Horticultural Therapy Research Articles

A Meta-analysis of Horticultural Therapy Programs for Older Adults with Dementia

Background and objective: This study analyzed the effect size of each element to secure the expertise of horticultural therapy programs for older adults with dementia.Methods: This study conducted a meta-analysis to analyze the effectiveness of horticultural therapy programs for older adults with dementia using 'horticulture' as a search term. To this end, 29 articles were selected and analyzed from a total of 147 articles published between 2003 and 2022.Results: First, the overall effect size of horticultural therapy for older adults with dementia was .522, which is statistically significant. This is considered a medium effect size according to Cohen's (1988) criteria for effect size. Second, the group size, a variable related to the number of subjects, showed the largest effect size when the group had 21–30 participants, and the number of sessions per week showed the largest effect size when the number of sessions was once a week, followed by twice a week, and so on. The effect size was largest when the total number of sessions was 21 or more, and when each session was conducted for 90-120 minutes.Conclusion: This study examined previous studies related to horticultural therapy programs for older adults with dementia through a meta-analysis and presented the results of a systematic effect size analysis. The significance of this study is that it summarized the factors that have a large effect and quantified the effect sizes so that it can be used in various horticultural therapy programs for older adults with dementia.

Horticultural therapy impact on people with dementia

BackgroundDementia is a progressive disease, and as the disease progresses, many families seek help through activities and therapies. In contrast to some other therapies, horticultural therapy (HT) is widely accepted by most people with dementia (PWD) because it invites them to the natural world.ObjectivesTo explore whether HT emotional and communication measures (i.e. appropriate expression of emotions, ability to communicate with others) are higher than in other activities offered to PWD in adult day care centers (ADCC) and continuing care retirement community (CCRC), and whether there is a difference between the impact of HT on the number of “positive actions” (communication actions and actions that fit the guided activity) vs. the other activities.Research design and methodsFifty-one PWD attending ADCCs and living in one CCRC were recruited to a structured HT activity and other activities that took place in the ADCCs and CCRC. The activity took place over 10 weeks. The effects were assessed using Dementia Care Mapping (DCM) and questionnaires.ResultsPaired t-tests found that higher levels of mood and behavior were observed during HT activities compared to the other activities. Also, communication and function actions were higher in the HT activities as compared to the other activities.Discussion and implicationsThis study adds to the growing evidence of the benefits of HT for PWD regardless of past experience in gardening/agriculture. HT seems to provide high therapeutic benefits and should be more prevalent in centers caring for PWD.

Seeds of Wellness: A Pilot Study of Horticultural Therapy and Nature-Based Expressive Arts to Support Holistic Wellness for Adults

ABSTRACT Ecotherapeutic and nature-based interventions have shown promise in supporting holistic wellness. A pilot study was conducted to measure the effectiveness of Seeds of Wellness, an eight-week horticultural therapy and nature-based expressive arts program designed to support holistic wellness. The Five Factor Wellness Inventory (5F-WEL) and Reese EcoWellness Inventory were used to measure change in wellness throughout the program. A check-in and follow-up assessment was developed and administered at the start and end of each weekly session to measure change throughout the program. The process of development, implementation, study results, and implications are reviewed. Statistical analysis showed that there was a significant improvement in overall EcoWellness Inventory scores from the start to the end of the program. According to the 5F-Wel, there was no significant change in overall wellness behavior scores from the start to the end of the program. However, weekly check-in and follow-up scores illustrated positive changes in participants from the start to the end of each session, suggesting that perceived wellness may have been positively impacted. Future studies could include a focus on the impact of horticultural and nature-based on perceived wellness.

