horticulture therapy dementia

Rooting for Brain Health: Horticultural Therapy for Dementia

By Genevieve Glass | May 11th, 2021

A scientific study shows that horticultural therapy — the practice of interacting with plants for a happier state of mind — can reduce apathy and improve cognitive function in people with dementia. 

Horticulture is the science and art of growing fruits, vegetables, flowers, or ornamental plants. For centuries, the focus of horticulture has been finding ways to change and improve plants — how humans can grow a bigger rose, a sweeter apple or a more pest resistant lemon, for instance. Somewhere along the way, it became recognized that not just the plant was being changed, but the person. That’s where horticultural therapy (HT) came to the fore, focusing on how the process of horticulture can be used to improve the individual. 

As a practice, horticultural therapy can benefit people with disabilities, injuries, diseases in many different settings, including hospitals, veteran centers and nursing homes, to name a few. A 2021 study suggests that HT may help people with dementia as well, reducing apathy (a common symptom of Alzheimer’s and related forms of dementia) and improving cognitive function after just 10 weeks. 

The small, randomized trial compared two groups of people with dementia who had no significant demographic or clinical profile difference at baseline evaluation. The HT group sessions were conducted once a week, with activities including planting, handicrafting, eating, drinking and cooking plants. The other group participated in usual-care activities twice a week, including puzzle games and body weight exercises. 

After 10 weeks, researchers found that the people with dementia who participated in HT had significantly lower levels of apathy and improved cognitive function scores as compared to the control group. 

These findings were not surprising to Joel Flagler, a registered horticultural therapist since 1984 and professor at Rutgers University. “Any time a person reconnects with nature, good feelings and healing can come,” he told Being Patient. “It’s important to remember that the plant doesn’t discriminate: The plant doesn’t care if the person has dementia, or they’re in a wheelchair, the plant is ready to respond to that person.” 

Having the responsibility of caring for another living being brings not only a sense of purpose to the individual, but also Flagler explained, as the plant starts to bloom and respond to the person’s care, a sense of accomplishment sets in. 

“I will ask people: ‘what does a plant need to survive?,’” Flagler said. “They’ll answer: water, sunshine and love. Now we’re bringing out their nurturing side, which is nice, because in a nursing facility or something of the sort, these individuals are always on the receiving end of care. Now we’re making them a caretaker and we’re bringing out their nurturing skills. Now we’re talking about real empowerment.” 

Flagler said he always reminds participants in his HT groups that plants are alive, so they must treat them with mutual respect. A typical session might begin by simply observing their surroundings and asking participants, “What’s blooming today?” or calling attention to a specific species and asking, “Who remembers azaleas?” The strategy of bringing something familiar and associated with a good feeling is key to a successful session. 

“Maybe someone grew that flower with their parents or grandparents. Maybe they bought their mom that flower on Mother’s Day. So it’s old and familiar and suddenly they’re drawn into the process,” he said.

The goal of HT is using the plant as a tool to stimulate the memory, facilitate conversation and engage one’s tactile and olfactory senses. Building focus and participation through social activity is one of the therapy’s pillars. In groups, an individual may be asked to pass a bit of a plant along to an individual. This calls on one to practice their hand-eye coordination, a complex cognitive ability, which unites one’s visual and motor skills.

According to Flagler, the beauty of horticultural therapy is that it can cater to the needs and goals of any individual or group, depending on their capabilities. Dementia, for example, is a broad term, encompassing many different levels of cognitive and physical function. Someone with advanced dementia may not be able to care for a plant. So instead, Flagler suggests crushing the leaves of a rosemary or geranium plant, inviting them to smell it and asking them what it brings to mind. This triggers their sense of smell, going straight to the brain’s olfactory bulb, otherwise known as the smell center — a structure in the front of the brain that connects directly to the amygdala and hippocampus, the brain’s hubs of emotion and memory.

If there’s not much greenery to work with in their immediate environment, a therapist will have to encourage the use of imagination in their session. But, as one might expect, in order for it to be considered horticulture, there must be some plants available to motivate the participants. 

“I always tell people, there’s no wrong way, let’s just have fun,” Flagler said of his approach. “Where there may have been disconnect and apathy, now we’re seeing direct involvement.”

The restorative and therapeutic power of nature comes in other forms, too: If the idea of gardening doesn’t light your fire, another study discovered that awe walks —  the practice of intentionally shifting attention outward instead of inward when walking outside — produced greater increases in daily experiences of compassion, admiration and amusement than those in the control group. 

According to the researchers, experiencing moments of awe are incredibly important for aging adults, who often experience higher levels of anxiety and sadness in their later years. Shifting attention to something vastly larger than themselves, like nature, may help put their problems into perspective and elicit a sense of connection to a larger community.

Flagler said that during the pandemic, when each day can feel as unpredictable as the next, growing plants has served as a way to keep people feeling more balanced. 

“When you plant seeds, you’re going to get a predictable outcome,” he explained. “You know that in 64 days (or whatever it says on the packet) you’re going to see growth, following a natural rhythm. The dependability of the garden and the plant has been very grounding for a lot of people who have come through a year, where day to day we didn’t know what to expect.” 

With every seedling planted comes an opportunity to better the environment, beautifying it with flowers, for example. This has many important ramifications for people, especially ones who don’t think they could contribute much to their community. “Suddenly, everyone who looks at what you’ve planted is a beneficiary of your actions,” Flagler said. “Horticulture can be a hobby that enriches our lives forever.” 

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