Horticultural therapies

A short video clip showing how horticultural therapy is incorporated into Alzheimer Scotland's supports.

Horticultural therapy and gardening interventions typically refer to approaches to therapy in which activities related to cultivating plants are used with a view to improving an individual's social, emotional, educational, psychological, and physical wellbeing. Horticultural therapies may occur inside as well as in outdoor garden areas. Alongside this range of approaches to dementia treatment is the provision of gardens, sometimes referred to as therapeutic gardens, which are intended as an environmental intervention to improve wellbeing. Gardens may vary in the degree to which they have been designed to provide specific sensory stimuli and may or may not include opportunities for participation in horticultural activities.

The garden and the activity of gardening provides a non-pharmacological approach that can be used for many health and wellbeing benefits and a number of studies have shown the benefits of therapeutic gardens and horticultural activities for people with dementia. The therapeutic intervention of gardening in the natural environment was shown in the critical review by York and Wiseman (2012) to increase wellbeing amongst individuals. Being in the outdoors offered a calming, neutral place for people to be connected to something real and also increased physical health and fitness with positive effects on mental health. Jarrot and Gigliotti (2010) evaluated responses to horticultural based activities for randomly assigned groups in eight care homes compared with responses to traditional activities. They showed that horticultural activities reached groups of participants who would often be difficult to engage in activities and resulted in higher levels of adaptive behaviour and in active and passive engagement. Similarly, Yasukawa (2009) showed improvements in communication, engagement, behaviour and cognitive abilities in a group of patients with Alzeimer’s who participated in horticultural activity over a period of three months. Connell et al., (2007) compared outdoor and indoor activity programmes on sleep and behaviour in nursing home residents with dementia and showed that the outdoor activity group experienced significant improvements in sleep patterns and also a decline in verbal agitation.

Hewitt et al. (2013) evaluated the impact of therapeutic gardening for people with young-onset dementia, measuring outcomes for both participants with dementia and their carers. The conclusion from their preliminary study suggested that structured gardening over a 12 months period had a positive impact on the wellbeing, cognition and mood of people with young-onset dementia. Specific attention was drawn to the relationship between the wellbeing of participants and their cognition; the results of the study suggested that wellbeing can be maintained despite the presence of a cognitive deterioration. Self-identity and purposeful activity were reported as common themes as benefits of the gardening group, participants felt useful and valued and had a sense of achievement. The finding from this preliminary study suggests that structured gardening may have a positive impact on the well-being, cognition and mood of people with early onset dementia.

Edwards et al 2012 created a therapeutic, interactive sensory garden with an adjoining atrium/sunroom overlooking the rest of the garden and can be partly opened to the air, smells and sunlight from the garden. Garden promoted interaction between staff and residents, people with dementia were the mean quality of life scores increased, mean depression scores decreased and mean agitation scores decreased by half. The findings from this small study indicate that an environmental change such as a therapeutic garden can improve the lives of people with dementia in a care setting and their formal and informal carers.

Lee & Kim’s 2008 pilot study explored the efficacy of gardening as a physical activity on sleep, agitation and cognition of people living with dementia in a care setting. Indoor gardening was found to be effective for sleep, agitation and cognition of people with dementia. Gardening was viewed to support physical activities as it can be modified to suit a wide range of physical, cognitive and social needs of people with dementia supporting the use of gardening.

Rappe & Topo 2007 present findings on the impact of plants, and of seeing and being outdoors on the wellbeing of people with dementia in day care and in residential care. The findings suggested that plants in the homes promoted wellbeing of the elderly with dementia, creating a pleasant homelike environment, reducing noise and delineated spaces. The contribution of the plants to the psychological and social wellbeing of the residents was prominent according to the respondents.

In the literature review by Gonzalez & Kirkevold (2013) there was promising evidence of sensory garden and horticultural activities. The findings on the benefits for people with dementia to relax, increased wellbeing and affect related to participating (passive or active) in sensory garden, horticulture therapy and indoor use of plants were fairly consistent and can conclude that these interventions might be beneficial. 

From the literature review, although using different methods there is consistent findings for the benefit of gardening and gardens on behavioural outcomes, well-being and affect suggests they may be appropriate for use in dementia care.