Webinar: Horticultural Therapy for Dementia
Dementia Australia webinars are free videos where subject experts discuss topics relating to dementia for a general audience.
Gardening is not only fun, awakens your senses and is good for your soul. A growing body of evidence shows that gardening may provide substantial therapeutic benefits for people living with dementia, decreasing symptoms and improving overall wellbeing and quality of life.
In this video, Kim Davis, a horticultural therapist, describes how you can work in your garden to gain these benefits, and let the garden work its magic on you and your loved one.
You will learn:
- what horticultural therapy is
- why gardening and plant based activities are therapeutic
- how to make everyday gardening activities a therapeutic practice for you and your loved one.
Transcript
[Beginning of recorded material]
Kim Davis: Hello, my name is Kim Davis and welcome to this presentation on horticultural therapy for dementia: ideas for you and your loved one living at home. We'll discuss some ideas for you to consider and thank you for watching. I would like to acknowledge the Wonnarua land I live on and pay my respects to the traditional custodians, the Elders, both past and present. I extend that respect to other Aboriginal and Torres Strait Islanders viewing this presentation around Australia. “When we work on the garden, the garden works on us.” This quote sums up the idea of horticultural therapy. Working with plants gives so much back including, fresh air, pleasure to the senses, calming, restful gentle exercise and connection with the world around us. According to research, putting hands in the soil puts you in contact with mood enhancing bacteria. This triggers the release of serotonin, a mood boosting happy hormone in your brain. It is a natural antidepressant and strengthens your immune system.
This is a quick overview of what we'll talk about today to make best use of your time. Firstly, there'll be an introduction. And then we'll look at: ‘What is horticultural therapy?’ ‘The benefits of horticultural therapy.’ ‘Creating a space for horticultural therapy.’ ‘Activities to do at home.’ ‘Other considerations and a conclusion.’ So, basically the 'What', the 'Why' and the 'How'. My name is Kim Davis and I've worked for over 20 years as a registered nurse in various psychiatric and mental health settings, including in aged care. I've also, over 20 years’ experience as a trained counsellor and most recently, followed a very long passion to work with plants, becoming a qualified horticulturist and a permaculture designer.
Let's start with two words. What is horticultural therapy? Horticulture, the art or practise of garden cultivation; And therapy, treatment that helps someone feel better and grow stronger. Horticulture basically incorporates gardening, all its gardening in all its diverse forms. It could be growing some veggies or an orchard. It could be putting a pot plant on a windowsill. And therapy, remediates a health problem usually followed by a diagnosis. Horticultural therapy takes many forms. Therapeutic plant-based activities, focusing on specific goals. It will often involve plants, but not always. It can be painting pots, drawing plants, or even cooking the produce from your garden. It can be conducted as one-to-one sessions or in small groups. An example of this is the Royal Botanic Gardens in Sydney who've been running a dementia programme over the last, usually over about six weeks. It can also occur in medical care, facility medical and care facilities, and may be conducted by a professional for the purpose of physical and mental rehabilitation. It can be done at home by carers, or in your own garden with a therapist. It can help improve memory, cognitive abilities, task initiation and social skills.
‘The benefits.’ What makes horticultural therapy and therapeutic gardens therapeutic? Intentional design. These are my two boys when they were young at the John Hunter Hospital Fairy Garden, alleviating the stress we all felt on many occasions when we were in hospital with their baby sister. It is intentionally designed for children and families to help with wellbeing during a child's hospital stay. There is deliberate use of PlayStations, and like a dementia garden, it has safe walking areas and easy to follow path and several seating options. And I can certainly attest that it definitely did its job when we were there. The following two slides are from serious academic journals and are absolutely not a comprehensive survey of the literature. It is a very quick and very selective look at some of the research and theory that supports the idea of horticultural therapy. They do show that the benefits of nature and horticultural therapy are taken seriously and have real benefits. We all benefit from nature, from being in nature and interacting with nature. We all need it.
