WindSong Memory Care Communities in Oregon, Washington and Colorado, noted “significant challenges to adhering to strict lockdown, including more dehydration and weight loss in residents.”

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Mental and physical problems also can occur in socially isolated adults living in their homes. The U.S. Centers for Disease Control and Prevention website cites evidence that isolation is associated with a 50 percent increased risk of dementia and other serious medical conditions in community-dwelling older adults.

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Antidotes to loneliness and isolation and strategies to increase resilience during the current pandemic have been challenging for adults of all ages, regardless of where they live.

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Researchers from Spain, Saudi Arabia, the United Kingdom, Norway and  Austria recently revealed evidence for a powerful mental health intervention that is free and readily available to most: contact with nature.

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The study found that increasing contact with blue-green spaces in nature was associated with mitigating the negative impacts of social isolation, increasing individuals’ resilience and maintaining positive mental health. Access to private outdoor spaces such as a garden or patio were perceived as most beneficial.

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The results, published in the November Science of the Total Environment journal, were based on more than 5,000 responses from adults age 26 to over 65 in nine countries during lockdown from the pandemic.

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Scientific evidence that spending time outdoors can improve wellbeing is not new. In an email interview, Richard Louv, author of books such as The Nature Principle, Vitamin N and Our Wild Calling, said there was a paucity of solid studies 15 years ago about the benefits of nature. But the Children & Nature Network that he co-founded in 2006 has compiled a library with summaries of more than 1,000 studies and reports on nature’s impact on children and adults.

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Architect Margaret Calkins, Ph.D., EDAC, FGSA, a nationally recognized trainer and researcher in the field of environments for elders, recently wrote a white paper, Designing Gardens to Attract Activity. She wanted to convince administrators, healthcare providers, family members and older adults living in residential homes of the benefits of spaces that help residents get outside regularly. She cited evidence that individuals in residential settings who go outdoors regularly exhibit less depression and time spent outdoors reduces stress in nursing home staff as well.

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Calkins reviewed a horticulture study of older adults in a three-month program of passive and active gardening activities. Depression was reduced and remained lower three months after the program ended. Additional improvements included quality of sleep and ability to concentrate.

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Marsha Stamm Gayl, a registered horticultural therapist with a private practice north of Philadelphia, said she conducted nature-based activities for the past nine years in 20 long-term care facilities, working with approximately 200 individuals per month. Beginning in March 2020, she was not allowed into the facilities.