Original Study
Effects of Horticulture on Frail and Prefrail Nursing Home Residents: A Randomized Controlled Trial

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Abstract

Objective

Frail nursing home residents face multiple health challenges as a result of their frail status. The aim of this study was to examine the effects of HT on the psychosocial well-being of frail and prefrail nursing home residents.

Setting

Nursing homes.

Participants

One hundred eleven participants were randomly allocated into the intervention [horticultural therapy (HT)] and control (social activities) conditions.

Intervention

HT group participants attended a weekly 60-minute session for 8 consecutive weeks. Control group activities were social in nature, without any horticulture components.

Measurements

The outcome measures include happiness, depressive symptoms, self-efficacy, well-being, social network, and social engagement. The time points of measurement were at baseline (T0), immediately postintervention (T1), and 12 weeks postintervention (T2). A modified intention-to-treat approach was adopted. A multivariate general estimating equation was used to analyze the data.

Results

Forty-six and 50 participants received at least 1 session of the intervention and control condition protocol, respectively. A significant interaction effect between group and time was observed only on the happiness scale (β = 1.457, P = .036), but not on other outcome variables. In a follow-up cluster analysis of those who received HT, a greater effect on subjective happiness (mean difference = 6.23, P < .001) was observed for participants who were happier at baseline.

Conclusion

HT was found to be effective in promoting subjective happiness for frail and prefrail nursing home residents. Its favorable effect suggests that HT should be used to promote the psychosocial well-being of those who are frail.

Section snippets

Methods

This study employed a randomized controlled trial design. The participants were randomly assigned into either the experimental (HT) or control (social activities) groups. The outcome variables were measured at 3 time points: at baseline (T0), immediately postintervention (T1), and in the 12th week postintervention (T2).

Results

Six hundred twenty-one residents were screened for eligibility in the 4 homes, and 111 eligible residents consented to take part in the study. They were randomly allocated into the HT group (n = 56) and control group (n = 55). The final mITT sample consisted of 46 and 50 subjects in the HT and control groups, respectively (Figure 2).

Discussion

A significant improvement in subjective happiness in the HT group over time was observed after controlling for baseline between-group differences (SHS and CCI scores). Significant changes were not observed in the rest of the outcome variables. The findings provide some preliminary support to the biophilia hypothesis. Horticultural therapy utilizes interactions with plants (living organisms) to promote people's psychosocial well-being. Apparently, the increase in happiness was not associated

Conclusion

HT was found to promote subjective happiness in this study's sample. Because frail older people tend to exhibit more severe symptoms of depression than most other segments of the population, this study therefore indicates that HT should be promoted as part of a program of activities for residents in long-term residential care. Nature-based activities are gaining popularity as a low-risk and enjoyable activity particularly beneficial for people who do not have the ability or opportunity to

Acknowledgments

This collaborative project was funded by the Pok Oi Hospital, Hong Kong SAR (PolyU: 5-ZH1B).

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      HLs provide a way for citizens or patients to re-establish spiritual and emotional connections with nature (Crewe and Forsyth, 2003; Scartazza et al., 2020). The therapeutic effects of horticulture on the elderly have been widely investigated (Ferrini, 2003; Beard and Bloom, 2015; Lai et al., 2018), and HL therapy has played a unique role in promoting improvement in physical and mental diseases (e.g., Alzheimer's disease and dementia) of the elderly and improving their quality of life (Whear et al., 2014; Zhao and Yue, 2017). The effect of HL-based horticultural therapy on the elderly is reflected in several areas, including the psychosocial, physical and functional, physiological, and cognitive, amongst others (Naderi and Shin, 2008; Jiang, 2010; Nicholas et al., 2019).

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    The authors declare no conflicts of interest.

    This project was a collaborative research funded by the Pok Oi Hospital, Hong Kong SAR, PolyU no. 5-ZH1B.

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