The Benefits of Horticultural Therapy in Residents with Dementia

In one study, 67% of patients admitted to a long-term care facility were diagnosed as having a dementia syndrome.90 Age appropriate environmental strategies have been explored in the attempt to reduce inappropriate behaviors in the elderly with cognitive impairment. Studies with a broad spectrum of ages suggest that having a daily view of a natural setting, or having access to gardens may promote healing and reduce tension. Kuo and Sullivan reported that knowing there is a park or garden nearby or seeing and having activities in a natural setting may reduce family aggression.

One of the important concepts to be considered in the design of residences for the elderly is to not replicate the modern medical center appearance. The sterile modern medical complex, often without the sight of or access to gardens or natural settings, may increase resident anxiety and fear as evidenced by elevated vital signs. Anxiety and fear may contribute to inappropriate behaviors, particularly for residents on long term care units. Dementia unit residents may resent being confined to a locked environment and may express this frustration through aggressive behavior. Cohen-Mansfield et al. reported that 93% of nursing home residents had agitated behavior once or more times per week during one shift, with a mean of 9.3 weekly reports of inappropriate behaviors. The National Nursing Homes Survey reported that 30-50% of late stage dementia patients exhibit inappropriate behavior. It has been suggested that inappropriate behaviors reflect the failure of the environment to meet the needs of the residents. As dementia patients have a limited capacity to communicate their needs and thoughts, inappropriate behaviors may be interpreted as an index of anxiety and depression.

Entering a rehabilitation center, assisted living or dementia residence requires adjustments that are usually not welcomed by the elderly. Most cognitively impaired elderly making this transition have little possibility of returning to a more independent environment. The more advanced demented elderly are often dependent on the dementia residence staff for some or most of their activities of daily living (ADLs), and they require being confined to a safe custodial environment with limited exposure to natural settings. McMinn and Hinton reported that the mandatory indoor confinement of dementia residents can result in increased verbal and physical agitation and increased use of psychotropic medications. One design intervention to decrease inappropriate behaviors is to increase opportunities for residents to leave the dementia unit to enjoy a garden setting.

Several authors have explored the value of a therapeutic garden for dementia residences. In the residential setting, Namazi and Johnson reported that having access to unlocked doors leading into a garden might increase autonomy and quality of life. The autonomy of choosing to exit from the residence may reduce the frequency of agitated behavior. Mather, Nemecek, and Oliver reported that a therapeutic garden reduced the incidence of inappropriate behaviors in a long-term dementia care facility in Canada. McMinn and Hinton reported decreased inappropriate behaviors following 32 days of confinement of dementia patients when access to an outdoor area was granted. Ellis found that light exercise in a dementia therapeutic garden could reduce disruptive behaviors. In addition, access to sunlight in the garden can naturally increase production of Vitamin D and help balance a resident's circadian rhythms.

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