Person-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Setting and Participants
2.3. Data Collection
2.4. Measurement
2.5. Ethical Consideration
2.6. Data Analysis
3. Results
3.1. Participant-Nursing Home Characteristics and Well-Being
3.2. Bivariate Associations between Person-Centered Climate, Greenery, and Well-Being
3.3. Multiple Linear Regression Models
4. Discussion
Methodological Consideration
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
EQ-VAS | LSQ | Depression c | |
---|---|---|---|
Unadjusted Model 1, R square (Adjusted R Square) p value | 0.09 (0.08), <0.001 | 0.17 (0.16), <0.001 | 0.10 (0.09), <0.001 |
Person-centered climate | 0.29 *** | 0.41 *** | −0.31 *** |
Unadjusted Model 2, R square (Adjusted R Square) p value | 0.10 (0.10), <0.001 | 0.20 (0.20), <0.001 | 0.12 (0.11), <0.001 |
Person-centered climate | 0.27 *** | 0.38 *** | −0.28 *** |
Greenery index | 0.13 ** | 0.18 *** | −0.15 ** |
Adjusted Model 3, R square (Adjusted R Square) p value | 0.36 (0.35), <0.001 | 0.34 (0.32), <0.001 | 0.17 (0.16), <0.001 |
Person-centered climate | 0.19 *** | 0.32 *** | −0.28 *** |
Greenery index | 0.06 | 0.10 * | −0.14 ** |
Frailty | −0.42 *** | −0.28 *** | -- c |
Age | -- | 0.10 * | -- |
Education | 0.08 * | -- | -- |
Length of residence | -- | −0.09 * | 0.00 |
Family visits | -- | 0.09 | -- |
Sex (male = 1, female = 0) | -- | −0.05 | -- |
Main source of income (retirement pension = 1, others = 0) | 0.09 * | −0.02 | -- |
Medical insurance (basic medical insurance for residents and self payment = 1, Medical insurance for employment = 0) | -- | −0.10 * | -- |
Multimorbidity (yes = 1, no = 0) | −0.22 *** | −0.10 * | 0.22 *** |
Nursing home ownership (private nursing home = 1, public and public–private nursing home = 0) | −0.00 | -- | -- |
Room types (single or couple room = 1, double or more = 0) | 0.02 | −0.06 | −0.05 |
Ratio of RNs/residents | -- | 0.07 | -- |
References
- WHO. Integrated Continuum of Long-Term Care. 2022. Available online: https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/ageing-and-health/integrated-continuum-of-long-term-care (accessed on 10 October 2022).
- Bayne, H.; Neukrug, E.; Hays, D.; Britton, B. A comprehensive model for optimizing empathy in person-centered care. Patient Educ. Couns. 2013, 93, 209–215. [Google Scholar] [CrossRef] [PubMed]
- McCance, T.; McCormack, B. Person-centred Practice Framework. In Person-Centred Practice in Nursing and Health Care: Theory and Practice; McCormack, B., McCance, T., Eds.; Wiley-Blackwell: Hoboken, NJ, USA, 2017. [Google Scholar]
- McCormack, B. Person-centredness in gerontological nursing: An overview of the literature. J. Clin. Nurs. 2004, 13, 31–38. [Google Scholar] [CrossRef] [PubMed]
- Sköldunger, A.; Sandman, P.; Backman, A. Exploring person-centred care in relation to resource utilization, resident quality of life and staff job strain—Findings from the SWENIS study. BMC Geriatr. 2020, 20, 465. [Google Scholar] [CrossRef] [PubMed]
- Ballard, C.; Corbett, A.; Orrell, M.; Williams, G.; Moniz-Cook, E.; Romeo, R.; Woods, B.; Garrod, L.; Testad, I.; Woodward-Carlton, B.; et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. PLoS Med. 2018, 15, e1002500. [Google Scholar] [CrossRef]
