By Victor S. Sierpina, MD
As the search for the Holy Grail of treating Alzheimer’s Disease and other dementias sputters along at a painstakingly slow pace, it turns out we may have overlooked a remarkably effective and low-cost approach: using nature and gardens therapeutically. In a well-done scholarly review article (1), the benefits of a variety of gardening approaches have been demonstrated to improve the lives of dementia patients and their families. The article is based on their review of nearly 800 articles, narrowed down to 91 most pertinent ones. The evidence is impressive.
The conclusions of this extensive literature review make it clear that if you are a change agent or decision-maker in a hospital, extended care facility, or other site that works to serve the needs of patients with dementia, that you should consider installation of a variety of nature therapy options.
Some of these you may never have heard of such as forest bathing, horticultural therapy, therapeutic gardens, virtual reality, and even 3D walls of nature scenes. Garden viewing, nature walking, and active planting, and harvesting can create improved affective, cognitive, physical benefits for those with dementia. Physiological changes occur as well, including slowing in hippocampal shrinkage, improved profiles of immune modulators, cytokines, and markers of inflammation. Mood, social interactions, self-confidence, and engagement are all noted to be altered by a variety of exposure to what therapeutic gardens and horticultural therapy offer.
A built environment that includes nature and garden exposure can promote sense of personal control, improved social support, positive distractions, reduction of environmental stressors, stimulating feelings all by connecting patient to natural settings. Oh yes, don’t forget about Vitamin D conversion from sunlight exposure.
Other findings from the literature reviewed include:
- Reduced falls and use of psychiatric and anti-psychotic medications
- Provide a sense of normalcy, positive distraction, substantial seating, places for play, extensive green space were appreciated by patient users and their families
- Provided indoor escape for users
- Decreased agitation and improved quality of life
- Increased concentration of geriatric garden users compared to those that di not use the garden
- Gardens that provided socialization and relaxing, soothing sounds of running water and pathways increased usage
- Well-designed gardens, including greenery, shades, water sounds, and adequate seating facilitated a sense of emotional well-being in chronically ill and handicapped children
- For those whom space and budget are limited or in the inpatient setting, technological advancements such as virtual reality (VR) and 3D simulation technologies reduced anxiety and agitation in AD patients
The authors also include practical considerations in garden and environmental design. Recommendations include ease of access, guidelines on movement and orientation, managing sensory stimuli, positive distractions, mental mapping, shelter and shade, safety considerations, and maintenance.
A community supported agricultural (CSA) program in Galveston, Texas called, appropriately Seeding Galveston builds kitchen gardens for our disadvantaged neighbors and those in so-called food deserts where access to fresh vegetables is limited or non-existent. With additional resources, their model could be able to develop kitchen gardens in settings that care for dementia patients.
Raised beds can be helpful to older patients in wheelchairs or with otherwise impaired mobility. While Seeding Galveston is just one example, other community, religious, civic, fraternal, and educational organizations, including local agricultural extensions might be set at the task of creating viewing gardens, walking gardens, or active planting and working gardens to support those with dementia.
Developing collaborations and sustainable support from hospitals and health care facilities is key to bringing the therapeutic garden concept to life. Roof top gardens are an underutilized space for those in urban areas and have also been shown to be of benefit to patients using them. Indoor atria can also serve as oxygen-rich green space.
The article summarizes: “Hospital environments that integrate TG (Therapeutic Gardens), or HG (Healing Gardens), and HT (Horticultural Therapy) have a profound effect on the physical, social, psychological, and mental status of AD and dementia patients. These settings use nature to foster social support, a sense of control, the opportunity for physical activity and positive distractions, to improve health outcomes.”
It is possible for your innovative health organization to reach out to those with dementia with environmental design and conscious intention to improve their lives in this green and healthy way. Can your team lead the way?
- Uwajeh PC, Iyendo TO, 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 15 (2019) 353-362. https://doi.org/10.1016/j.explore.2019.05.002