Efficacy of Horticultural Therapy on Positive, Negative, and Affective Symptoms in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background/Objectives: Positive symptoms, negative symptoms, and emotional disturbances are core features of schizophrenia. Although horticultural therapy (HT) has shown promise as an adjunctive treatment, evidence supporting its effectiveness remains limited. This systematic review and meta-analysis aimed to assess the impact of HT on total symptoms, positive symptoms, negative symptoms, and emotional disturbances in individuals with schizophrenia. Methods: We conducted a search for randomized controlled trials (RCTs) published up to March 2024 across multiple databases, including PubMed, Embase, Cochrane Library, CINAHL, CEPS, CNKI, Wanfang, and Yiigle. A random-effects model was employed to calculate the standardized mean difference (SMD). Results: A total of 35 studies enrolling 2899 participants were included. Our results indicated that, in the short term (≦3 months), HT has moderate to large effect sizes on total symptoms (SMD = 0.690, 95% CI 0.463 to 0.916), positive symptoms (SMD = 0.695, 95% CI 0.038 to 1.351), negative symptoms (SMD = 0.681, 95% CI 0.395 to 0.967), depression (SMD = 0.646, 95% CI 0.334 to 0.959), and anxiety (SMD = 0.627, 95% CI 0.364 to 0.890), with more pronounced benefits for anxiety symptoms in patients with a shorter duration of illness. In the long term (>3 months), HT shows large effect sizes for total symptoms (SMD = 1.393, 95% CI 0.858 to 1.928), negative symptoms (SMD = 1.389, 95% CI 0.935 to 1.842), anxiety (SMD = 1.541, 95% CI 1.042 to 2.040), and moderate to large effect sizes for positive symptoms (SMD = 0.667, 95% CI 0.077 to 1.258) and depression (SMD = 0.707, 95% CI 0.198 to 1.217). Additionally, longer weekly treatment durations are associated with better outcomes for total symptoms and negative symptoms. Schizophrenia patients with more severe initial symptoms may be potential responders to HT. Conclusions: These findings support the efficacy of HT in improving symptoms and emotional well-being in schizophrenia patients. Further trials with more rigorous designs are warranted to confirm these benefits.

Psychological and physiological benefits of horticultural therapy for Chinese older adults.

Gardening as a leisure activity has been shown to be potentially beneficial for older adults, this study aimed to assess the physiological and psychological impacts of a specific horticultural activity, watering indoor plants, compared with playing a computer game - the Klondike Solitaire Card Game. This crossover study included 100 older adults recruited from a nursing care facility for older people in Shanghai, China. They were allocated to either engage in watering indoor plants (horticultural group) or playing a computer game (control group). For the inclusion criteria, screening for cognitive function was conducted to exclude those with severe cognitive impairments, thereby focusing on those capable of participating fully in the study activities. Brainwave activities, blood pressure, and psychological states were measured through pre- and post-test questionnaires to evaluate the physiological and psychological effects. The activity of watering indoor plants was associated with significant reductions in both systolic and diastolic blood pressure, in contrast to the computer game activity. Additionally, participants in the horticultural group showed increased brainwave mean values, indicating heightened relaxation and focus, while decreases were observed in the control group. The experimental group reported reduced anxiety scores, along with increased feelings of comfort and relaxation, and also exhibited significantly higher meditation levels, which indicates a profound mental relaxation effect. Our findings suggest that engaging in indoor horticultural activities, such as watering houseplants for 10minutes, can reduce mental and physical stress levels in older adults.

Evaluation of Horticultural Therapy for Enhancing Women's Well-Being: A Randomized Waitlist-Controlled Trial

Objectives: The current study seeks to evaluate the effectiveness of a horticultural program specifically designed to improve the overall well-being of women in Hong Kong. Methods: A two-arm randomized waitlist-controlled trail was employed in the current study. A total of 208 adult female participants recruited from communities in Hong Kong attended the intervention. Participants’ physical, mental and spiritual well-being were measured pre-, post and 2-month after the intervention. Results: In both within-group and between-group comparison, the physical health condition of participants showed no significant change, while substantial improvements were observed in both mental and spiritual well-being. Participants with high initial scores for depressive and anxiety symptoms experienced more significant enhancements across all body–mind–spirit dimensions. Clonclusions: This study provides robust evidence that the horticultural program significantly contributes to the holistic improvement of the body–mind–spirit well-being of the participants. It holds promise for broader application within community mental health service settings.

