Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review
Abstract
:1. Introduction
1.1. Benefits of Contact with Nature
1.2. The Therapeutic Effects of Gardens and Horticulture
1.3. The Effects of Therapeutic Gardens and Horticultural Therapy on People with Dementia
1.4. Objectives and Research Questions
- How effective are therapeutic gardens for PWD?
- Which domains (behavioral, cognitive, mood, sleep, physiological, etc.) are the most affected?
- Which garden design features have the greatest effects (presence of water, types of plant, presence of animals, etc.)?
- Which activities undertaken in the garden are the most effective (structured activities such as gardening or recreational activities such as doing physical exercises, spending time in the garden, or walking)?
2. Materials and Methods
2.1. Search Methods for Identifying the Studies
- relating to the neurodegenerative disease of the population considered, i.e., dementia OR Alzheimer’s disease OR mild cognitive impairment (MCI);
- in combination (AND) with horticultural therapy OR garden therapy OR healing garden OR therapeutic garden OR wander garden OR gardens for cognitive impairment.
2.2. Inclusion Criteria
- -
- Type of publication: articles published in scientific journals
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- Language: English
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- Research design: experimental or quasi-experimental, with transversal or longitudinal designs, and studies with a control group, OR using correlational methods that relate the time spent in the gardens with the outcomes; individual case studies
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- Type of intervention: therapeutic gardening or horticultural activities in indoor and outdoor natural settings
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- Population: people with MCI, PWD (Alzheimer’s disease or other types of dementia)
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- Reference setting: therapeutic gardens for PWD in various residential care facilities, i.e., adult day services [31,32], dementia care units [33,34,35,36], nursing homes [32,37,38,39,40,41], long-term care settings [42], care institutions for dementia patients [43], hospitals [39,44,45], and mental health services [46].
2.3. Exclusion Criteria
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- Books, chapters of books, doctoral theses, proceedings
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- Articles based exclusively on descriptive studies, expert opinions
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- Reviews and meta-analyses
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- Studies on typically-functioning elderly people
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- Studies involving patients with diseases other than dementia
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- Studies on the effects of mere exposure to nature in various settings, rather than on therapeutic gardens or gardening.
3. Results
3.1. Characteristics of the Studies
3.1.1. Types of Study, Country, Year of Publication
3.1.2. Characteristics of the Samples
3.1.3. Assessment Measures
3.2. Findings in Regard to Our Research Questions
3.2.1. Engagement
3.2.2. Affect
3.2.3. Depression/Mood
3.2.4. Agitation
3.2.5. Quality of Life/Wellbeing
3.2.6. Self-Consciousness
3.2.7. Sleep
3.2.8. Stress
3.2.9. Cognition
3.2.10. Behavior
3.2.11. Falls
3.2.12. Activities of Daily Living
3.2.13. Medication
4. Discussion
4.1. Research Questions and Related Answers
4.2. Limitations and Future Developments
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Appendix A
Study | Activity | Description of Activity |
---|---|---|
[31] | Horticultural therapy, 30 min per session, once a week for 9 weeks | The time of year when the activities were undertaken is not stated, but each group had horticulture therapy in more than one setting, depending on the summer heat (indoors, in a screened-in porch, in an outdoor area with raised beds). Two horticulture therapists with experience of working with older adults planned the sessions, some involving teamwork, others conducted individually in parallel activities. The care home staff were invited to help with the horticultural activity (during the sessions with individuals who needed one-to-one attention). Facilitators presented the activity, encouraged social interaction and reminiscencing with questions about participants’ social stories and past experiences of gardening, farming, cooking, and other related topics. Before each activity, the facilitators prepared the material for each participant, involving them in the choice of plants and containers. The activities were personalized. For example, individuals with a tendency to wander were instructed to fill watering cans for others who had more mobility issues, and those who were bothered by dirt were given gloves. Adapted gardening tools were used. |