- Yoon, J.Y. Relationships among person-centered care, nursing home adjustment, and life satisfaction: A cross-sectional survey study. Int. Psychogeriatr. 2018, 30, 1519–1530. [Google Scholar] [CrossRef]
- Sjögren, K.; Lindkvist, M.; Sandman, P.; Zingmark, K.; Edvardsson, D. Person-centredness and its association with resident well-being in dementia care units. J. Adv. Nurs. 2013, 69, 2196–2205. [Google Scholar] [CrossRef]
- Kim, S.K.; Park, M. Effectiveness of person-centered care on people with dementia: A systematic review and meta-analysis. Clin. Interv. Aging 2017, 12, 381–397. [Google Scholar] [CrossRef] [Green Version]
- Li, J.; Porock, D. Resident outcomes of person-centered care in long-term care: A narrative review of interventional research. Int. J. Nurs. Stud. 2014, 51, 1395–1415. [Google Scholar] [CrossRef]
- Roos, C.; Silén, M.; Skytt, B.; Engström, M. An intervention targeting fundamental values among caregivers at residential facilities: Effects of a cluster-randomized controlled trial on residents’ self-reported empowerment, person-centered climate and life satisfaction. BMC Geriatr. 2016, 16, 130. [Google Scholar] [CrossRef] [Green Version]
- Astell-Burt, T.; Hartig, T.; Putra, I.G.N.E.; Walsan, R.; Dendup, T.; Feng, X. Green space and loneliness: A systematic review with theoretical and methodological guidance for future research. Sci. Total Environ. 2022, 847, 157521. [Google Scholar] [CrossRef]
- Dadvand, P.; Bartoll, X.; Basagaña, X.; Dalmau-Bueno, A.; Martinez, D.; Ambros, A.; Cirach, M.; Triguero-Mas, M.; Gascon, M.; Borrell, C.; et al. Green spaces and General Health: Roles of mental health status, social support, and physical activity. Environ. Int. 2016, 91, 161–167. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gianfredi, V.; Buffoli, M.; Rebecchi, A.; Croci, R.; Oradini-Alacreu, A.; Stirparo, G.; Marino, A.; Odone, A.; Capolongo, S.; Signorelli, C. Association between Urban Greenspace and Health: A Systematic Review of Literature. Int. J. Environ. Res. Public Health 2021, 18, 5137. [Google Scholar] [CrossRef] [PubMed]
- Nguyen, P.; Astell-Burt, T.; Rahimi-Ardabili, H.; Feng, X. Green Space Quality and Health: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 11028. [Google Scholar] [CrossRef] [PubMed]
- Rahimi-Ardabili, H.; Astell-Burt, T.; Nguyen, P.; Zhang, J.; Jiang, Y.; Dong, G.; Feng, X. Green Space and Health in Mainland China: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 9937. [Google Scholar] [CrossRef]
- Dahlkvist, E.; Hartig, T.; Nilsson, A.; Hogberg, H.; Skovdahl, K.; Engstrom, M. Garden greenery and the health of older people in residential care facilities: A multi-level cross-sectional study. J. Adv. Nurs. 2016, 72, 2065–2076. [Google Scholar] [CrossRef] [PubMed]
- Edwards, C.A.; McDonnell, C.; Merl, H. An evaluation of a therapeutic garden’s influence on the quality of life of aged care residents with dementia. Dementia 2013, 12, 494–510. [Google Scholar] [CrossRef]
- Artmann, M.; Chen, X.; Iojă, C.; Hof, A.; Onose, D.; Poniży, L.; Lamovšek, A.Z.; Breuste, J. The role of urban green spaces in care facilities for elderly people across European cities. Urban For. Urban Green 2017, 27, 203–213. [Google Scholar] [CrossRef]
- Dahlkvist, E.; Engström, M.; Nilsson, A. Residents’ use and perceptions of residential care facility gardens: A behaviour mapping and conversation study. Int. J. Older People Nurs. 2020, 15, e12283. [Google Scholar] [CrossRef] [Green Version]
