INFLUENCE OF GARDENING AND GREEN

ENVIRONMENT ON THE SUBJECTIVE WELL-BEING

OF THE ELDERLY: A STUDY WHICH FOCUSES ON

THE THERAPEUTIC ASPECTS OF HORTICULTURE.

By

Sreejith A. and S. Binukumar

Study carried out for

The Garden City Group Inc. Agriculture Development Corporation

Trivandrum

Ph: +91 9447583751

2008

2

ABSTRACT

The number of elderly is increasing, especially the proportion of

the oldest. Since diseases and impairments that hamper functional

ability are most common among the oldest, it is probable that the

number of elderly living in long-term care will remain high or even

increase despite the emphasis placed on promoting home care.

Many negative features characterize institutional living. These

include loss of autonomy and self-esteem, loneliness and hopelessness.

Depression and dementia are frequent among the elderly in long-term

care. The functionally efficient and sterile environment of institutions can

accelerate decline in the abilities of the elderly.

Supportive environments are associated with positive health

outcomes. An environment that provides aesthetic pleasure and

possibilities for engaging in meaningful activities, as well as providing

opportunities for socializing, may enhance coping during institutional

living. Plants are a principal feature of the supportive environment

because restoration from stress and cognitive fatigue are related to

natural environments containing plants.

The intention of this study was to consider whether green environments

and activities related to plants had effects that could be associated with

the well-being of the elderly living in long-term care. The increasing

numbers of elderly with many chronic diseases add to health care

3

requirements and costs to the community. If a green environment were

associated with enhancing well-being, landscape design and horticulture

could represent an economically sustainable means to create supportive

environments in institutional settings.

Historically, horticulture has proven to be an effective means of

therapy for many different populations. Horticultural Therapy (HT)

generally refers to the use of horticultural activities that are adapted to

meet specific goals of an individual with special needs in treatment (Relf,

1997). Many individuals benefit from these activities, including elderly

adults, disabled children, mentally and physically disabled adults, or

other individuals who could benefit from participating in horticultural

activities, but who require special adaptations or modifications to do so

(Relf and Dorn, 1995).

Horticulture has become a valuable therapeutic tool because the

activities can easily be adjusted and adapted to meet the needs of any

specific population without altering the main objectives of the program.

The scarcity of peer-reviewed academic literature on the subject of

HT may suggest that although HT is used by occupational therapists, the

lack of evidence-based practice produced by research findings may

inhibit its use.

Further research is necessary to identify outcome measures related to

client’s perceptions of the benefits gained from HT. The research

4

proposal, aims to investigate the benefits gained from group based HT

from the client’s perception.

The author works as a Horticultural Landscape Designer and

wishes to use HT as treatment and is therefore interested to highlight

and identify the benefits of HT for clients suffering from mental illness.

Horticulture is as old as human civilization, agriculture and

horticulture has been viewed as an art and science of growing crops.

Only recently horticulture and green environment has been viewed as a

method for therapeutic effects.

Theory of Horticulture Therapy is widely applied recently all over

the world. The preliminary results of using horticulture and other vertical

methods such as gardening suggests that the subjects are more easily

cured of their ailments and have a positive and therapeutic influence on

their psychology.

The researcher believes that the results of this study will be

positive and help the practitioners of horticultural therapy to restructure

their approach to achieve better results in treating subjects in need. The

results obtained will help the practitioners and researchers to construct

therapeutic designs more efficiently. The researcher is of the view that

the findings of the study may help to develop Horticulture Therapy (HT)

as a popular method of healing among needy patients.

5

There is a need for replication studies in the area of horticultural

therapy. A review of the literature from around the globe has shown

promise but in India, less research has been done in the field of

horticultural therapy and there exists a wide gap in the quantity and

quality of available literature in the country. More research is needed to

validate the positive impact of horticultural therapy.

This literature review included in the study discusses historical

information, cultural attitudes, contemporary views, contemporary

action, and relevant research pertaining to contemporary therapeutic

garden design. Chapter III will outline the methods used for the visual

analysis, behavioral observation, and interviews conducted on the

campus.

