Horticultural Therapy for Alzheimer’s and Dementia

Music, dance, massage, aromatherapy - the list of nonpharmacological therapies for individuals with Alzheimer’s and other dementias has continued to expand over the years. Included within this list is horticultural therapy, an ancient practice that is now being utilized in different settings and for various purposes. 

This post will provide some background information on horticultural therapy, dive into current research on its suggested benefits for Alzheimer’s disease and dementia, and discuss important features of Alzheimer’s/dementia-friendly gardens. 

What is Horticultural Therapy (HT)?

Horticultural therapy is a form of therapy that encourages individuals to use plants and plant-related activities to improve wellbeing and achieve specific documented treatment goals [1]. It involves the guidance of a trained horticultural therapist and the usage of a therapeutic garden, a peaceful plant-filled environment designed for individuals to participate in both horticultural and non-horticultural activities [2]. 

History of HT

The practice of horticultural therapy dates as far back as 2000 BC in Mesopotamia [1]; however, in the United States, the therapeutic effects of garden environments have only been observed as early as the 19th century. 

Dr. Benjamin Rush (known by many as the “Father of American Psychiatry”) was the first to document the positive effects working within garden settings had for individuals suffering from mental illness. In the 1940s and 1950s, horticultural therapy was used for the rehabilitation of WWI veterans [2]. From then on, this form of therapy continued to expand and be utilized for a wide range of conditions, including Alzheimer’s disease and other dementias. 

Benefits of HT for Alzheimer’s and Dementia 

Note: The benefits listed below have been taken from a variety of research studies featuring participants with Alzheimer’s and other dementias, as well as participants with other conditions. 

Physical Benefits

• Improved upper body flexibility and aerobic endurance [3, 5]
• Greater mastery of fine motor skills with simple repetitive motions [4, 5]
• Maintenance of muscle mass as a result of increased levels of daily physical activity and participation in activities of varying difficulty [5] 

Cognitive Benefits

• Positive effects on cognitive function, perhaps through stimulating the frontal lobe when utilizing all five senses or participating in various types of activities that encourage learning new skills, taking in new information, making decisions, etc. [3, 6]
• Increased levels of brain nerve growth factors related to memory [7]

Psychological Benefits

• Increased positive affect and engagement, even with varying levels of impairment across participants [8]
• Increased sense of agency and establishment of a new identity outside of diagnosis [3]
• Reduced agitation when participating in activities that encourage social interaction and engagement of multiple senses [6]

Social Benefits

• Teamwork and communication to achieve certain goals or help out other individuals [3, 6, 10]
• Deep and meaningful relationships with others, formed through reminiscence and shared communication regarding HT or experiences living with dementia [10]

Alzheimer’s/Dementia-Friendly Gardens 

If you don’t have access to a HT program with a trained horticultural therapist, don’t worry! Here are a few important features to keep in mind to make your own gardens more friendly for folks with Alzheimer’s and other dementias [11]: 

• Orientation: Individuals with Alzheimer’s and other dementias can have trouble remembering where they are going and/or where they came from, which can damage their self-esteem and prevent them from wanting to explore the outdoors. Clear paths, visual cues and signs, and obvious entry/exit points in gardens allow individuals to orient themselves and feel more in control. 
• Accessibility: There are many mental and physical obstacles that individuals with Alzheimer’s and other dementias may encounter. Some examples of ways to make gardens more accessible are having wide paths, plenty of seating for resting, shaded areas in the summer and warm areas in the winter, and accessible garden tools. 
• Sensory stimulation: Engaging the senses can encourage reminiscence, as well as make the garden experience more pleasurable and engaging all throughout the year. Choosing familiar plants and decorations with a variety of colors, smells, heights, and textures can encourage individuals to interact more with the garden; however, they must also be arranged in a way that is not overwhelming for the senses.
• Safety: Safety always comes first! For example, avoid planting toxic/harmful plants that could be consumed and have handrails in place and remove any hazards that could cause falls. 

Takeaways

Overall, more research is needed to fully understand the effects of horticultural therapy on physical, cognitive, psychological, and social functioning for individuals living with Alzheimer’s and other dementias. However, there are several studies demonstrating the effectiveness of this form of therapy for encouraging daily activity to maintain physical health, improving cognitive function through sensory stimulation, building trust and community, boosting self-confidence and sense of accomplishment, etc. 

Horticultural activities can be modified so that individuals with different needs/levels of impairment and various experiences with horticulture can feel included - there is something for everyone! Additionally, horticultural activities can easily be integrated into individuals’ daily schedules and adapted based on specific care settings. 

References

1. Scott, 2017: https://doi.org/10.1007/978-981-287-082-7_268 
2. American Horticultural Therapy Association: https://www.ahta.org/about-horticultural-therapy 
3. Lin et al., 2022: https://doi.org/10.1111/jocn.16095 
4. Joy et al., 2020: https://doi.org/10.3390/ijerph17041303 
5. Park et al., 2016: https://doi.org/10.21273/HORTTECH.26.4.474 
6. Zhao et al., 2020: https://doi.org/10.1111/jocn.15204 
7. Park et al., 2019: https://doi.org/10.3390/ijerph16050760 
8. Gigliotti et al., 2004: https://doi.org/10.1177/1471301204042335 
9. Noone and Jenkins, 2017: https://doi.org/10.1080/13607863.2017.1393793 
10. Hall et al., 2018: https://doi.org/10.1177/1471301216643847 
11. The Association for Dementia Studies at the University of Worcester, 2022: https://www.worcester.ac.uk/documents/Making-your-garden-dementia-friendly-booklet-final.pdf