- White, P.C.; Wyatt, J.; Chalfont, G.; Bland, J.M.; Neale, C.; Trepel, D.; Graham, H. Exposure to nature gardens has time-dependent associations with mood improvements for people with mid- and late-stage dementia: Innovative practice. Dementia 2018, 17, 627–634. [Google Scholar] [CrossRef]
- O’Connor, B.P.; Davidson, H.; Gifford, R. Window View, Social Exposure and Nursing Home Adaptation. Can. J. Aging 1991, 10, 216–223. [Google Scholar] [CrossRef]
- Carver, A.; Lorenzon, A.; Veitch, J.; Macleod, A.; Sugiyama, T. Is greenery associated with mental health among residents of aged care facilities? A systematic search and narrative review. Aging Ment. Health 2020, 24, 1–7. [Google Scholar] [CrossRef] [PubMed]
- Mcsweeney, J.; Rainham, D.; Johnson, S.A.; Sherry, S.B.; Singleton, J. Indoor nature exposure (INE): A health-promotion framework. Health Promot. Int. 2015, 30, 126–139. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Polit, D.F.; Beck, C.T. Multivariate Statistics. In Nursing Research: Generating and Assessing Evidence for Nursing Practice, 10th ed.; Wolters Kluwer: Philadelphia, PA, USA; Baltimore, MD, USA; New York, NY, USA; London, UK; Buenos Aires, Argentina; Hong Kong; Sydney, Australia; Tokyo, Japan, 2017; pp. 351–378. [Google Scholar]
- Yang, Y.; Li, H.; Xiao, L.D.; Zhang, W.; Xia, M.; Feng, H. Resident and staff perspectives of person-centered climate in nursing homes: A cross-sectional study. BMC Geriatr. 2019, 19, 292. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Edvardsson, D.; Sandman, P.; Rasmussen, B. Swedish language Person-centred Climate Questionnaire—Patient version: Construction and psychometric evaluation. J. Adv. Nurs. 2008, 63, 302–309. [Google Scholar] [CrossRef]
- Carlsson, M.; Hamrin, E. Evaluation of the life satisfaction questionnaire (LSQ) using structural equation modelling (SEM). Qual Life Res. 2002, 11, 415–425. [Google Scholar] [CrossRef]
- Feng, Y.; Parkin, D.; Devlin, N.J. Assessing the performance of the EQ-VAS in the NHS PROMs programme. Qual Life Res. 2014, 23, 977–989. [Google Scholar] [CrossRef] [Green Version]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 2001, 16, 606–613. [Google Scholar] [CrossRef]
- Lou, Y.; Xu, L.; Carlsson, M.; Lan, X.; Engström, M. Quality of life of older people in nursing homes in China–evaluation and application of the Chinese version of the life satisfaction questionnaire. BMC Geriatr. 2022, 22, 328. [Google Scholar] [CrossRef]
- EQ-5D. EQ-5D User Guides. 2022. Available online: https://euroqol.org/publications/user-guides (accessed on 12 April 2022).
- Wang, W.; Bian, Q.; Zhao, Y.; Li, X.; Wang, W.; Du, J.; Zhang, G.; Zhou, Q.; Zhao, M. Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population. Gen. Hosp Psychiatry 2014, 36, 539–544. [Google Scholar] [CrossRef]
- Zhao, M.; Mou, H.; Zhu, S.; Li, M.; Wang, K. Cross-cultural adaptation and validation of the FRAIL-NH scale for Chinese nursing home residents: A methodological and cross-sectional study. Int. J. Nurs. Stud. 2020, 105, 103556. [Google Scholar] [CrossRef]
- Kaehr, E.; Visvanathan, R.; Malmstrom, T.K.; Morley, J.E. Frailty in Nursing Homes: The FRAIL-NH Scale. J. Am. Med. Dir. Assoc. 2015, 16, 87–89. [Google Scholar] [CrossRef] [PubMed]
