The Impact of a Dementia-Friendly Garden Design on People With Dementia in a Residential Aged Care Facility: A Case Study

Abstract

Background: There is a paucity of evidence on the efficacy of garden design based on dementia-friendly environment (DFE) characteristics on the level of agitation, apathy, and engagement of people with dementia in residential aged care facilities (RACFs). Objective: To investigate the effect of a garden improved according to DFE characteristics on agitation, apathy, and engagement of people with dementia in one RACF. Methods: A case study design with a mixed-method approach was used. Results: There was no significant improvement in the level of participants’ agitation following visits to the improved garden, χ2(2) = 5.167, p = .076. A high level of engagement was found in participants during the intervention (Week 1-1, p < .01; Week 1-2, p < .01; Week 2, p < .01; Week 3, p < .05; and Week 4, p < .05) when compared to before intervention (Week 0). A higher level of apathy was found in participants at Week 0 when compared to during the intervention (Week 1-1, p < .05; Week 1-2, p < .01; Week 2, p < .05; Week 3, p < .01; and Week 4, p < .01). Five themes emerged from participant interviews: the presence of sensory-provoking elements in the garden, meaningful engagement in the garden, accessibility of the garden, garden impacts, and garden experiences that demonstrated the effectiveness of the garden. Conclusions: The garden promoted engagement and decreased apathy of people with dementia living in the RACF with the researcher’s partial facilitation of the intervention sessions. The qualitative findings indicated the effectiveness of the garden in reducing agitation.

The effect of garden use on quality of life and behavioral and psychological symptoms of dementia in people living with dementia in nursing homes: a systematic review

“…Seven publications used a before-and-after non-randomized design ( 25 – 27 , 36 , 41 , 43 ), and seven had a mixed-methods design ( 12 , 32 , 34 , 35 , 39 , 40 , 42 ). A non-comparative quantitative descriptive study design was used in two publications ( 33 ), one used a quantitative randomized controlled trial design ( 31 ), one was a non-randomized clustered controlled trial ( 28 ), and one had a qualitative study design ( 37 ).…”

“…The number of participants included in the publications ranged from 10 people living with dementia ( 34 , 41 ) to 541 residents [of whom 453 people living with dementia (83.7%) or a score of ≥ 5 on the Psychogeriatric Assessment Scale Cognitive Impairment Scale (PAS-Cog)] ( 33 ). Ten publications included only people living with dementia as participants ( 25 , 27 , 28 , 31 , 33 , 34 , 36 , 37 , 41 , 43 ), while seven included people living with dementia as well as staff members and relatives as participants ( 12 , 26 , 29 , 32 , 35 , 39 , 42 ), and two only included staff members as participants ( 30 , 40 ).…”

“…They can be grouped into interventions regarding the evaluation of (1) effects of specifically designed nursing home gardens, (2) participation of the people living with dementia in activities in the garden of the nursing home, and (3) other interventions. Eight studies described an evaluation of the effects of specifically designed gardens ( 25 – 28 , 34 , 36 , 39 , 42 ), three regarded interventions in which the people living with dementia participated in activities that took place in different environments, for example, the garden vs. the living room ( 29 , 31 , 32 ), and the rest of the publications described a range of other interventions, like an evaluation of the effects of garden visits ( 40 , 43 ), garden visits in different seasons ( 29 , 41 ), of (not) having independent access to the outdoor spaces ( 33 ), and creating and testing a decision tool for personalized nature activities ( 37 ). Furthermore (a number of), sessions were part of the intervention in only three publications ( 32 , 36 , 42 ).…”

“…The outcome QoL was measured both quantitatively ( 12 , 33 , 34 , 39 ), and qualitatively ( 35 , 37 , 39 ). The measurements of BPSD showed the most homogeneity: eight of the 10 publications used quantitative measures, of which six the Cohen-Mansfield Agitation Inventory [-Short Form; CMAI (-SF)] ( 26 , 27 , 29 , 31 , 34 , 42 ). Other measurements used were the number of falls, number of incidents, scheduled and pro re nata psychiatric medications, the modified Baumgarten, Becker and Gauthier's checklist, the Person-Environment Apathy Rating Scale (PEAR), and the Neuropsychiatric Inventory Nursing Homes (NPI-NH) ( 12 , 25 , 26 , 41 , 42 ).…”

“…The measurements of BPSD showed the most homogeneity: eight of the 10 publications used quantitative measures, of which six the Cohen-Mansfield Agitation Inventory [-Short Form; CMAI (-SF)] ( 26 , 27 , 29 , 31 , 34 , 42 ). Other measurements used were the number of falls, number of incidents, scheduled and pro re nata psychiatric medications, the modified Baumgarten, Becker and Gauthier's checklist, the Person-Environment Apathy Rating Scale (PEAR), and the Neuropsychiatric Inventory Nursing Homes (NPI-NH) ( 12 , 25 , 26 , 41 , 42 ). Only three publications (also) used qualitative measures, namely a survey, a semi-structured questionnaire, and a semi-structured interview ( 26 , 40 , 42 ).…”