[43] | Indoor gardening, 1 h per session, twice a day for 4 weeks | The time of year when the activities were undertaken is not stated. Each individual was assisted by three registered nurses in the choice of their preferred plant and a name to give their container. The containers were located in the day room at the care home and could be accessed all day. Activities included: picking seeds, filling containers, planting roots or seeds, touching, watering, organizing containers, cleaning floors, harvesting, cutting, and washing. Participants had to make multiple trips to fill small watering cans and wash dirty cloths. They were encouraged to look at and touch their plants whenever they wished and, once harvested, the products were served as a side dish with their meals. The plants chosen were filipendula and soybean sprouts as they are familiar, affordable, edible, easy to grow and bloom, and require little space. |
[32] | Horticultural therapy, 50 min per session, twice a week for 6 weeks | The time of year when the activities were undertaken is not stated. Two facilitators developed the activities, chosen for their simplicity, cost and versatility. When a group exceeded eight participants it was split into two to provide step-by-step assistance and a constant supply of materials to participants. Activities ranged from sowing to training topiaries to craft activities that included horticultural materials and themes. Participants were encouraged to interact and remember through questions about gardening and cooking. The activities depended on the plants in season. Participation was voluntary and proposed to elderly people who were told that the activity would involve gardening. |
[37] | Horticultural therapy, 30 min per session, twice a week for 6 weeks | The time of year when the activities were undertaken and the type of trainer are not stated. Each session had a different theme (sowing, fertilizing, planting, caring for flowers). |
[46] | Structured gardening program, 1 h a week, 46 sessions | From May 2009 to May 2010 Each session was arranged to include first some time to plan the activity and socialize, then an hour of gardening followed by a moment of reflection and discussion on the activities. There were 6 occupational therapists, a horticultural therapist, a psychologist, a volunteer, and a support worker at each session. A flexible and adaptive approach, based on positive reinforcement, was used. Activities: digging and planting spring flowering bulbs in the flowerbeds, removing leaves, sensory activities. Options were given where possible so that participants could have choice and autonomy. After each session, a diary was updated with photos and written information that participants used to communicate with their relatives. |
[42] | Therapeutic gardening and cognitive behavioral therapy, 40/60-min sessions, 3–4 times a week, over 6 weeks | The time of year when the activities were undertaken is not stated. A weekly calendar indicated the day, time, and type of activity for the day to encourage a sense of autonomy and competence, and to promote a sense of readiness for the therapist’s arrival. It was sometimes necessary to encourage PWD to take part in the activity, to support their efforts in the garden as much as possible, involve them in discussions about their own care, and encourage their active participation, giving voice to the needs related to horticulture and other issues. Simple tasks: picking seeds, planting, taking care of the garden. Patients were encouraged to independently choose 8 flowers and plants to put in a flower bed. They chose the better-known ones and the therapist encouraged their memories with questions about their history and their family. |
Study | Type of Garden | Description of the Garden |
---|---|---|
[33] [34] [35] | Wander garden | The garden could be seen in its entirety from a large floor-to-ceiling wide window in the dining room, which was also used as an activity room. Two doors, one on each side, led to a walkway that went around the perimeter of the garden. Two of the three outer walls of the walkway had large windows and there were three doors for exiting the garden. These doors had the standard electronic constraints to prevent escape. The third outer wall had a small window with panes above eye level for providing natural light without offering a view of the outside environment. The doors to the wander garden were usually open after breakfast and closed after dinner, even when the weather was unfavorable. Activities comprised daily garden viewing, garden walks, and garden activities when the weather allowed. [32] The garden was used less in the winter months but residents of the nursing home could see it through the dining room window. From mid-October to mid-March the garden remained closed due to the cold. It was also closed for 2 weeks in April for administrative reasons. The doors to the garden were closed at 4:30 pm in April and May, and at 8 pm in June. In July and August it was too hot to go out before 4–5 pm. [36] Visits to the garden were mainly between August and October, and increased over this time, then decreased between December and February. They increased again between March and April, leveling off until July, but no longer reached the numbers of the first months of opening. |
[38] | Therapeutic garden | The garden was used in Spring. Elements in the garden included memory boxes, a tinka car, a platform overlooking the Australian countryside, a woodpile, an aviary, a quiet area with water features, and flower beds where residents can dig and pick products. |