- Fritz, C.O.; Morris, P.E.; Richler, J.J. Effect size estimates: Current use, calculations, and interpretation. J. Exp. Psychol. Gen. 2012, 141, 2–18. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cohen, J. A power primer. Psychol Bull. 1992, 112, 155–159. [Google Scholar] [CrossRef] [PubMed]
- Dung, V.; Thi Mai Lan, N.; Thu Trang, V.; Xuan Cu, T.; Minh Thien, L.; Sy Thu, N.; Dinh Man, P.; Minh Long, D.; Trong Ngo, P.; Minh Nguyet, L. Quality of life of older adults in nursing homes in Vietnam. Health Psychol. Open 2020, 7, 275475626. [Google Scholar] [CrossRef]
- Li, J.; Xu, X.; Sun, J.; Cai, W.; Qin, T.; Wu, M.; Liu, H. Activities of daily living, life orientation, and health-related quality of life among older people in nursing homes: A national cross-sectional study in China. Qual Life Res. 2020, 29, 2949–2960. [Google Scholar] [CrossRef] [PubMed]
- Drageset, J.; Eide, G.E.; Corbett, A. Health-related quality of life among cognitively intact nursing home residents with and without cancer—A 6-year longitudinal study. Patient Relat. Outcome Meas. 2017, 8, 63–69. [Google Scholar] [CrossRef] [Green Version]
- Xiao, H.; Yoon, J.Y.; Bowers, B. Quality of life of nursing home residents in China: A mediation analysis. Nurs. Health Sci. 2017, 19, 149–156. [Google Scholar] [CrossRef]
- Onunkwor, O.F.; Al-Dubai, S.A.R.; George, P.P.; Arokiasamy, J.; Yadav, H.; Barua, A.; Shuaibu, H.O. A cross-sectional study on quality of life among the elderly in non-governmental organizations’ elderly homes in Kuala Lumpur. Health Qual Life Outcomes 2016, 14, 6. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Buckinx, F.; Reginster, J.Y.; Petermans, J.; Croisier, J.L.; Beaudart, C.; Brunois, T.; Bruyère, O. Relationship between frailty, physical performance and quality of life among nursing home residents: The SENIOR cohort. Aging Clin. Exp. Res. 2016, 28, 1149–1157. [Google Scholar] [CrossRef]
- Silva E Farias, I.P.; Montenegro, L.D.A.S.; Wanderley, R.L.; de Pontes, J.C.X.; Pereira, A.C.; de Almeida, L.D.F.D.; Cavalcanti, Y.W. Physical and psychological states interfere with health-related quality of life of institutionalized elderly: A cross-sectional study. BMC Geriatric. 2020, 20, 386. [Google Scholar] [CrossRef]
- Shippee, T.P.; Henning-Smith, C.; Kane, R.L.; Lewis, T. Resident- and Facility-Level Predictors of Quality of Life in Long-Term Care. Gerontologist 2015, 55, 643–655. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Røen, I.; Kirkevold, Ø.; Testad, I.; Selbæk, G.; Engedal, K.; Bergh, S. Person-centered care in Norwegian nursing homes and its relation to organizational factors and staff characteristics: A cross-sectional survey. Int. Psychogeriatr. 2018, 30, 1279–1290. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Boscart, V.M.; Sidani, S.; Poss, J.; Davey, M.; d’Avernas, J.; Brown, P.; Heckman, G.; Ploeg, J.; Costa, A.P. The associations between staffing hours and quality of care indicators in long-term care. BMC Health Serv. Res. 2018, 18, 750. [Google Scholar] [CrossRef]
- Sugiyama, T.; Carver, A.; Sugiyama, M.; Lorenzon, A.; Davison, T.E. Views of Greenery and Psychological Well-Being in Residential Aged Care Facilities: Longitudinal Associations. HERD 2022, 15, 219–232. [Google Scholar] [CrossRef]