Effectiveness of Horticultural Therapy in Older Patients With Dementia: A Meta-Analysis Systemic Review.

Our study aims to assess the effectiveness of horticultural therapy in improving outcomes in older patients with dementia. A systematic review and meta-analysis. The included studies comprised randomised controlled trials (RCTs) that aimed to assess the effectiveness of horticultural therapy on cognitive function in older patients with dementia. The study design and data extraction were independently conducted by two investigators, who also evaluated the risk of bias using RoB 2.0. The meta-analysis was carried out using Stata 15.1 software. On November 2023, we searched relevant English and Chinese publications in PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases. The meta-analysis included a total of 9 RCTs, involving 655 older patients diagnosed with dementia. The findings from these studies demonstrated that horticultural therapy had a significant positive impact on various aspects of the patients' well-being when compared to conventional care. Specifically, it was found to improve cognitive function scores, alleviate symptoms of depression, enhance daily activities and enhance overall quality of life. When conducting a subgroup analysis, it was observed that horticultural therapy had a statistically significant effect on cognitive function in older patients with dementia when the intervention frequency was at least two times per week. Furthermore, interventions with a duration of less than 6 months were found to be more effective than those lasting 6 months or longer. Additionally, outdoor horticultural therapy was found to be superior to indoor interventions. Moreover, structured interventions were observed to yield better outcomes compared to non-structured interventions. More high-quality studies are needed to further corroborate these findings due to the low quality of the included studies. Horticultural therapy has been found to have a significantly positive impact on the cognitive function, depression status, ADL, and quality of life of older patients with dementia. We provide references for non-pharmacologic treatment of older patients with dementia. WHAT PROBLEM DID THE STUDY ADDRESS?: This study aimed to measure the efficacy of horticultural therapy in older patients with dementia across four dimensions: cognitive function, depression levels, daily living activities and overall quality of life. WHAT WERE THE MAIN FINDINGS?: In older patients with dementia, horticultural therapy has been proven to have a significant positive impact on cognitive function, depressive status, activities of daily living and quality of life. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This study will inform non-pharmacological interventions for older patients with dementia worldwide. No Patient or Public Contribution.

Application of horticulture therapy as a health intervention for elderly people in nursing homes: a scoping review†

Abstract Objective To review the scope of interventional studies on horticultural therapy (HT) applied to elderly people in nursing institutions to support the efficient implementation of HT among this target group. Methods In accordance with the scoping review framework proposed by the Joanna Briggs Institute (JBI), the PubMed, JSTOR, Web of Science, CNKI, and Wanfang databases were searched. Data from the retrieved literature were summarized and analyzed. Results In all, 18 studies were included in this review. The target population groups of interventions included self-supporting elderly people, cognitively impaired elderly people, elderly people with negative emotions, and elderly people with frailty living in nursing institutions. HT interventions, including planting, craft activities, derivative activities, and outdoor viewing activities, are implemented indoors, outdoors, or in mixed settings. The most common duration of the intervention was 8 weeks, the most common frequency was once per week, and the most common session duration was 60 min. Conclusions The measurements used in HT interventions included assessments of physical, psycho-mental, and social health; quality of life; and activity effects. Future studies should include partially dependent groups and completely dependent groups of elderly individuals, interventions that last at least 6 months, scientifically designed activity intensity and safety-guarantee plans, and outcome-evaluation indicators such as compliance and intervention benefits.