The researcher believes that the present study indeed could help to

design therapies that have positive impacts on older participants in

terms of their psychological well-being and enlarge their social networks

with friends and strengthen their relationships with their families. It is

expected that there will be more studies promoting gardening amongst

the elderly from different organizations and that the government could

promote such meaningful activities in terms of financial and land

support.

6

The main purpose of this study was to examine whether exposure to a

green environment and activities related to plants and gardening affected

subjective well-being of the elderly living in institutional care.

A further study on this topic is suggested on the therapeutic aspects of

horticulture and green environment on the wellbeing of patients with

different illness condition. A study on the awareness of the public

towards the care of elderly using horticulture also can be carried out.

The awareness level may vary from person to person depending on the

education background.

7

Chapter 1

INTRODUCTION

1.1 INTRODUCTION

The number of elderly is increasing, especially the proportion of

the oldest. Since diseases and impairments that hamper functional

ability are most common among the oldest, it is probable that the

number of elderly living in long-term care will remain high or even

increase despite the emphasis placed on promoting home care.

Many negative features characterize institutional living. These

include loss of autonomy and self-esteem, loneliness and hopelessness.

Depression and dementia are frequent among the elderly in long-term

care. The functionally efficient and sterile environment of institutions can

accelerate decline in the abilities of the elderly.

Supportive environments are associated with positive health

outcomes. An environment that provides aesthetic pleasure and

possibilities for engaging in meaningful activities, as well as providing

opportunities for socializing, may enhance coping during institutional

living. Plants are a principal feature of the supportive environment

because restoration from stress and cognitive fatigue are related to

natural environments containing plants.

8

The intention of this study was to consider whether green environments

and activities related to plants had effects that could be associated with

the well-being of the elderly living in long-term care. The increasing

numbers of elderly with many chronic diseases add to health care

requirements and costs to the community. If a green environment were

associated with enhancing well-being, landscape design and horticulture

could represent an economically sustainable means to create supportive

environments in institutional settings.

1.1.1 Horticultural Therapy (HT)

Historically, horticulture has proven to be an effective means of

therapy for many different populations. Horticultural Therapy (HT)

generally refers to the use of horticultural activities that are adapted to

meet specific goals of an individual with special needs in treatment (Relf,

1997). Many individuals benefit from these activities, including elderly

adults, disabled children, mentally and physically disabled adults, or

other individuals who could benefit from participating in horticultural

activities, but who require special adaptations or modifications to do so

(Relf and Dorn, 1995).

Horticulture therapy programs are usually led by a professional

who is trained to “tailor the use of plants to fit the therapy and

rehabilitation needs of those individuals with whom they are working”

(AHTA publication). Although the specific needs of any particular

9

population and even the needs of several individuals within a certain

population may vary, the main goals of a HT program remain the same.

As Relf states, “the specific goals toward which a HT program is directed

may differ distinctly from one institution to another and from one

population to another. However, the ultimate goal of these programs is

the improved physical and mental health of the individual” (Relf [Hefley],

1973).

Horticulture has become a valuable therapeutic tool because the

activities can easily be adjusted and adapted to meet the needs of any

specific population without altering the main objectives of the program.

Horticultural Therapy (HT) is an accepted though relatively

underused intervention, despite its versatility, effectiveness and cost-

efficiency. This review shows that much of the literature is dated

describing the successful use of HT within long-term institutions. It is

apparent from the literature that HT may not be fully utilised with the

recent changes from institutionalised to community-based care.

The scarcity of peer-reviewed academic literature on the subject of

HT may suggest that although HT is used by occupational therapists, the

lack of evidence-based practice produced by research findings may

inhibit its use.

Further research is necessary to identify outcome measures related to

client’s perceptions of the benefits gained from HT. The research

10

proposal, aims to investigate the benefits gained from group based HT

from the client’s perception.

The author works as a Horticultural Landscape Designer and

wishes to use HT as treatment and is therefore interested to highlight

and identify the benefits of HT for elderly suffering from mental illness.

1.2 PRESENT STATUS OF THE STUDY

Horticulture is as old as human civilization, agriculture and

horticulture has been viewed as an art and science of growing crops.

