Effects of horticultural therapy: Perspectives of frail and pre-frail older nursing home residents

The perspectives of elderly residents in nursing home on gardening activities: a qualitative study

OBJECTIVE

This research was conducted to explore in depth the physical, psychological and social effects of gardening activities on elderly individuals residing in a nursing home.

MATERIAL AND METHOD

A descriptive qualitative research design was employed in the study with a purposive sampling method to select participants. The research was conducted with 21 elderly residents in a nursing home located in the eastern region of Turkey and participated in gardening activities. The data of the research were collected using the Participant Introduction Form and the Semi-Structured Interview Form. Content analysis was conducted to analyze the data.

RESULTS

In the study, the elderly participants shared their views on gardening activities, which were categorised into three main themes as physical, psychological, and social impacts. Regarding the physical impacts, participants noted that gardening activities enhance and promote physical mobility. They described several psychological benefits of gardening activities. In the emotional dimension, they reported feelings of happiness, enjoyment, relaxation, and a sense of achievement and satisfaction while they highlighted experiences of reminiscence, cognitive stimulation, being in the present and a deeper connection with nature in the cognitive dimension. Participants also stated that gardening activities led to increased interpersonal interactions, enhanced communication, and strengthened social bonding, reflecting the positive social impacts of these activities.

CONCLUSION

Elderly residents in the nursing home reported experiencing positive physical, psychological, and social impacts from gardening activities. Based on these findings, it is recommended to incorporate gardening activities as a strategy for promoting active ageing among elderly individuals in institutional care settings.

Effectiveness of horticultural therapy in aged people with depression: A systematic review and meta-analysis

Background

Depression, an increasing global crisis, has affected many people's daily life, especially for older adults. Horticultural therapy has been widely used in non-pharmacological treatment for patients with depression, with a body of studies demonstrating its therapeutic effects. However, a lack of systematic reviews and meta-analyses makes it difficult to get a holistic picture of this research field.

Objectives

We aimed to evaluate the reliability of the previous studies and the effectiveness of horticultural therapy (including the intervention of environmental settings, activities, and duration) on older adults with depression.

Methods

This systematic review was conducted under the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. We searched relevant studies in multiple databases, and the original search was finished on 25 September 2022. We included studies using randomized controlled trials (RCTs) or quasi-experimental designs.

Results

We yielded a total of 7,366 studies and finally included 13 which involved 698 aged people with depression. Results from meta-analysis indicated significant effects of horticultural therapy on reducing depressive symptoms for the older adults. Besides, we found different outcomes among various horticultural interventions (such as environmental setting, activities, and duration). Depression reduction was more effective in care-providing settings than in community settings; participatory activities were more effective in reducing depression than observational activities; intervention of 4–8 weeks might represent the optimal course of treatment compared to interventions more than 8 weeks in duration.

Conclusion

We came up with a comprehensive set of recommendations based on the meta-analysis: aged people in care-providing settings with depression could get the most benefit from horticultural therapy by participating in participatory activities for 4–8 weeks.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022363134, identifier CRD42022363134.

A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home

Background

Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs.

Methods

A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs. Results were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus.

Results

The participating NH’s care concept aims to improve residents’ functional abilities and wellbeing as well as staff members’ job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff.

Conclusion

The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.

"Human Flourishing with Dignity": A Meta-Ethnography of the Meaning of Gardens for Elderly in Nursing Homes and Residential Care Settings

This study aims to identify and synthesize qualitative research regarding residents' experiences of gardens while living in nursing homes and residential care facilities. To provide an optimal nursing environment inspired by nature, we need to derive knowledge from the residents' perspective. An interpretive meta-synthesis approach, a meta-ethnography, was chosen for this study. Altogether, six articles representing three continents and comprising 124 participants were included. The six articles that fulfilled the inclusion criteria were analyzed and synthesized according to Noblit & Hare's seven phases of meta-ethnography and the recent eMERGe guidelines. Four themes were identified: (1) The garden-a place to feel a connection with life, (2) the garden-a place to sense and find comfort, (3) the garden-a place to feel healthy and alive, and (4) the garden-a place to relate past and present. An overarching metaphor, "human flourishing with dignity," offers a deeper understanding of the meaning of the garden for older people in nursing homes and residential care. This meta-ethnography provides a reflective, systematic, data-driven synthesis based on literature spanning ten years. Rather than simply relying on retelling, the narration of experiences according to the primary researcher's descriptions and interpretations results in new knowledge. The significance of gardens for older people's health and well-being needs to be given greater attention and space in nursing practice, education, and health policies.