Pilot study of telehealth delivery of horticultural therapy (TeleHT) as an acceptable intervention and in reducing suicide risk factors in veterans

ObjectivesConverging evidence indicates that Horticultural Therapy (HT) contributes to significant reductions in stress, loneliness, and depression, notable risk factors for suicidality. This pilot study aimed to assess the initial feasibility and acceptability of HT when virtually administered. InterventionTelehealth-delivered horticultural therapy (TeleHT) was administered to groups of Veterans, including those with elevated suicide risk over the course of four weeks. Participants were each sent a package through the mail of at-home gardening supplies that were used to facilitate multisensory, nature experiences during weekly HT sessions administered via Zoom. Outcome measuresParticipants completed thermometer-based scales for the suicide risk factors of stress, loneliness, depression, and pain before and after each TeleHT session. Post-intervention qualitative assessments were completed upon the conclusion of the four-week intervention. ResultsSignificant reductions in stress, depression, and loneliness risk were observed from weekly pre- to post-session measures (p < 0.05), with 89.1 % HT completion rate. Stress, pain, depression, and loneliness indices also showed small to medium sized symptom reduction amongst Veterans with no history of suicidality (Cohen’s d=−0.70, d=−0.49, d=−0.62, d=−0.71), while those with elevated suicide risk at baseline also showed reduction in these risk factors with small to medium effect sizes (d=−0.58, d=−.018, d=−0.46, d=−0.41). Qualitative post-intervention assessments indicated a high degree of acceptability and pointed to the inclusion of mailed gardening packages as particularly relevant to positive experiences. ConclusionsWhile future work is needed to fully assess efficacy, findings from this pilot study demonstrate an initial feasibility and acceptability through a high retention rate and positive qualitative assessments for TeleHT that mirror that of the in-person intervention.

Effect of horticultural therapy on static, dynamic balance and gait speed among institutionalized older adults with cognitive impairment.

Although horticultural therapy has been used successfully to reduce neuropsychiatric symptoms in elderly people with cognitive impairment, we do not yet know how it affects balance. The aim of our study was to determine the acceptability and effect of a 12-week horticultural therapy on balance and walking speed among institutionalized older adults with cognitive impairment. This mixed-methods controlled trial included 23 participants. Subjects in the experimental group (n=13) participated in a 60 min horticultural therapy programme twice a week for 12weeks in addition to the institution's usual social activities. Subjects in the control group (n=10) participated in the institution's usual social activities. Static and dynamic balance were measured with the Performance Oriented Mobility Assessment scale. In addition, gait speed was measured. Qualitative data were collected through a semi-structured interview with participants of the experimental group. At the end of the intervention period, the experimental maintained their baseline performance on the static balance, while the control group showed a decline. The gait speed of the experimental improved, while that of the control group did not change. In dynamic balance, no changes were demonstrated. The results of our qualitative data analysis indicate that horticultural therapy increases the possibility of social interactions, encourages older people to engage in conversation. As a conclusion, horticultural therapy should be more widely included in programmes for older people with cognitive impairment.

2197 Effectiveness of horticultural therapy on the psychosocial and physical function of older adults with normal cognitive function.

Abstract Introduction Horticultural therapy (HT) is not uncommonly used as non-pharmacological therapy for patients with dementia. However, less is known about its effects on older adults with normal cognition. This systematic review and meta-analysis syntheses available evidence to evaluate the effects of HT on psychosocial and physical function in cognitively intact older adults. Method A systematic search in 9 electronic databases for experimental and quasi-experimental studies was performed between January 1, 2001, and July 19, 2021. Studies involving participants above 60 years old with normal cognition, analysing psychosocial and physical effects of HT, were included. Cochrane Risk of Bias 2 (RoB2) tool and Risk of Bias in Non-randomised Studies- of Interventions (ROBINS-I) were used to assess risk of bias. Meta-analysis was conducted using Stata software. Cochran’s Q test and I2 were used to explore statistical heterogeneity. Narrative synthesis was conducted for trials unsuitable for quantitative pooling. Results Nineteen articles (2191 participants) were included. Meta-analyses found that HT showed moderate-large effects on psychosocial outcomes, with improved self- efficacy (Hedges’ g = 0.49, 95%Confidence Interval: 0.07,0.91, 3 trials, I2:0.00%) and self-esteem (g = 1.01, 95%CI:0.33,1.68, 2 trials, I2:0.00%), and decreased depressive symptoms (g = −3.33, 95%CI:-6.29,-0.37, 4 trials, I2:98.51%). Narrative synthesis suggested benefits in Health-related Quality of Life. Regarding physical effects, HT improved exercise duration and intensity (g = 1.37, 95%CI:0.92,1.82, 2 trials, I2:0.00%). Effects on anxiety, social engagement and fitness did not achieve statistically significance. Conclusion The findings support the potential role of HT in promoting psychosocial and physical function among older adults with intact cognition. Given high statistical heterogeneity, more work is needed to explore the effect of possible moderators on treatment effects.