[39] [44] | Japanese garden | Abstract naturalistic garden with plants, stones, stepping stones, bamboo fences, stone basins, stone lanterns. [44] TEST 1: 16 March–4 April (participants were seated so as to view the unreconstructed, natural area from an open door. TEST 2: 22 June–10 July (same situation as TEST 1 but viewing a Japanese garden); TEST 3: from 19 to 25 October (the summer months were skipped due to the heat; same situation as TEST 2 but with the door closed); TEST 4, a week after TEST3 (same situation as TEST 3 but with chrysanthemum scent). [39] TEST 1: 1–15 April (before the construction of the gardens); TEST 2: 1–15 June (after the construction of the gardens, viewing with the door open); TEST 3: 19–25 October (summer skipped due to the heat; viewing the gardens with the door closed). The tests took place from 9:30 to 12:30, and from 13:00 to 16:30. While participants were viewing the gardens, the staff recorded heart rate and behavior, and did not encourage discussion, but only answered the participants’ questions. |
[40] | Nature garden | Observations throughout the year except January, peaking from May to September. Renovated space with fruit trees and vegetable beds, both passive and active spaces, following previously-established guidelines. |
[36] | Indoor therapeutic garden | The sessions took place in the morning between 9:00 and 14:00, in groups of about 20 participants, from June 2015 to June 2016. The garden of the care home (located in the city center) included a large, purpose-built area covering 300 square meters with non-toxic plants that promote olfactory, visual, and tactile stimuli. The trail was endless and encouraged movement and contact with the plants. The entrance gave direct access to the trail, built with smooth, non-slip material. Inside the garden there were two areas for sitting and socializing, and a fountain with running water. The garden walls had large glass windows, covered with a safety film, affording a direct view from the inside. Temperature and humidity were kept constant. Garden plants: ficus benjamina, croton variegatum, aglaonema commutatum, spathiphyllum wallisii, anthurium andreanum, dracena marginata, variegated ground cover scindapsus, feijoa sellowiana, shefflera act., trinette, rosmarinus officinalis, jasminea, dwarf officinalis, white heavenly muse. Patients were accompanied by the session managers to the therapeutic garden where they strolled and were encouraged to touch the plants and flowers. |
[41] | Indoor sensory garden | The time of year was not stated. The garden was placed in the dining room on the first floor, on a dining table, set apart from other activities in the room by a curtain. |
Outside sensory garden | The time of year was not stated, but the excessively cold climate limited participants’ opportunities to experience the outdoor garden. Windows in the walls of the dining room on the first floor let in natural light, enabling residents to view nature. Participants were encouraged by the researchers to interact with all the plants. They were asked what the plants reminded them of, involving all the senses—taste, touch, scent. Plants: Coriandrum sativum, Lactuca sativa “Simpson Elite”, Hosta “Patriot”, Rosemary, Brassica juncea “Red Giant”, Chrysanthemum, Dracaena. | |
[45] | Art memory life garden | The time of year was not stated. The garden contained artistic, natural and cultural features. It was 4000 square meters in size, accessible directly from the day room at the Cognitive Behavioral Unit. It was surrounded by buildings on three sides and it had an opening overlooking the city on the fourth. Access was reserved for residents and visitors to the center. Climate was continental, with cold winters and frequent rains. The garden faced south and the building was to the north, with both sunny and shaded areas thanks to the presence of plants and numerous old trees. Residents could use it as they wished, in the utmost autonomy, to contemplate the plants and artworks, use the benches, and have conversations. They could put their things on the tables, and find magazines. There were drinks available. The flowers could be touched and picked. The sculptures could be touched and were designed for tactile exploration. Residents could receive their loved ones of all ages in the garden. There were planters with small strawberry plants, herbs, and fragrant plants, and the residents could watch and water them, and taste the fruits. They could also look at the Galileo thermometer and the insect cages. They received friends and relatives with no time constraints or fixed schedules, and went to the garden with them as often as they wished. If small children were visiting, it was preferable to receive them in the garden. Residents could have meals or snacks in the garden too whenever they wished. The general criteria for creating a therapeutic garden had been adopted, including: avoiding glare, and sudden changes of lighting between indoor and outdoor spaces; hygiene and accessibility (no stagnant water); simple and clear layout to facilitate orientation; private and shared spaces, avoiding large spaces and stressful elements; a view from inside the garden; surveillance by staff; a view of the city; furniture adapted to residents’ physical needs; water features. Symbolic elements were linked to the local culture. Plants: strawberries and aromatic plants, old trees, non-toxic plants, flowers with bright colors. |
Study | Study Design | Study Duration | Intervention/ Exposure | Control | Outcomes | Measures | Results |
---|---|---|---|---|---|---|---|
