An Introduction to the Evidence Supporting Therapeutic Gardens

What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly?

INTRODUCTION

It is well known that the population around the world is aging at an unprecedented rate and is an enduring global phenomenon, with profound implications for many facets of human life. A 2010 report from the Population Division, Department of Economic and Social Affairs of the United Nations predicts that the United States will experience major increases of individuals 65 years old and older, from 13.3% at this time to a projected 20.1% in 20 years.1 However, the Republic of Korea will surpass the American aging with one of the greatest increases in elderly populations in the world, from 11.5% in 2011 to almost one quarter (24%) of the population in 2031. The United Nations also predicts that in 20 years a larger proportion of the Korean elderly (22.4%) will be very old, 80 years old or older. Clearly these nations need to prepare for the dramatic changes in population demographics.

For some elderly, aging brings declines in cognition and function that may precipitate losing independent living. In general, for those persons with advancing medical and psychiatric problems, declining cognitive and functional changes may necessitate entering assisted living or dementia residences.3 In either case, the role of health scientists is to find the most supportive and pleasant environments during these latter chapters of life. Economics will also play a major role in determining some of the most cost-effective ways to humanely care for the elderly, as the proportions of working individuals will greatly diminish in the future.

Constructing rehabilitation centers, assisted living or dementia residence gardens that encourage autonomy and sensory stimulation is an economically sound, non-pharmacological strategy for improving the quality of life for persons needing these types of residences. Therapeutic gardens offer elderly residents the choice of leaving the residential unit for a natural setting designed to promote exercise and stimulate all the senses. Another aim of therapeutic gardens is to promote ambulation, positive reminiscences, decreased stress and stabilized sleep wake cycles.  As described in this article, exposure to nature has been associated with reduction in pain, improvement in attention and modulation of stress responses. In addition, some studies have reported that having free access to an outdoor area may reduce some agitated behaviors, medications and falls in dementia residents.

Horticulture has been used as a therapeutic modality since ancient times. However, despite its long use in fields of physical therapy, psychiatric occupational and recreational rehabilitation, there are few strong quantitative studies supporting the efficacy of garden settings for therapy and rehabilitation.10 Nevertheless, there is an increasing body of literature supporting the theoretical therapeutic mechanism of nature on attention, stress and healing. We present some of the findings in the English literature that support initiating research in the effectiveness of horticultural therapy in garden settings for elderly individuals.


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