Only recently horticulture and green environment has been viewed as a

method for therapeutic effects.

Theory of Horticulture Therapy is widely applied recently all over

the world. The preliminary results of using horticulture and other vertical

methods such as gardening suggests that the subjects are more easily

cured of their ailments and have a positive and therapeutic influence on

their psychology.

The researcher believes that the results of this study will be

positive and help the practitioners of horticultural therapy to restructure

their approach to achieve better results in treating subjects in need. The

results obtained will help the practitioners and researchers to construct

therapeutic designs more efficiently. The researcher is of the view that

the findings of the study may help to develop Horticulture Therapy (HT)

as a popular method of healing among needy patients.

11

1.3 NEED AND SIGNIFICANCE OF THE STUDY

There is a need for replication studies in the area of horticultural

therapy. A review of the literature from around the globe has shown

promise but in India, less research has been done in the field of

horticultural therapy and there exists a wide gap in the quantity and

quality of available literature in the country. More research is needed to

validate the positive impact of horticultural therapy.

Earlier works of Dr. Wilson, Clare Cooper Marcus, Marni Barnes,

and Roger Ulrich supplies a body of relevant research suggesting that

exposure to natural settings may lessen stress and promote healing,

therefore improving health outcomes. Given this knowledge, the present

study tries to evaluate the influence of green environment and

horticultural therapy on the elderly. Recommendations for improvement

will also be given. All will provide insight into how to use therapeutic

gardens to facilitate the healing process. This study will further add to

the critical body of knowledge that is the departure point for more

documented and empirical research necessary to enable appropriate and

specific design recommendations for contemporary therapeutic garden

designs.

This literature review included in the study discusses historical

information, cultural attitudes, contemporary views, contemporary

action, and relevant research pertaining to contemporary therapeutic

12

garden design. Chapter III will outline the methods used for the visual

analysis, behavioral observation, and interviews conducted on the

campus.

The researcher believes that the present study indeed could help to

design therapies that have positive impacts on older participants in

terms of their psychological well-being and enlarge their social networks

with friends and strengthen their relationships with their families. It is

expected that there will be more studies promoting gardening amongst

the elderly from different organizations and that the government could

promote such meaningful activities in terms of financial and land

support.

1.4 STATEMENT OF THE PROBLEM

The present study is undertaken with the objective of

understanding the influence of green environment and horticultural

activities on the subjective well –being of the elderly. So the present

study is entitled as “INFLUENCE OF GARDENING AND GREEN

ENVIRONMENT ON THE SUBJECTIVE WELL-BEING OF THE ELDERLY:

A STUDY WHICH FOCUSES ON THE THERAPEUTIC ASPECTS OF

HORTICULTURE”.

13

1.5 OPERATIONAL DEFINITION OF TERMS

1.5.1 Gardening

To care for plants usually in a garden or landscape through such

formidable chores as buying and propagating plants, pest control,

fertilizing, pruning, soil management, transplanting, compost making,

watering, weather forecasting, taking protective measures, and weeding.

(Davesgarden website 2008)

1.5.2 Green Environment

Abounding in or the surrounding environment covered with green growth

or flora together with the ecosystems that is beneficial to the biosphere

of or concerned with conservation and improvement of the environment

(Collins Essential English Dictionary 2006)

1.5.3 Elders

Most developed world countries have accepted the chronological age of

65 years as a definition of 'elderly' or older person, but like many

westernized concepts, this does not adapt well to the situation in Africa.

While this definition is somewhat arbitrary, it is many times associated

with the age at which one can begin to receive pension benefits. At the

moment, there is no United Nations standard numerical criterion, but

the UN agreed cutoff is 60+ years to refer to the older population. (WHO

2007)

14

1.5.4 Horticultural Therapy

Horticultural therapy is the practice of horticulture as therapy to

improve human well-being. According to the American Horticultural

Therapy Association (AHTA), HT is defined as “a process utilizing plants

and horticultural activities to improve social, educational, psychological

and physical adjustment of persons thus improving their body, mind, and

spirit.”