Connecting college students with nature: An evaluation indicator system for the implementation of horticultural therapy programmes on university campuses

ABSTRACT The introduction of horticultural therapy to university campuses has gradually become an effective way to promote college students’ interaction with nature, improve their health and increase the quality of their study environment. However, many current studies have focused on measuring and evaluating the physical and mental health benefits of horticultural therapy programmes for college students, while less attention has been paid to exploring how to implement such programmes in a planned and sustainable manner. The main purpose of this study is to construct an evaluation system for the implementation of horticultural therapy programmes on university campuses, so as to better guide the sustainable development of campus horticultural therapy. The analytic hierarchy process (AHP) and the Delphi method were combined in this study. Delphi method was used to carry out two rounds of consultation for 10 experts, to select and revise indicators at all levels and establish an evaluation system. Expert and college student opinions were combined to determine the weight of indicators at each level using AHP. The evaluation system constructed by Delphi method included 4 indicators in the criteria layer and 12 indicators in the indicator layer. The weight analysis of AHP showed that horticultural therapy plan (0.341) was most important in the criteria layer, followed by the natural healing environment (0.289), the horticultural therapy team (0.190) and post-maintenance management (0.180). In conclusion, the evaluation system constructed systematically sorts out the elements of conducting horticultural therapy programmes on Chinese university campuses, which has good application and promotion value.

The Growing Group: A service evaluation of community horticultural therapy for adults with a learning disability and mental health difficulties

The Growing Group: A service evaluation of community horticultural therapy for adults with a learning disability and mental health difficulties

초등 Wee 클래스 상담사 대상 원예치료 프로그램 도입 방안

This study aimed to gather essential data for integrating horticultural therapy activities into the Wee class counseling program. The findings revealed that a substantial proportion (40.9%) reported substantial experience implementing horticultural therapy in the Wee classes, with 37.5% of sessions led by horticultural therapists. Horticultural therapy was widely perceived as beneficial for counseling (33.1%). The key prerequisites for introducing horticultural therapy into Wee classes were training for horticultural therapy counselors (59.1%) and budget support (27.3%). The anticipated benefits included diversifying counseling techniques (26.5%), applicability to diverse clients (25.3%), promoting counselor self-healing (12.6%), and emotional purification (33.9%). Target groups were individuals with emotional issues such as anxiety and depression (30.7%), interpersonal relationship problems (17.8%), behavioral problems like violence (13.5%), and addiction issues (11.5%). Counselor training (59.1%) was the foremost prerequisite for implementing horticultural therapy due to its educational effectiveness (34.6%), applicability in group counseling (29.8%), and potential to help counselors with burnout (19.1%). As for the composition of the horticultural treatment training program, 'the composition of the actual program that can be actually applied to horticultural treatment' was the highest (32.5%), and the most preferred operating session was 5 to 8 sessions (47.8%). The intention to participate in the horticultural treatment therapy sessions was reported to be high after the training (90.9%). The necessity of horticultural therapy programs, based on the characteristics of Wee class counselors, was analyzed using t-tests for quantitative variables and chi-square tests (𝒙2) for qualitative variables with multiple categories. A significant correlation was found between counseling experience and the degree of training participation (p=.002), although the need for training was not significantly correlated with experience. Furthermore, there was a significant correlation between the operational experience of horticultural therapy programs and the degree of training participation (p=.012). Chi-square tests were employed to evaluate distribution variances among different groups based on their operational experience with horticultural therapy programs.