- Hartig, T.; Mitchell, R.; de Vries, S.; Frumkin, H. Nature and health. Annu. Rev. Public Health 2014, 35, 207–228. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gardner, W.; States, D.; Bagley, N. The Coronavirus and the Risks to the Elderly in Long-Term Care. J. Aging Soc. Policy 2020, 32, 310–315. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Armitage, R.; Nellums, L.B. COVID-19 and the consequences of isolating the elderly. Lancet Public Health 2020, 5, e256. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wang, R.; Feng, Z.; Liu, Y.; Lu, Y. Relationship between neighbourhood social participation and depression among older adults: A longitudinal study in China. Health Soc. Care Community 2020, 28, 247–259. [Google Scholar] [CrossRef]
- Ulrich, R.S. View through a window may influence recovery from surgery. Science 1984, 224, 420–421. [Google Scholar] [CrossRef] [Green Version]
- Kent, M.; Schiavon, S. Evaluation of the effect of landscape distance seen in window views on visual satisfaction. Build Environ. 2020, 183, 107160. [Google Scholar] [CrossRef]
- Brooks, A.M.; Ottley, K.M.; Arbuthnott, K.D.; Sevigny, P. Nature-related mood effects: Season and type of nature contact. J. Environ. Psychol. 2017, 54, 91–102. [Google Scholar] [CrossRef]
- Lucas, J.A.; Levin, C.A.; Lowe, T.J.; Robertson, B.; Akincigil, A.; Sambamoorthi, U.; Bilder, S.; Paek, E.K.; Crystal, S. The Relationship between Organizational Factors and Resident Satisfaction with Nursing Home Care and Life. J. Aging Soc. Policy 2007, 19, 125–151. [Google Scholar] [CrossRef] [PubMed]
- Toh, H.J.; Yap, P.; Wee, S.L.; Koh, G.; Luo, N. Feasibility and validity of EQ-5D-5L proxy by nurses in measuring health-related quality of life of nursing home residents. Qual Life Res. 2021, 30, 713–720. [Google Scholar] [CrossRef] [PubMed]
- Sandvoll, A.M.; Grov, E.K.; Simonsen, M. Nursing home residents’ ADL status, institution-dwelling and association with outdoor activity: A cross-sectional study. PeerJ 2020, 8, e10202. [Google Scholar] [CrossRef] [PubMed]
Variables | n (%) | Mean (SD)/Median (IQR), Min–Max |
---|---|---|
Age (years) | 82.7 (8.3), 52–101 | |
Length of residence (years) | 2.0 (1: 4), 0.1–25 | |
Times of family visits a | 3 (0: 5), 0–6 | |
Sex | ||
Female | 228 (48.5) | |
Male | 242 (51.5) | |
Marital status | ||
Divorced/single/widow(er) | 405 (86.2) | |
Married | 65 (13.8) | |
Education | ||
No formal/primary school | 359 (76.4) | |
Junior high school | 72 (15.3) | |
High school | 26 (5.5) | |
College or higher | 13 (2.8) | |
Having children | ||
No | 118 (25.1) | |
Yes | 352 (74.9) | |
Main source of income | ||
Family members or others | 310 (66.0) | |
Retirement pension | 160 (34.0) | |
Medical insurance | ||
Medical insurance for employees | 85 (18.1) | |
Basic medical insurance for residents or self-paid | 385 (81.9) | |
Multimorbidity | ||
No | 261 (55.5) | |
Yes | 209 (44.5) | |
Number of residents/nursing home | 85 (46: 200), 20–328 | |
Ratio of RNs/residents | 0.004 (0:0.03), 0–0.09 | |
Ratio of total staff/residents | 0.23 (0.2:0.3), 0.12–0.46 | |
Greenery index | 10 (9:11), 6–13 | |
Percentage of residents visiting garden | 0.6 (0.5:0.8), 0.1–1.0 | |
Nursing home ownership | ||
Public and public–private nursing home | 275 (58.5) | |
Private nursing home | 195 (41.5) | |
Type of room (number of residents sharing the same bedroom) | ||
Double or more | 286 (60.9) | |