[31] Gigliotti and Jarrott (2005) | Multiple treatment | 9 weeks | Horticultural therapy (HT), 30 min per session, once a week, 9 weeks | Same group: traditional activities (TA) (exercise, crafts, games, puzzles) | Engagement | Ad hoc observational tool | HT > TA (t = 13.47, p < 0.001) |
Affect | Ad hoc observational tool based on DCM | HT > TA (t = 5.15, p < 0.001) | |||||
[33] Detweiler et al. (2008) | Pre-test, post-test | 2 years | Use of a wander garden after construction | No control group | Behavior | CMAI short form | T1 > T0 (final CMAI score with total days in the garden (r = −0.388, p < 0.05) |
Incident reports | No difference | ||||||
Medication | Pro re nata (PRN) | T1 > T0 (total year PRNs with total observation year PRNs baseline (r = 0.585, p < 0.01) | |||||
[43] Lee and Kim (2008) | Pre-test, post-test | 5 weeks | Indoor gardening, 1-h sessions, twice a day, for 4 weeks | No control group | Sleep | Sleep diaries | T1 > T0 on: WASO frequency (t = 3.568, p = 0.002) and WASO duration (t = 2.781, p = 0.011); Nap frequency (t = 6.480, p < 0.001) and duration (t = 7.933, p < 0.001); NST: (t = -3.493, p = 0.002); NSE: (t = −3.048, p = 0.006); No difference in T1 on: Sleep onset (t = 1.555, p = 0.134); Wake up time (t = −1.646, p = 0.114); TST (t = −0.030, p = 0.976) |
Agitation | M-CMAI | T1 > T0 (t = −4.002, p = 0.001) | |||||
Cognition | HDS-R | T1 > T0 (t = −12.044, p < 0.001) | |||||
[34] Detweiler et al. (2009) | Pre-test, post-test; single blind | 2 years | Use of a wander garden after construction: HUG (high use of garden) N = 14 | LUG (low use of garden) N = 14 | Medications | Dosage | Likelihood ratio test: T1 > T0 in both groups Primary antidepressant (χ2 = 28.377, 3 df, p < 0.001), Secondary antidepressant (χ2 = 16.152, 2 df, p < 0.001), Antipsychotics (χ2 = 24.923, 3 df, p < 0.001), Hypnotics (χ2 = 5.700, 2 df, 0.05 < p < 0.1); HUG > LUG on secondary antidepressant (χ2 = 9.689, 1 df, p < 0.005), Antipsychotic s(χ2 = 22.618, 3 df, p < 0.001); LUG < HUG on Hypnotics (χ2 = 27.879, 2 df, p < 0.001); No difference in T1 in both groups on Anxiolytics (χ2 = 1.032, 1 df, p > 0.25) |
Falls | Number Severity | Total number of falls (both groups) decreases in T1 from 288 to 200; Likelihood ratio test: HUG > LUG on number (χ2 = 4.1304, 1 df, p < 0.05) and on severity (χ2 = 4.1298, 1 df, p < 0.05) also among merry walker users and wheelchair users (χ2 = 16.5296, 1 df, p < 0.001) | |||||
[32] Jarrott and Gigliotti (2010) | Comparative RCT | 6 weeks | Horticultural therapy (HT), 50 min per session, twice a week, 6 weeks N = 75 | Traditional activities (TA) N = 54 | Affect | AARS (pleasure, anxiety/sadness, interest, no anger) | Wilcoxon–Mann–Whitney U test No difference between HT and TA: pleasure (z = −1.544, p = 0.123); anxiety (z = −0.086, p = 0.932); interest (z = −1.26, p = 0.208) |
Engagement | MPES | Wilcoxon–Mann–Whitney U test HT > TA on: AE (z = −2.90, p < 0.001); SE (z = −4.60, p < 0.001); PE (z = −2.72, p < 0.01); OE (z = 3.47, p < 0.001); no difference between HT and TA on NE (z = −1.45, p < 0.15) | |||||
[35] Murphy et al. (2010) | Pre-test post-test; | 1 year | Use of a wander garden after construction | No control group | Agitation | Short form CMAI | A Hierarchical Linear Modeling T1 > T0 (t = −2.702; p < 0.05) |
[37] Luk et al. (2011) | Pre-test, post-test; RCT; single blind | 6 weeks | Horticultural therapy (HT), 30 min per session, twice a week, 6 weeks N = 7 | Other activities (OA) (origami, puzzles, drawing, collage) N = 7 | Agitation | C-CMAI | No difference in T1 between HT and OA (HT: p = 0.115; OA: p = 0.249) |
[38] Edwards et al. (2013) | Pre-test, post-test | 6 months | Use of a therapeutic garden after reconstruction | No control group | Quality of life | DEMQOL | T1 > T0 (t = 4.57, 9 df, p < 0.001) |
Agitation | CMAI | T1 > T0 (t = 7.48, 9 df p < 0.001) | |||||
Depression | SCDD | T1 > T0 (t = 2.4, 9 df p < 0.02) | |||||
[46] Hewitt et al. (2013) | Pre-test, post-test | 1 year | Structured gardening program 1 h a week, 46 sessions | No control group | Wellbeing | Bradford Well-Being Profile | No difference in T1: sessions 1–21 (t = 1.43, p = 0.21); sessions 22–46 (t = 0.88, p = 0.425) |
Cognition | MMSE | T1 < T0 (t = 3.88, p = 0.012) | |||||
[44] Goto et al. (2017) | Multiple treatment | 7 weeks | Exposure to a Japanese garden | 4 exposure tests: standard garden Test1; Japanese garden with open door Test2; Japanese garden with closed door Test3, Japanese garden with closed door plus scent Test4 | Stress | Fingertip heart rate monitor | t test (p < 0.05) Test2, Test3 and Test4 > Test1; Test2 and Test4 > Test3 |
Engagement | Behavioral assessment checklist | Test2, Test3 and Test4 > Test1 in attention; T2 > T1 (p < 0.005); Test2 > Test3 and Test4; Test4 > Test3 | |||||
[39] Goto et al. (2018) | Multiple treatment | 6 weeks | Exposure to two Japanese gardens: one in hospital garden and one on terrace | 3 exposure tests: standard gardens Test1; Japanese garden with open door Test2; Japanese garden with closed door Test3 | Stress | Fingertip heart rate monitor | Wilcoxon test and Bonferroni post-test (p < 0.05) Test2 > Test1 in both gardens |
Engagement | Behavioral assessment checklist | Wilcoxon test (p < 0.05) Test2 > Test1 on responses to gardens and on responses to caregivers in both gardens; Test2 > Test1 on memory recall in both gardens; Test3 < Test2 on positive comments and memory recall in both gardens | |||||