Perception of Horticultural Therapy for Job Stress among Various Hospital Workers

Perception of Horticultural Therapy for Job Stress among Various Hospital Workers

Impact of horticultural therapy on patients admitted to psychiatric wards, a randomised, controlled and open trial

Psychiatric inpatients often endure anxiety. This randomized trial assessed the impact of horticultural therapy on anxiety in adult psychiatric inpatients over four weeks, compared to standard care. Recruiting 211 inpatients from six units were randomized into control (n = 105) and experimental (n = 106) groups. Control received usual care; the experimental group had horticultural therapy alongside usual care. Anxiety, measured using HADS-A scale at four weeks, aimed to establish horticultural therapy's superiority. After four weeks, horticultural therapy significantly reduced anxiety compared to standard care (P < 0.001). These results argue in favor of integrating horticultural therapy into psychiatric nursing practices.Trial registration: No Clinical Trail: NCT02666339 (1st registration: 28/01/2016).

Critical therapeutic landscape design elements for cognitive impairments in the Royal Talbot rehabilitation centre

PurposeTherapeutic landscapes can be beneficial for patients recovering from cognitive and behavioural impairments. The therapeutic garden in the Royal Talbot rehabilitation centre (RTRC) located in Kew, Melbourne is a precedent for its nature design outdoor spaces and horticultural therapy (HT) program for patients with cognitive impairments due to brain and spinal cord injuries. There have been no studies into the physical design of the RTRC therapeutic garden.Design/methodology/approachThis case study unveils the critical design themes, and dominant physical elements of the RTRC therapeutic garden through site observation and analysis over the course of two months, a semi-structured interview with a key staff, and graphical representations using integrated photography and collaborative digital tools of AutoCAD and Adobe Photoshop.FindingsSeven critical design themes are identified for the RTRC garden: (1) space layout and organization, (2) physical and visual access, (3) pathway and facility, (4) multisensory vegetation, (5) amenity, wayfinding and seasonal interest, (6) cognitive stimulation, (7) utility and HT. Qualitative and quantitative data analysed in visual and descriptive format reveal multisensory vegetation, amenity, wayfinding and seasonal interest, and utility and HT are the top three most pivotal critical design themes in the RTRC therapeutic garden.Research limitations/implicationsThe findings of this case study can be used to impart knowledge about the design of therapeutic landscape settings for cognitive impairments to design professionals and the public.Originality/valueThere is no case study has been conducted for this precedent of therapeutic garden in the Royal Talbot rehabilitation centre that targets for cognitive impairment patients. With the increasing awareness in medical and healthcare environments, this case study would help to inject mutual understanding, generate knowledge and design awareness among design professionals and public, and to cultivate more good quality healthcare settings.

From Horticultural Therapy to Natural Healing: Types, Development, Mechanisms, and Prospects

From Horticultural Therapy to Natural Healing: Types, Development, Mechanisms, and Prospects

The Application of Horticultural Therapy in Shaping the Positive Psychological Qualities of Chinese Teachers' Children

As a special group of education objects, Chinese teachers' children are affected by the professional characteristics and ideas of their parents, and generally face greater psychological pressure. Their construction of positive psychological quality is relatively insufficient. The concept of horticultural therapy and experiential practical activities provide a new way to shape the positive psychological quality of Chinese teachers' children. It is particularly necessary to apply horticultural therapy to the children of Chinese teachers to improve their mental health. The combination of horticulture and mental health education of Chinese teachers' children helps to shape the positive and optimistic mentality of teachers' children, and helps to improve the communication ability and learning enthusiasm of teachers' children, which is of great value in shaping the positive psychological quality of Chinese teachers' children.

Art therapies and cognitive function in elderly with subjective cognitive decline: a protocol for a network meta-analysis

IntroductionSubjective cognitive decline means a decline in the subjective perception of self-cognitive function, which is likely to evolve into mild cognitive impairment and dementia. The number of elderly with subjective...