1.6 OBJECTIVES OF THE STUDY

The main purpose of this study was to examine whether exposure to a

green environment and activities related to plants and gardening affected

subjective well-being of the elderly living in institutional care. The more

specific objectives were:

1. To examine whether plants and nurturing them have meanings

that can be associated with the subjective well-being of the elderly

living in sheltered care (I).

2. To establish the role of plants in well-being of the elderly

individuals with dementia and to describe how nursing staff regard

plants in a care environment (II).

3. To examine the perceived effects and meanings the elderly attach

to garden visits in long-term nursing care and to assess whether

15

associations exist between experiences from garden visits and self-

rated depression (III).

4. To examine if the frequency of outdoor visits to a garden

environment is associated with self-rated health of the elderly in

long-term nursing care (IV).

5. To establish the factors impacting on the accessibility of the

outdoor environment and the frequency of outdoor visits in

institutional care (III, IV).

1.7 HYPOTHESIS OF THE STUDY

1. Depression and dementia are frequent among the elderly and

functionally inefficient and sterile environment can accelerate

decline in the abilities of the elderly.

2. Green environments and activities related to plants had effects that

could be associated with the well-being of the elderly.

3. Landscape design and horticulture could represent an

economically sustainable means to create supportive environments

in institutional settings.

4. There is significant difference in the well-being of elderly under in

horticulture related activities and horticultural therapy.

16

1.8 SCOPE OF THE STUDY

The major aim of this study was to examine whether exposure to a

green environment and activities related to plants and gardening affected

subjective well-being of the elderly living in institutional care.

It is expected that the study would throw light on various aspects

of elderly care using horticulture and green environment

1.9 METHODOLOGY IN BRIEF

Both quantitative and qualitative methods were used in the study.

Data were gathered through interviews, using scaled and open-ended

questionnaires, and validated scaled questionnaires addressed specific

health aspects.

1.10 LIMITATIONS OF THE STUDY

1 The small sample size of the clients would not give reliable

statistical results.

2 It may be difficult to relate cause and effect in this study due to

other contributory factors effecting the well-being and mental state

of the clients, e.g. relationship issues.

3 Seasonal effects – the study will take place during Spring/Summer

– Seasonal Affective Disorder (SAD) could be a factor.

4 Semi-structured interviews –the location of the interviews, either in

the CMHT or clients home may result in some inconsistence.

17

5 The study is not quantitative; the Perceived Restorativeness Scale

(PRS)(Hartig et al 1996) could be included to create a mixed

methodology.

6 Time constraints will limit the quantity of data obtained.

1.10.1 Ensuring trustworthiness

“Trustworthiness refers to the degree of confidence scholars can have in

the accuracy and lack of bias of the research” (Kielhofner, 1992).

Fieldhouse (2002) indicates that “traditionally the benchmarks for good

research have been validity and reliability (Bowling 1997) and that in

qualitative research, checks and balances exist to accommodate the

complexity of using a human instrument to gather and analyse data –

and the concept of trustworthiness in a study has evolved to supersede

validity and reliability. This ensures that the “lived experience” is

faithfully conveyed, that findings are rooted in it and that the process is

logical, traceable and documented.” These guidelines will be used in this

research.

1.11 FORMAT OF THE REPORT

The study is reported in five chapters, the following being the details.

Chapter 1: INTRODUCTION

This chapter contains all the relevant sectors and details

pertinent to the area under investigation.

18

Chapter 2: REVIEW OF RELATED LITERATURE

Presents the review of related literature and studies pertaining

to the study undertaken.

Chapter 3: METHODOLOGY

Gives a detailed description of the method adopted for the

study, tools used for the study, the sample taken,

administration of the tools and an account of the statistical

techniques used for analysing the data obtained from the study.

Chapter 4: RESULTS AND ANALYSIS

Concerned with the analysis of the data followed by the results

of the study.

Chapter 5: CONCLUSIONS AND SUGGESTIONS

Summarises the study in retrospect. The important findings

and a few recommendations for further research are presented.

The report is followed by Bibliography and Appendices pertaining to the

study.

19

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