[40] White et al. (2018) | Pre-test post-test; RCT | 1 year | Exposure to a nature garden | No control group | Mood | Datasheets | Logistic regression T1 > T0 (mean change score = 0.44, p < 0.001) |
[42] Mitchell and Van Puymbroeck (2019) | Pre-test, post-test; single case | 6 weeks | Therapeutic gardening and CBT 40–60 min, 3–4 times a week, over 6 weeks | No control group | Affect (anxiety) | BAI | Improvement 36% |
Depression | GDS-SF | Improvement 53% | |||||
Falls | Number | Falls decreased from 7 to 0 | |||||
[36] Pedrinolla et al. (2019) | Pre-test, post-test; RCT; single blind | 6 months | Use of an indoor therapeutic garden (TG) 2 h per session, 5 times a week, 120 sessions N = 82 | Spending time in a standard area (Control group, CG) N = 81 | Behavior | NPI | Two-way repeated-measures ANOVA TG > CG in T1 (mean between groups difference of -31.8; 95% CI: -35.1 to -28.5; F = 279.2, p < 0.001) |
Cognition | MMSE | Two-way repeated-measures ANOVA TG > CG in T1 (mean difference between groups of 1.8; 95% CI: 1.4 to 2.2; F = 78.5, p < 0.001) | |||||
Medications | Dosage of quetiapine | Two-way repeated-measures ANOVA TG > CG in T1 (−150 mg; 95% CI: −175 to −120: F = 87.3, p < 0.001 | |||||
Stress | Salivary cortisol | Two-way repeated-measures ANOVA TG > CG in T1 (F = 25.1, p < 0.001) | |||||
Diastolic blood pressure | Two-way repeated-measures ANOVA (−2.6; mm Hg 95% CI: −3.5 to −1.7, F = 32.3, p < 0.001) | ||||||
Activity of the day | Barthel Index | Two-way repeated-measures ANOVA No difference between TG and CG in T1 (F = 2.1; ns) | |||||
[41] Collins et al. (2020) | Multiple treatment Single cases | 12 weeks | Use of an indoor sensory garden and an outside sensory garden 30–45 min per session, 3 times a week | 4 phases: baseline phase1, indoor sensory garden phase2, outside sensory garden phase3, return to baseline phase4 | Agitation | CMAI, ABMI | phase2 and phase3 > phase1; phase3 > phase2 |
Quality of life | DEMQOL, SIS | phase2 and phase3 > phase1; phase3 > phase2 | |||||
[45] Gueib et al. (2020) | Pre-test, post-test | 2 weeks | Use of a therapeutic garden (TG)12 h N = 16 | No use of the therapeutic garden (Control group, CG) | Self-Consciousness | SCQ | TG > CG in T1 (TG: T1 SCQ = 10.41 [6.49–11.75] versus CG: T1 SCQ = 7.95 [6.00–9.16], p = 0.0079) |
References
- Wilson, E.O. Biophilia; Harvard University Press: Cambridge, MA, USA, 1984. [Google Scholar]
- Ulrich Roger, S.; Simons, R.F.; Losito, B.D.; Fiorito, E.; Miles, M.A.; Zelson, M. Stress recovery during exposure to natural and urban environments. J. Environ. Psychol. 1991, 11, 201–230. [Google Scholar] [CrossRef]
- McMahan, E.A.; Estes, D. The effect of contact with natural environments on positive and negative affect: A meta-analysis. J. Posit. Psychol. 2015, 10, 507–519. [Google Scholar] [CrossRef]
- Kaplan, S. The restorative benefits of nature: Toward an integrative framework. J. Environ. Psychol. 1995, 15, 169–182. [Google Scholar] [CrossRef]
- James, W. Psychology: The Briefer Course; Holt: New York, NY, USA, 1892. [Google Scholar]
- Ohly, H.; White, M.P.; Wheeler, B.W.; Bethel, A.; Ukoumunne, O.C.; Nikolaou, V.; Garside, R. Attention Restoration Theory: A systematic review of the attention restoration potential of exposure to natural environments. J. Toxicol. Environ. Health Part B 2016, 19, 305–343. [Google Scholar] [CrossRef] [Green Version]
- Thaneshwari, P.K.; Sharma, R.; Sahare, H.A. Therapeutic gardens in healthcare: A review. Ann. Biol. 2018, 34, 162–166. [Google Scholar]
- Janzen, S.; Zecevic, A.A.; Kloseck, M.; Orange, J.B. Managing agitation using nonpharmacological interventions for seniors with dementia. Am. J. Alzheimers Dis. Other Dement. 2013, 28, 524–532. [Google Scholar] [CrossRef]
- Momtaz, R.I. Healing Gardens—A Review of Design Guidelines. Int. J. Curr. Eng. Technol. 2017, 7, 1864–1871. [Google Scholar]
- Söderback, I.; Söderström, M.; Schälander, E. Horticultural therapy: The ‘healing garden’and gardening in rehabilitation measures at Danderyd hospital rehabilitation clinic, Sweden. Pediatr. Rehabil. 2004, 7, 245–260. [Google Scholar] [CrossRef] [PubMed]
- Moeller, C.; King, N.; Burr, V.; Gibbs, G.; Gomersall, T. Nature-based interventions in institutional and organisational settings: A scoping review. Int. J. Environ. Health Res. 2018, 28, 293–305. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Barrett, J.; Evans, S.; Mapes, N. Green dementia care in accommodation and care settings: A literature review. Hous. Care Support 2019, 22, 193–206. [Google Scholar] [CrossRef]
- Motealleh, P.; Moyle, W.; Jones, C.; Dupre, K. Creating a dementia-friendly environment through the use of outdoor natural landscape design intervention in long-term care facilities: A narrative review. Health Place 2019, 58, 102148. [Google Scholar] [CrossRef]
- Jensen, L.; Padilla, R. Effectiveness of Environment-Based Interventions That Address Behavior, Perception, and Falls in People With Alzheimer’s Disease and Related Major Neurocognitive Disorders: A Systematic Review. Am. J. Occup. Ther. 2017, 71, 7105180030p1–7105180030p10. [Google Scholar] [CrossRef]
- Smith, B.C.; D’Amico, M. Sensory-Based Interventions for Adults with Dementia and Alzheimer’s Disease: A Scoping Review. Occup. Health Care 2019, 34, 171–201. [Google Scholar] [CrossRef]
