Enriched gardens improve cognition and independence of nursing home residents with dementia: a controlled trial

Abstract

Background: Dementia is a major issue worldwide, and considerable efforts were made to design therapeutic mediation tools and evaluate their benefits on the health of patients. Methods:Design: Multi-center cluster-controlled trial. Settings and participants: Four nursing homes that offered separated access to one conventional sensory garden (CSG) and one enriched garden (EG). The participants were residents with dementia, independent for walking and with no severe dementia or behavioural troubles. Eligible residents were distributed into three groups based on the proximity of their rooms to the CSG or EG for the first two groups respectively, and without easy access to either garden for the third (control) group. Interventions: We asked staff members to frequently invite residents to visit the EG or the CSG depending on their group allocation. No invitation to gardens was made to the controls. We installed 12 enrichment modules in the EG that stimulated cognitive and walking/balance functions.Measures: Cognitive function (MMSE), independence for activities of daily living (ADL) and risk of falls (unipodal stance and Timed up and go – (TUG)) were assessed at baseline and after six months.Results: The 120 participants were 81·0 +/- 3·5 years old and comprised of 83 women. Their MMSE score was 17·5 +/- 2·9. Patients characteristics were not significantly different between the three groups. Among the participants invited to visit the EG group, six months changes in MMSE showed improved compared to other groups (+ 0·93 +/- 0·65 vs -0·25 +/- 0·71 and -0·24 +/- 0·73 in the EG vs CSG and control groups, respectively, P < 0·0001). Changes in ADL, TUG and unipodal stance were significantly improved in the group visiting the EG as compared to other groups, which indicates better functioning. Conclusions: EGs offer a new approach to therapeutic mediation for residents of nursing homes with dementia.