Firstly, let's look at nature as therapy. "Natural enriched environments are associated with emotional resilience." "Nature-based mindfulness is moderately superior to mindfulness conducted in non-natural settings." "Natural environments turn out to be particularly rich in characteristics necessary for restorative experiences." "The systematic review and meta-analysis show that nature walk effectively improve mental health, positively impacting depression and anxiety." To some, it may go without saying but nature is good for people. Being in it or even just having a view from a bed in a hospital or care facility. Gardening is good for our health.
‘Gardening as a therapy.’ "There is increasing evidence that gardening provides substantial human health benefits." "Gardening and horticultural therapy has been widely recognised as a multicomponent approach that has affected a broad range of health and wellbeing outcomes." "Gardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a 'social prescription' globally, for people with long-term conditions." For thousands of years, people have recognised the benefit of time spent in gardens as refuge from extreme climates and as a place of recuperation and healing. Gardening has real and demonstrable benefits for a wide range of physical, mental, and social conditions.
‘Gardens and meaning.’ Gardens provide meaning in many different ways, both for the individual and the collective. People of any age can play in a garden. It connects the generations, reflects our inner landscape and can be spiritual. As we witness the seasons changing, we can recognise that the seasons in our own lives change, and this is particularly relevant with dementia. It's a place of recovery, rest, and rejuvenation for all. A place for ceremonies and so much more.
The following slide is a collection of quotes from research demonstrating the benefits of horticultural therapy for people living with dementia. "Patients with dementia benefit from horticultural activities by alleviating their degrees of agitate behaviours, increasing time of engaging in activities and decreased time of doing nothing." "Involvement in horticulture-based activities led to positive impacts on engagement, social interactions, and mental and physical wellbeing in people living with dementia." "Engaging people with dementia in participatory horticultural activities in contact with natural elements can decrease their dementia symptoms and their caregiver's distress but also increase people with dementia's quality of life." "Governments and policy-makers should consider horticultural therapy as an important tool to prevent the decline of cognitive function in cognitive impairment population."
If you think this is a good idea for you and your loved one, give it a go. Be open to their needs, symptoms, capacity and preferences. It is not a one-size fits all. And if it's not for them, take yourself out for a walk in the garden to gain these benefits. All of the benefits of gardens and nature are for carers too. Remember, what works for one family might not work for another. We offer ideas for you to experiment with at home. Success is not a destination. Remember, that success is not measured by a horticultural outcome. If seeds don't sprout, if plants don't thrive, that is okay.
‘Making or finding a therapeutic space.’ To do horticultural therapy, you need a garden, but let's not be too constrained in what we mean by a garden. If you have a garden, you do it there. If not, a balcony, a kitchen table or even a windowsill will do. You could even view your garden from a window with a cupper, as an invitation to use it. ‘Designing a therapeutic space for dementia.’ We all design all the time. And any garden space can be designed and optimised for horticultural therapy. Please don't be put off by the idea of design. Design in this context can be as simple as making sure an area is safe, comfortable, and receives a little sunlight. Or of course, it could be complex and a full-time job for someone like us but there are still some design principles that can help. In the next few slides, we'll walk through some simple and effective ways to make your garden space, whatever it may be, suitable for a little at-home horticultural therapy.
‘Site analysis for your dementia friendly garden.’ In garden design, we will approach a new garden with a site analysis, looking at the characteristics of a space and thinking about what works, what doesn't work for the garden we want to make, or for the activity we want to undertake. Making a space to do horticultural therapy with dementia in mind is just the same. What do you have that you can work with? What do you need to change? And to us, one of the most important things in a garden is a comfortable place to sit. Places to work, sunny spots and shelters from the elements. Consider choosing robust furniture. Find quiet, sheltered, shady areas where you can rest. Place aromatic plants, near seating areas and make the most of views. Even a confined view within your garden or a distant view beyond the garden.
‘Garden essentials for dementia.’ Some things are essential in a therapeutic garden. Sunlight to grow although some indoor plants don't need direct sunlight. Plants, the foundation of horticultural therapy. Soil, you can mix your own soil medium or buy ready-made pocket-potting mixes and seed raising mixes to make it really easy. And water. You will need access to this for indoors and outdoors.