- Lakhani, A.; Norwood, M.; Watling, D.P.; Zeeman, H.; Kendall, E. Using the natural environment to address the psychosocial impact of neurological disability: A systematic review. Health Place 2018, 55, 188–201. [Google Scholar] [CrossRef] [PubMed]
- 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 2018, 24, 1–7. [Google Scholar] [CrossRef]
- Kamioka, H.; Tsutani, K.; Yamada, M.; Park, H.; Okuizumi, H.; Honda, T.; Okada, S.; Park, S.-J.; Kitayuguchi, J.; Abe, T.; et al. Effectiveness of horticultural therapy: A systematic review of randomized controlled trials. Complement. Med. 2014, 22, 930–943. [Google Scholar] [CrossRef] [PubMed]
- Blake, M.; Mitchell, G. Horticultural therapy in dementia care: A literature review. Nurs. Stand. 2016, 30, 41–47. [Google Scholar] [CrossRef]
- Zhao, Y.; Liu, Y.; Wang, Z. Effectiveness of horticultural therapy in people with dementia: A quantitative systematic review. J. Clin. Nurs. 2020. [Google Scholar] [CrossRef]
- Whear, R.; Coon, J.T.; Bethel, A.; Abbott, R.; Stein, K.; Garside, R. What Is the Impact of Using Outdoor Spaces Such as Gardens on the Physical and Mental Well-Being of Those With Dementia? A Systematic Review of Quantitative and Qualitative Evidence. J. Am. Med. Dir. Assoc. 2014, 15, 697–705. [Google Scholar] [CrossRef] [Green Version]
- Abraha, I.; Rimland, J.M.; Trotta, F.M.; Dell’Aquila, G.; Cruz-Jentoft, A.J.; Petrovic, M.; Gudmundsson, A.; Soiza, R.; O’Mahony, D.; Guaita, A.; et al. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open 2017, 7, e012759. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Uwajeh, P.C.; Iyendo, T.O.; Polay, M. Therapeutic gardens as a design approach for optimising the healing environment of patients with Alzheimer’s disease and other dementias: A narrative review. Explore 2019, 15, 352–362. [Google Scholar] [CrossRef]
- Orr, N.; Wagstaffe, A.; Briscoe, S.; Garside, R. How do older people describe their sensory experiences of the natural world? A systematic review of the qualitative evidence. BMC Geriatr. 2016, 16, 116. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lu, L.-C.; Lan, S.-H.; Hsieh, Y.-P.; Yen, Y.-Y.; Chen, J.-C.; Lan, S.-J. Horticultural Therapy in Patients With Dementia: A Systematic Review and Meta-Analysis. Am. J. Alzheimers Dis. Other Dement. 2020. [Google Scholar] [CrossRef]
- Gonzalez, M.T.; Kirkevold, M. Design Characteristics of Sensory Gardens in Norwegian Nursing Homes: A Cross-Sectional E-Mail Survey. J. Hous. Elder. 2016, 30, 141–155. [Google Scholar] [CrossRef]
- Borgen, L.; Guldahl, A.S. Great-granny’s Garden: A living archive and a sensory garden. Biodivers. Conserv. 2010, 20, 441–449. [Google Scholar] [CrossRef] [Green Version]
- D’Andrea, S.J.; Batavia, M.; Sasson, N. Effect of horticultural therapy on preventing the decline of mental abilities of patients with Alzheimer’s type dementia. J. Ther. Hortic. 2007, 18, 8–17. [Google Scholar]
- Moher, D.; Liberati, A.; Tetzlaff, J.; Altman, D.G. The PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009, 6, e1000097. [Google Scholar] [CrossRef] [Green Version]
- Gigliotti, C.; Love-Norris, D.; Gigliotti, S. Therapeutical alternatives for persons with dementia: A comparison between music therapy and horticulture therapy in institutional care programs. Gerontologist 2004, 44, 658. [Google Scholar]
- Gigliotti, C.M.; Jarrott, S.E. Effects of Horticulture Therapy on Engagement and Affect. Can. J. Aging Rev. Can. Vieil. 2005, 24, 367–377. [Google Scholar] [CrossRef]
- Jarrott, S.E.; Gigliotti, C.M. Comparing Responses to Horticultural-Based and Traditional Activities in Dementia Care Programs. Am. J. Alzheimers Dis. Other Dement. 2010, 25, 657–665. [Google Scholar] [CrossRef]
- Detweiler, M.B.; Murphy, P.F.; Myers, L.C.; Kim, K.Y. Does a Wander Garden Influence Inappropriate Behaviors in Dementia Residents? Am. J. Alzheimers Dis. Other Dement. 2008, 23, 31–45. [Google Scholar] [CrossRef]
- Detweiler, M.B.; Murphy, P.F.; Kim, K.Y.; Myers, L.C.; Ashai, A. Scheduled Medications and Falls in Dementia Patients Utilizing a Wander Garden. Am. J. Alzheimers Dis. Other Dement. 2009, 24, 322–332. [Google Scholar] [CrossRef] [PubMed]
- Murphy, P.F.; Miyazaki, Y.; Detweiler, M.B.; Kim, K.Y. Longitudinal analysis of differential effects on agitation of a therapeutic wander garden for dementia patients based on ambulation ability. Dementia 2010, 9, 355–373. [Google Scholar] [CrossRef]
- Pedrinolla, A.; Tamburin, S.; Brasioli, A.; Sollima, A.; Fonte, C.; Muti, E.; Smania, N.; Schena, F.; Venturelli, M. An Indoor Therapeutic Garden for Behavioral Symptoms in Alzheimer’s Disease: A Randomized Controlled Trial. J. Alzheimers Dis. 2019, 71, 813–823. [Google Scholar] [CrossRef] [PubMed]
- Luk, K.Y.; Lai, K.Y.C.; Li, C.C.; Cheung, W.H.; Lam, S.M.R.; Li, H.Y.; Ng, K.P.; Shiu, W.H.; So, C.Y.; Wan, S.F. The effect of horticultural activities on agitation in nursing home residents with dementia. Int. J. Geriatr. Psychiatry 2011, 26, 435–436. [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] [PubMed]
- Goto, S.; Shen, X.; Sun, M.; Hamano, Y.; Herrup, K. The Positive Effects of Viewing Gardens for Persons with Dementia. J. Alzheimers Dis. 2018, 66, 1705–1720. [Google Scholar] [CrossRef]
- White, P.C.; Wyatt, J.; Chalfont, G.; Bland, J.M.; Neale, C.; Trépel, 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]
