Horticulture therapy employs plants and gardening activities in therapeutic and rehabilitation activities and could be utilized to improve the quality of life of the worldwide aging population, possibly reducing costs for long-term, assisted living and dementia unit residents. Preliminary studies have reported the benefits of horticultural therapy and garden settings in reduction of pain, improvement in attention, lessening of stress, modulation of agitation, lowering of as needed medications, antipsychotics and reduction of falls. This is especially relevant for both the United States and the Republic of Korea since aging is occurring at an unprecedented rate, with Korea experiencing some of the world's greatest increases in elderly populations. In support of the role of nature as a therapeutic modality in geriatrics, most of the existing studies of garden settings have utilized views of nature or indoor plants with sparse studies employing therapeutic gardens and rehabilitation greenhouses. With few controlled clinical trials demonstrating the positive or negative effects of the use of garden settings for the rehabilitation of the aging populations, a more vigorous quantitative analysis of the benefits is long overdue. This literature review presents the data supporting future studies of the effects of natural settings for the long term care and rehabilitation of the elderly having the medical and mental health problems frequently occurring with aging.

A retrospective analysis was followed on 20 case reports covering the possible correlation between the atypical antipsychotic, quetiapine, and neuroleptic malignant syndrome (NMS), determined by the study of 7 different NMS criteria guidelines. A great majority (19) of the case studies did not meet the requirements of all 7 guidelines, frequently due to unreported information. Nor was quetiapine proven to be the sole cause of the possible NMS in the two age groups investigated. Only one case was found to have no other medication or medical conditions confounding the relationship of quetiapine and NMS symptoms, and that case was in the context of a significant quetiapine overdose. The other 19 cases demonstrated the difficulty of identifying the cause of NMS when polypharmacy and other medical conditions are involved. The authors note the need for caution in deciding both the presence of NMS and the causal factors of the symptoms.

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disorder clinic were reviewed. All participants underwent brain magnetic resonance imaging to augment diagnostic accuracy. For the same reason, metaiodobenzylguanidine (MIBG) cardiac scintigraphy was performed in most participants. Individuals with a history of abdominal surgery, gastrointestinal diseases such as ulcerative colitis and cholecystolithiasis, diabetes mellitus, and other systemic diseases that might potentially cause IPO or volvulus were excluded. For the same reason, individuals patients taking trihexyphenidyl and other anticholinergic agents were excluded.Two-hundred fifty individuals with PD (132 men, 118 women; mean age 67 (range 46-84); mean disease duration 5.3 years (range 1-15 years)) were enrolled in the study. Of these, six (2.4%) had been admitted to the gastroenterology unit because of emergency IPO (five cases) or sigmoid colon volvulus (case 3 and at the second admission of case 6) ( Table 1). All six patients had acute onset of abdominal bloating, pain, nausea, or vomiting. 1 Abdominal X-ray and computed tomography showed dilation of the colon with or without the small intestine in all six individuals. 1 Two cases with volvulus showed a double loop sign at the sigmoid colon, 1,4,5 which required emergency endoscopic reposition. The clinical features of the six individuals were as follows: mean age 78.5 (range 69-82); three male, three female; ordinary Hoehn Yahr motor grade 3.2 (range 2-5); illness duration 5.3 years (range 2-9 years; taking a large levodopa dose 420 mg/d (in 5); constipation; regular bowel medication (e.g., magnesium oxide) (in 5); urinary dysfunction (in 5); mean hospital stay 44 days (range 1-112 days); no recurrence after discharge for mean 1.3 years (range 1-4 years). One patient (case 2) died from aspiration pneumonia.Mechanisms of constipation in PD are prolonged colonic transit (autonomic) and disturbed defecation (somatic and autonomic), 1 reflecting Lewy body pathology in the myenteric plexus. 1 The incidence of IPO and volvulus in our cases (2.4%, 6/250) is almost in accordance with that found in the previous study (7.1%, 8/ 112). 2 After hospitalization, patients were started on mosapride (selective 5HT-4 stimulating agent), 6 domperidone (peripheral dopaminergic blocker), and Dai-Kenchu-Tou (an herbal medicine containing hydroxy-beta-sanshool with 5HT-3-stimulating properties), 7 which seemed to prevent the recurrence of IPO. In conclusion, the incidence of emergency IPO in individuals with PD at a movement disorder and gastroenterology clinics was 2.4%; all were older adults. Although rare, emergency IPO requires hospitalization and may have a poor outcome. Therefore, preventative treatment of constipation with prokinetic drugs is necessary particularly in older adults with PD.The present study was approved by the ethics committee at