‘Accessibility for dementia.’ Can people get to the garden safely and easily? Finding your way. Can people find their way in and around the space? Avoid dead end paths and keep it simple and inviting. Landmarks and simple signage. A simple garden arch can become a landmark along with ornaments to help find your way around the garden. Railings and non-slip surfaces may need to be considered. And boundary fence. Is the property or the area that you're going to garden in, secure?
‘Accessibility ideas.’ Can they do gardening safely and easily? Raised garden beds are a common and easy way to improve accessibility, but there are plenty of other tricks too. This photo is an image of my own mother in her garden with her hip height, raised garden bed. And she truly loved her time in the garden. I would also consider if you're putting a raised garden bed in making enough area for circulation around it, so there's not overstretching going on. Think about workbenches, seating, shade, et cetera. This is a wall garden, so if you've got a really tiny outdoor space but still want to do an outside gardening activity, you could think about a wall garden and possibly fill it with annuals. You could still do all your seed raising and rotate those little pot plants. Making it personal. Dementia gardens can play a key role in triggering memories. This photo is a garden space designed by my sister-in-law for her mother to view through her window. It also became a social focus for the residents. A place to gather and chat, whilst admiring the beautiful flowers. And this photo shows a ceramic by my partner's grandmother that decorated her garden for many years. She lived at home with dementia for a long time. Choosing plant species with particular meaning for a person can be a powerful way to connect in the garden.
‘Using all the senses.’ Appealing to the senses can be very calming and grounding. This can be very individual, but think about, ‘smell’. For scent, we can place aromatic plants near seating or on path edges where they can be brushed past. Think about Lavender or Rosemary, for example, or Gardenia's in bloom. ‘Touch.’ You can use textured plants like Landy or fluffy grasses. Or something as simple as a comfortable seat where people can feel the breeze on their face or the sun on their back. Wooden furniture can be much more tactile than plastic or metal. ‘Taste.’ Small edible berries like blueberries can be used for taste or edible herbs or fruit that can be picked. ‘Sound.’ Consider flowing water in a bird bath. It could be as simple as putting one of those solar little battery things to move water around. Attracting birds to your garden. Hearing the bird song or wind chimes hanging from trees. ‘Sight.’ Contrasting colours and shapes and textures can be used to create visual interest. Long lasting flowers and seasonal changes can also be used. The colour palette used in the garden can be warmer or cooler and trigger more vibrant or calmer responses respectively. One word of caution, we need to think about allergy and potentially poisonous plants.
‘Activities.’ The next few slides will show some examples of activities that can be used in the garden or even inside the house, to help the person living with dementia to connect with the garden. Propagation, sowing seeds, pricking and thinning out seedlings. Or it could be as simple as just pulling out the little weeds in your seedlings. Planting seedlings, cuttings, and the benefits of these activities is that the repetitive nature of these can be meditative and calming, and it can help improve manual dexterity. Most of these activities can be done indoors or outdoors while sitting at a table. Harvesting. Picking fruit, harvesting vegetables and herbs, and picking flowers for an indoor display. And the benefits is exercise, shared enjoyment, and the nutritional benefits that you can get from eating your own produce. Garden maintenance activities. Taking time, paying attention, doing it together. Gardens do need some maintenance. Sweeping, it could be very gentle, sweeping, raking. When raking beautiful autumn leaves, I gather some of them in a clear bowl and bring them inside to a table for us to enjoy. It reminds us of the season that we're in, and you can run your hands through them for a sensory experience. Deadheading, which is simply removing spent flowers from shrubs and lifting and dividing. Many of these regular activities can be enjoyed by the person living with dementia and you together.
And finally, some practicalities. There are a host of safety considerations. We're not going to cover safety in any exhaustive way here. But some things you will need to think about include sharp tools, weather, wildlife, pathogens, plant allergies, and trips and falls. The list goes on, but these will generally be gardens you already have access to. So, it's something you would usually be thinking about already.
Finally, in relation to dignity of risk. It is a risk worth taking. And look after yourself. What are your capacities? You need rest too. Take the time to know yourself, process emotions, and get help and support if needed. The garden is one more extraordinary resource to help you navigate your experience. Finally, there's no right or wrong way to garden. Start small and let the garden do its work on you. Thank you very much.
[END of recorded material]
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