- Collins, H.; Van Puymbroeck, M.; Hawkins, B.L.; Vidotto, J. The Impact of a Sensory Garden for People with Dementia. Recreat. J. 2020, 54, 48–63. [Google Scholar] [CrossRef]
- Mitchell, K.; Van Puymbroeck, M. Recreational Therapy for Dementia-Related Symptoms in a Long-Term Care Setting: A Case Study. Ther. Recreat. J. 2019, 53, 165–174. [Google Scholar] [CrossRef]
- Lee, Y.; Kim, S. Effects of indoor gardening on sleep, agitation, and cognition in dementia patients—A pilot study. Int. J. Geriatr. Psychiatry 2008, 23, 485–489. [Google Scholar] [CrossRef] [PubMed]
- Goto, S.; Gianfagia, T.J.; Munafo, J.P.; Fujii, E.; Shen, X.; Sun, M.; Shi, B.E.; Liu, C.; Hamano, H.; Herrup, K. The Power of Traditional Design Techniques: The Effects of Viewing a Japanese Garden on Individuals With Cognitive Impairment. HERD Health Environ. Res. Des. J. 2017, 10, 74–86. [Google Scholar] [CrossRef]
- Gueib, C.; Pop, A.; Bannay, A.; Nassau, E.; Fescharek, R.; Gil, R.; Luc, A.; Jonveaux, T.R. Impact of a Healing Garden on Self-Consciousness in Patients with Advanced Alzheimer’s Disease: An Exploratory Study1. J. Alzheimers Dis. 2020, 75, 1283–1300. [Google Scholar] [CrossRef] [PubMed]
- Hewitt, P.; Watts, C.; Hussey, J.; Power, K.; Williams, T. Does a Structured Gardening Programme Improve Well-Being in Young-Onset Dementia? A Preliminary Study. Br. J. Occup. 2013, 76, 355–361. [Google Scholar] [CrossRef]
- Judge, K.S.; Orsulic-Jeras, S.; Camp, C.J. Use of Montessori-based activities for clients with dementia in adult day care: Effects on engagement. Am. J. Alzheimers Dis. 2000, 15, 42–46. [Google Scholar] [CrossRef]
- Bradford Dementia Group. Evaluating Dementia Dare: The DCM Method; University of Bradford, Bradford Dementia Group: Bradford, UK, 1997. [Google Scholar]
- Lawton, M.P.; Van Haitsma, K.; Klapper, J. Observed affect in nursing home residents with Alzheimer’s disease. J. Gerontol. 1996, 51, 3–14. [Google Scholar] [CrossRef] [Green Version]
- Beck, A.T.; Epstein, N.; Brown, G.; Steer, R.A. An inventory for measuring clinical anxiety: Psychometric properties. J. Consult. Clin. Psychol. 1988, 56, 893–897. [Google Scholar] [CrossRef]
- Cohen-Mansfield, J. Assessment of agitation. Int. Psychogeriatr. 1996, 8, 233–245. [Google Scholar] [CrossRef] [PubMed]
- Kaufer, D.I.; Cummings, J.L.; Ketchel, P.; Smith, V.; MacMillan, A.; Shelley, T.; Lopez, O.L.; DeKosky, S.T. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J. Neuropsychiatry Clin. Neurosci. 2000, 12, 233–239. [Google Scholar] [CrossRef]
- Cohen-Mansfield, J.; Werner, P.; Marx, M.S. An Observational Study of Agitation in Agitated Nursing Home Residents. Int. Psychogeriatr. 1989, 1, 153–165. [Google Scholar] [CrossRef]
- Smith, S.C.; Lamping, D.L.; Banerjee, S.; Harwood, R.; Foley, B.; Smith, P.; Cook, J.C.; Murray, J.; Prince, M.; Levin, E.; et al. Measurement of health-related quality of life for people with dementia: Development of a new instrument (DEMQOL) and an evaluation of current meth-odology. Health Technol. Assess. 2005, 9, 1–93. [Google Scholar] [CrossRef]
- Bradford Dementia Group. The Bradford Well-Being Profile; University of Bradford: Bradford, UK, 2008. [Google Scholar]
- Bucks, R.S.; Ashworth, D.L.; Wilcock, G.K.; Siegfried, K. Assessment of activities of daily living in dementia: Devel-opment of Bristol Activities of Daily Living Scale. Aging Ageing 1996, 25, 113–120. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Alexopoulos, G.S.; Abrams, R.C.; Young, R.; Shamoian, C.A. Cornell scale for depression in dementia. Biol. Psychiatry 1988, 23, 271–284. [Google Scholar] [CrossRef]
- Sheikh, J.I.; Yesavage, J.A. Geriatric Depression Scale: Recent evidence and development of a shorter version. Clin. Gerontol. 1986, 5, 165–172. [Google Scholar]
- Folstein, M.F.; Folstein, S.E.; McHugh, P.R. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975, 12, 189–198. [Google Scholar] [CrossRef]
- Hasegawa, I.Y. The revised Hasegawa’s dementia scale (HDS-R): Evaluation of its usefulness as a screening test for dementia. J. Hong Kong Coll. Psychiatr. 1994, 4, 20–24. [Google Scholar]
- Gil, R.; Arroyo-Anllo, E.M.; Ingrand, P.; Gil, M.; Neau, J.P.; Ornon, C.; Bonnaud, V. Self-consciousness and Alzheimer’s disease. Acta Neurol. Scand. 2001, 104, 296–300. [Google Scholar] [CrossRef] [Green Version]
- Gil, R. Conscience de Soi. Conscience de l’Autre et démences. Psychol. Neuropsychiatr. Vieil. 2007, 5, 87–99. [Google Scholar]
- Arroyo-Anlló, E.M.; Bouston, A.T.; Fargeau, M.-N.; Baz, B.O.; Gil, R. Self-Consciousness in Patients with Behavioral Variant Frontotemporal Dementia. J. Alzheimers Dis. 2016, 49, 1021–1029. [Google Scholar] [CrossRef]
- I Mahoney, F.; Barthel, D.W. Functional Evaluation: The Barthel Index. Md. State Med J. 1965, 14, 61–65. [Google Scholar]
- Gottfries, C.G. Is there a difference between elderly and younger patients with regard to the symptomatology and aetiology of depression? Int. Clin. Psychopharmacol. 1998, 13, S13–S18. [Google Scholar] [CrossRef]
- Clarke, D.M.; Kissane, D. Demoralization: Its Phenomenology and Importance. Aust. N. Z. J. Psychiatry 2002, 36, 733–742. [Google Scholar] [CrossRef] [PubMed]
- Tecuta, L.; Tomba, E.; Grandi, S.; Fava, G.A. Demoralization: A systematic review on its clinical characterization. Psychol. Med. 2015, 45, 673–691. [Google Scholar] [CrossRef] [PubMed]