Single room or a room for couples | 184 (39.1) | |
EQ-5D-5L | ||
Mobility (no problems/slight problems/moderate problems/severe problems/unable) | 283/108/35/16/28 | |
Self-care (no problems/slight problems/moderate problems/severe problems/unable) | 356/61/21/8/24 | |
Usual activities (no problems/slight problems/moderate problems/severe problems/unable) | 337/79/28/12/14 | |
Pain/discomfort(no/slight/moderate/severe/extreme) | 220/160/60/25/5 | |
Anxiety/depression(no/slight/moderate/severe/extreme) | 356/80/20/11/3 |
Variables Mean (SD) | EQ-VAS c | LSQ c | Depression d |
---|---|---|---|
Sex, effect size (p-value) a | 0.043 (0.356) | 0.098 (0.034) | 0.055 (0.229) |
Female | 70.1 (16.9) | 66.8 (10.9) | 2.8 (3.8) |
Male | 70.7 (20.1) | 64.6 (10.4) | 2.4 (3.4) |
Marital status, effect size (p-value) a | 0.004 (0.937) | 0.072 (0.121) | 0.011 (0.805) |
Divorced/single/widow(er) | 70.6 (18.1) | 65.4 (10.7) | 2.6 (3.6) |
Married | 69.2 (21.5) | 67.6 (10.7) | 2.9 (4.2) |
Having children, effect size (p-value) a | 0.021 (0.644) | 0.279 (<0.001) | 0.035 (0.448) |
No | 70.3 (21.1) | 60.3 (10.4) | 2.9 (3.8) |
Yes | 70.4 (17.7) | 67.5 (10.2) | 2.5 (3.6) |
Main source of income, effect size (p-value) a | 0.107 (0.020) | 0.132 (0.004) | 0.006 (0.898) |
Family members or others | 68.6 (19.9) | 64.6 (10.9) | 2.8 (3.9) |
Retirement pension | 73.7 (15.1) | 67.7 (10.0) | 2.3 (3.0) |
Medical insurance, effect size (p-value) a | 0.046 (0.314) | 0.147 (0.001) | 0.061 (0.185) |
Medical insurance for employees | 71.8 (18.7) | 68.7 (10.1) | 2.7 (3.5) |
Basic medical insurance for residents or self-paid | 70.1 (18.6) | 65.0 (10.7) | 2.6 (3.7) |
Multimorbidity, effect size (p-value) a | 0.294 (<0.001) | 0.126 (0.006) | 0.225 (<0.001) |
No | 75.3 (16.5) | 67.0 (10.0) | 1.9 (2.8) |
Yes | 64.2 (19.2) | 64.0 (11.3) | 3.5 (4.3) |
Nursing home ownership, effect size (p-value) a | 0.145 (0.002) | 0.001 (0.975) | 0.055 (0.236) |
Public and public–private nursing home | 72.5 (18.3) | 65.8 (10.7) | 2.3 (3.2) |
Private nursing home | 67.3 (18.6) | 65.5 (10.6) | 3.0 (4.2) |
Number of residents in nursing home, effect size (p-value) a,b | 0.007 (0.873) | 0.031 (0.508) | 0.030 (0.512) |
Fewer residents (≤85 residents) | 69.9 (20.3) | 65.9 (11.3) | 2.8 (4.0) |
More residents (>85 residents) | 70.8 (16.5) | 65.5 (10.1) | 2.3 (3.2) |
Type of room (number of residents sharing the same bedroom), effect size (p-value) a | 0.152 (0.001) | 0.116 (0.012) | 0.109 (0.018) |
Double or more | 68.0 (19.9) | 64.7 (11.2) | 2.9 (3.9) |
Single or couple | 74.0 (15.6) | 67.2 (9.7) | 2.1 (3.1) |
Variables | Mean (SD)/Median (Q1:Q3) | (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) | (12) | (13) | (14) | (15) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age (1) | 82.7 (8.3) | -- | ||||||||||||||
Education (2) | 0.09 | -- | ||||||||||||||
Length of residence (3) | 2.0 (1: 4) | −0.12 * | −0.13 ** | -- | ||||||||||||
Family visits (4) | 3 (0: 5) | 0.51 *** | 0.22 *** | .−0.47 *** | -- | |||||||||||
Ratio of RNs/residents (5) | 0.004 (0:0.03) | 0.33 *** | 0.28 *** | −0.25 *** | 0.51 *** | |||||||||||
Ratio of total staff/residents (6) | 0.23 (0.2:0.3) | 0.31 *** | 0.28 *** | −0.27 *** | 0.45 *** | 0.72 *** | ||||||||||
Greenery index×percentage visit of garden (7) a | 6.0 (2.4) | −0.03 | −0.14 ** | 0.04 | −0.03 | −0.22 *** | −0.32 *** | |||||||||