- Costanza, A.; Amerio, A.; Radomska, M.; Ambrosetti, J.; Di Marco, S.; Prelati, M.; Aguglia, A.; Serafini, G.; Amore, M.; Bondolfi, G.; et al. Suicidality Assessment of the Elderly With Physical Illness in the Emergency Department. Front. Psychiatry 2020, 11, 558974. [Google Scholar] [CrossRef] [PubMed]
- Erlangsen, A.; Nordentoft, M.; Conwell, Y.; Waern, M.; De Leo, D.; Lindner, R.; Oyama, H.; Sakashita, T.; Andersen-Ranberg, K.; Quinnett, P.; et al. Key Considerations for Preventing Suicide in Older Adults: Consensus Opinions of an Expert Panel. Crisis 2011, 32, 106–109. [Google Scholar] [CrossRef]
- Mielke, M.M.; Frank, R.D.; Dage, J.L.; Jeromin, A.; Ashton, N.J.; Blennow, K.; Karikari, T.K.; Vanmechelen, E.; Zetterberg, H.; Algeciras-Schimnich, A.; et al. Comparison of Plasma Phosphorylated Tau Species with Amyloid and Tau Positron Emission Tomography, Neurodegeneration, Vascular Pathology, and Cognitive Outcomes. JAMA Neurol. 2021. [Google Scholar] [CrossRef]
- Costanza, A.; Xekardaki, A.; Kövari, E.; Gold, G.; Bouras, C.; Giannakopoulos, P. Microvascular Burden and Alzheimer-Type Lesions Across the Age Spectrum. J. Alzheimers Dis. 2012, 32, 643–652. [Google Scholar] [CrossRef]
- Goadder, J.; Abraham, I.L. Effects of relaxing music on agitation during meals among nursing home residents with severe cognitive impairment. Arch. Psychiatr. Nurs. 1994, 8, 150–158. [Google Scholar] [CrossRef]
- Callahan, C.M.; Unverzagt, F.W.; Hui, S.L.; Perkins, A.J.; Hendrie, H.C. Six-Item Screener to Identify Cognitive Impairment Among Potential Subjects for Clinical Research. Med. Care 2002, 40, 771–781. [Google Scholar] [CrossRef] [Green Version]
Characteristics | Studies Selected (As Numbered in Reference List) | ||||
---|---|---|---|---|---|
Number of participants | 1 < N < 10 | [38,41,42] | |||
11 < N < 20 | [37,46] | ||||
21 < N < 30 | [34,40,43,44] | ||||
31 < N < 40 | [33,35,39,45] | ||||
41 < N < 50 | [31] | ||||
51 < N < 100 | / | ||||
101 < N < 150 | [32] | ||||
151 < N < 200 | [36] | ||||
Study design | Pre-test—Post-test | Longitudinal | Multiple treatment * | Comparative ** | |
No control group [31,33,35,38,39,40,43,44,46] | [33,38,40,43,46] | [35] | [31,39,44] | ||
With control group [32,34,36,37,45] | [34,36,37,45] | [32] | |||
Single case [41,42] | [42] | [41] | |||
Data collection methods | Family report | [33,36,38,46] | |||
Staff report | [33,38,39,40,41,43,44,46] | ||||
Researcher report—direct observation | [31,32,33,34,35,36,37,39,42,43,44] | ||||
Task/test administered to participants | [36,37,38,41,42,43,45,46] | ||||
Measurements | Quantitative | [32,34,35,36,37,39,40,41,42,43,44,45] | |||
Mixed *** | [31,33,38,46] | ||||
Country of the study | USA [31,32,33,34,35,41,42]; CHINA [37]; AUSTRALIA [38]; UK [40,46]; SOUTH KOREA [43] JAPAN [39,44]; ITALY [36]; FRANCE [45] |
Study | Country | Sample | Sex | Type of Dementia | Stage of Dementia | Age of Participants |
---|---|---|---|---|---|---|
[31] | USA | 48 | 26 M/22 F | unspecified | MMSE: M = 13.07 | 46–98 (M = 80) |
[33] | USA | 34 (final sample 29) | 34 M | unspecified | n.a. | 74–92 (M = 80.71) |
[43] | SOUTH KOREA | 23 | / | unspecified | mild or severe | / |
[34] | USA | 28 | 28 M | unspecified | n.a. | 74–92 (M = 80.5) |
[32] | USA | 129 | 53% F | unspecified | MMSE: M = 9.62 | M = 80 |
[35] | USA | 34 | 34 M | unspecified | n.a. | 74–92 (M = 80.71) |
[37] | CHINA | 14 | 1 M/13 F | unspecified | MMSE: M = 13.4 | M = 84.9 |
[38] | AUSTRALIA | 10 | 1 M/9 F | 7 Alzheimer’s disease, 2 unspecified, 1 mixed | 4 severe, 3 moderate, 3 mild | 79–90 |
[46] | UK | 12 | 4 M/8 F | Young-onset dementia: 9 Alzheimer’s disease, 1 frontotemporal, 1 mixed Alzheimer’s and vascular, 1 dementia with Lewy bodies | MMSE: M = 17, range = 8;28 | 43–65 (M = 58.6) |
[44] | JAPAN | 25 (6 in all conditions) | n.a. | unspecified | middle-late MMSE: M = 10 | M = 91 |
[39] | JAPAN | 16 + 16 (6 in all conditions) | n.a. | unspecified | 8 severe, 14 moderate, 8 mild (no data on 2) MMSE: M = 12 | M = 91 |
[40] | UK | 28 | n.a. | unspecified | middle-late | / |
[42] | USA | 1 | 1 F | unspecified | moderate | 76 |
[36] | ITALY | 163 | 42 M/121 F | Alzheimer’s disease | MMSE: M = 13 | M = 77 |
[41] | USA | 4 | 4 F | 3 unspecified, 1 Alzheimer’s disease | n.a. | 77, 95, 92, 95 |
[45] | FRANCE | 34 | 13 M/21 F | Alzheimer’s disease and related disorders | MMSE: control group M = 12.4 experimental group M = 10.2 | M = 82 |
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Murroni, V.; Cavalli, R.; Basso, A.; Borella, E.; Meneghetti, C.; Melendugno, A.; Pazzaglia, F. Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 9595. https://doi.org/10.3390/ijerph18189595
Murroni V, Cavalli R, Basso A, Borella E, Meneghetti C, Melendugno A, Pazzaglia F. Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(18):9595. https://doi.org/10.3390/ijerph18189595
Chicago/Turabian StyleMurroni, Veronica, Raffaele Cavalli, Andrea Basso, Erika Borella, Chiara Meneghetti, Andrea Melendugno, and Francesca Pazzaglia. 2021. "Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review" International Journal of Environmental Research and Public Health 18, no. 18: 9595. https://doi.org/10.3390/ijerph18189595
APA StyleMurroni, V., Cavalli, R., Basso, A., Borella, E., Meneghetti, C., Melendugno, A., & Pazzaglia, F. (2021). Effectiveness of Therapeutic Gardens for People with Dementia: A Systematic Review. International Journal of Environmental Research and Public Health, 18(18), 9595. https://doi.org/10.3390/ijerph18189595