Safety (8) | 5.3 (1.1) | 0.09 * | 0.09 | −0.07 | 0.11 * | 0.04 | −0.01 | 0.08 | -- | |||||||
Everydayness (9) | 5.5 (1.0) | 0.05 | 0.12 * | −0.01 | 0.06 | 0.02 | −0.04 | 0.09 | 0.89 *** | -- | ||||||
Hospitality (10) | 5.2 (1.1) | 0.01 | 0.06 | −0.01 | 0.03 | −0.05 | −0.08 | 0.12 ** | 0.82 *** | 0.84 *** | -- | |||||
Person-centered climate total (11) | 91.0 (16.8) | 0.06 | 0.10 * | −0.03 | 0.08 | 0.02 | −0.04 | 0.10 * | 0.96 *** | 0.96 *** | 0.91 *** | -- | ||||
Frailty (12) | 1.5 (2.0) | 0.02 | −0.02 | −0.12 ** | 0.11 * | 0.07 | 0.09 * | −0.16 ** | −0.20 *** | −0.24 *** | −0.25 *** | −0.24 *** | -- | |||
EQ-VAS (13) | 70.4 (18.6) | 0.07 | 0.16 *** | −0.01 | 0.05 | −0.01 | −0.06 | 0.05 | 0.29 *** | 0.30 *** | 0.26 *** | 0.30 *** | −0.47 *** | -- | ||
LSQ (14) | 65.7 (10.7) | 0.20 *** | 0.07 | −0.18 *** | 0.23 *** | 0.15 ** | 0.13 ** | 0.17 *** | 0.36 *** | 0.36 *** | 0.36 *** | 0.38 *** | −0.34 *** | 0.41 *** | -- | |
Depression (15) | 2.6 (3.6) | −0.00 | 0.02 | 0.09 * | −0.07 | 0.04 | 0.05 | −0.21 *** | −0.26 *** | −0.25 *** | −0.32 *** | −0.28 *** | 0.52 *** | −0.40 *** | −0.50 *** | -- |
EQ-VAS | LSQ | Depression c | |
---|---|---|---|
Unadjusted Model 1, R square (Adjusted R Square) p value | 0.09 (0.08), <0.001 | 0.17 (0.16), <0.001 | 0.10 (0.09), <0.001 |
Person-centered climate | 0.29 *** | 0.41 *** | −0.31 *** |
Unadjusted Model 2, R square (Adjusted R Square) p value | 0.09 (0.08), <0.001 | 0.20 (0.20), <0.001 | 0.15 (0.14), <0.001 |
Person-centered climate | 0.29 *** | 0.39 *** | −0.28 *** |
Greenery index × percentage of visits garden | -- | 0.18 *** | −0.23 *** |
Adjusted Model 3, R square (Adjusted R Square) p value | 0.36 (0.35), <0.001 | 0.35 (0.34), <0.001 | 0.21 (0.20), <0.001 |
Person-centered climate | 0.20 *** | 0.32 *** | −0.27 *** |
Greenery index × percentage of visits garden | -- | 0.18 *** | −0.25 *** |
Frailty | −0.42 *** | −0.26 *** | -- c |
Age | -- | 0.09 * | -- |
Education | 0.08 * | -- | -- |
Length of residence | -- | −0.10 * | 0.04 |
Family visits | -- | 0.09 | -- |
Sex (male = 1, female = 0) | -- | −0.05 | -- |
Main source of income (retirement pension = 1, others = 0) | 0.10 * | −0.02 | -- |
Medical insurance (basic medical insurance for residents and self payment = 1, Medical insurance for employment = 0) | -- | −0.09 * | -- |
Multimorbidity (yes = 1, no = 0) | −0.22 *** | −0.11 ** | 0.22 *** |
Nursing home ownership (private nursing home = 1, public and public–private nursing home = 0) | −0.01 | -- | -- |
Room type (single or couple room = 1, double or more = 0) | 0.03 | −0.04 | −0.09 * |
Ratio of RNs/residents | -- | 0.12 * | -- |
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Xu, L.; Lou, Y.; Li, C.; Tao, X.; Engström, M. Person-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2023, 20, 749. https://doi.org/10.3390/ijerph20010749
Xu L, Lou Y, Li C, Tao X, Engström M. Person-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2023; 20(1):749. https://doi.org/10.3390/ijerph20010749
Chicago/Turabian StyleXu, Lijuan, Yan Lou, Caifu Li, Xuemei Tao, and Maria Engström. 2023. "Person-Centered Climate, Garden Greenery and Well-Being among Nursing Home Residents: A Cross-Sectional Study" International Journal of Environmental Research and Public Health 20, no. 1: 749. https://doi.org/10.3390/ijerph20010749