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ORIGINAL ARTICLE

Therapeutic effects of an indoor gardening programme for older people


living in nursing homes
Mimi Mun Yee Tse

Aims. To explore the activities of daily living and psychological well-being of older people living in nursing homes and also to
examine the effectiveness of a gardening programme in enhancing socilaisation and life satisfaction, reducing loneliness and
promoting activities of daily living for older people living in nursing homes.
Background. Life in nursing homes can mean very limited physical and social activity, leading to further decline in function for
many older people.
Design. This was a quasi-experimental pre and posttest control group design.
Methods. Older people from nursing homes were invited to join the eight week indoor gardening programme (experimental
group), while older people in other nursing homes were treated as the control group; they received regular care without the eight
week indoor gardening programme. There were 26 older people (25 female and one male; mean age 85 years) in the experimental group and 27 (20 female and seven male; mean age 82 years) in the control group. Demographic data including age,
gender, educational level and financial situation were collected, in addition to information regarding life satisfaction, loneliness,
physical activity and social network situation, before and after the eight week indoor gardening programme for both the
experimental and control groups. Also, details of experimental group subjects experience of the indoor gardening programme
were elicited using open-ended questions.
Results. There were significant improvements in life satisfaction and social network and a significant decrease in perception of
loneliness for older people in the experimental group after the eight week indoor gardening programme, while the activities of
daily living were unchanged for both groups after the programme.
Relevance to clinical practice. Given the positive effects of gardening activities, it is suggested that they be promoted more
widely among nursing home residents.
Key words: China, gardening programme, nurses, nursing, nursing homes, older people
Accepted for publication: 15 November 2008

Introduction
With the increase in average life expectancy, the impact of
disease and the increase in the prevalence of disabilities
(LEGCO Panel on Welfare Services 2005), older adults are in
increasing need of some form of alternative accommodation
and/or residential care facilities (Sandberg et al. 2001). In
Author: Mimi MY Tse, RN, PhD, Assistant Professor, School of
Nursing, The Hong Kong Polytechnic University, Kowloon, Hong
Kong

Hong Kong, it is estimated that 55% of people aged 65 years


and older need institutionalised care (LEGCO Panel on
Welfare Services 2005) and that 95% of institutionalised
older people reported having one or more chronic diseases
(Census and Statistics Department 2005).
Nursing homes serve the needs of disabled older people
who are unable to function independently and who will
Correspondence: Mimi MY Tse, School of Nursing, The Hong Kong
Polytechnic University, Kowloon, Hong Kong. Telephone: 852 2766
6541.
E-mail: hsmtse@inet.polyu.edu.hk

 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 949958


doi: 10.1111/j.1365-2702.2009.02803.x

949

MMY Tse

benefit from 24-hour access to personal and professional care


from nursing staff. However, life in nursing homes can mean
very limited physical and social activity, leading to further
decline in function for many older people (Lassey & Lassey
2001). This paper reports a research study attempting to
explore the activities of daily living and psychological-well
being of older people living in nursing homes and to examine
the effectiveness of a gardening programme in enhancing
socialisation and life satisfaction, reducing loneliness and
promoting activities of daily living in nursing homes.

Background
Moving to and living in a nursing home is a difficult
experience for many people. It is likely to be traumatic and
depressing for those already struggling with loss of health or
ill health, pain, dependency and limited social and material
resources (Grek 2008). The establishment of nursing homes
serves older individuals who are unable to function independently (Lassey & Lassey 2001). Nevertheless, nursing home
placement implies an alteration of living environment, which
can lead to reduced socialisation with family and community,
a decrease in physical activity and an increased perception of
loneliness (DAmico-Panomeritakis & Sommer 1999). It is
noted that levels of physical activity for older people living in
nursing homes are much lower compared with those of
community-dwelling older adults (Lee et al. 2005).
Apart from the change in physical environment and level of
physical activity, older people in nursing homes face changes
in their daily life routine, social networks and support
(Johnson 1996). Admission to a nursing home means a
discontinuation of customary lifestyles to the individual (Lee
et al. 2002). The older person may feel a great sense of loss at
leaving their beloved homes, family and neighbourhood
(Reed & Roskell Payton 1996, Lassey & Lassey 2001).
Nursing home residents have expressed loss of freedom,
loss of control, feelings of loneliness and a sense of failure at
having to stay in nursing homes (Kellett 1999, Tse 2007).
Living in a nursing home is regarded as living in a jail (Tse
2007, p. 913), where there was no freedom of movement, a
lack of privacy and a loss of control over many things
(Iwasiw et al. 1996, Wilson 1997). Residents also stressed the
feeling of loneliness in the nursing home and said that they
were by themselves and surrounded by strangers and sick
people (Sim & Leung 2000, Tse 2007). Such negative feelings
about life in a nursing home have detrimental effects on their
health status, leading to a poor quality of life.
The new paradigm for older people care focuses on the
primary and secondary prevention of functional morbidity
and premature mortality, as well as enhancing the quality of
950

life for older people (Rubenstein & Nahas 1998); as such,


social support networks are important in the prevention of
cognitive dysfunction and functional decline (Rubenstein &
Nahas 1998). It is noted that gardening activity may be a
good strategy for enhancing physical and cognitive function
as well as socialisation among older people (Larson 2006).
Gardening is defined as the art and science of growing
flowers, fruits, vegetables, trees and shrubs, resulting in the
development of the minds and emotions of individuals, the
enrichment and health of communities and the integration of
the garden in the breadth of modern civilization (Relf 1992,
p. 201). Gardening activities provide regular physical activity
that enhances physiological stability and high-level functioning (Brown et al. 2004). The benefits of gardening on levels of
physical ability can be seen in increased muscular strength,
improved fine motor skills and improved balance, including
transplanting, which needs the practices of grasp and release
and flexion of the thumb and forefinger (McGuire 1997,
Brown et al. 2004).
Gardening activities promote enthusiasm and a sense of
responsibility and accomplishment, from the selection of
plant materials to growing flower-producing plants that
create hope until bloom time. Learning new gardening skills
stimulates curiosity among older people (Wakefield et al.
2007). Gardening can extend the social network of participants by providing opportunities to foster social interaction
with each other (Larson 2006). There are positive effects of
gardening activity among community-dwelling older people,
with a significant improvement in psychological well-being
(Heliker et al. 2000). However, there is a lack of literature
regarding the use of gardening activities for older people
living in nursing homes.
The aim of the study was to explore the effectiveness of an
indoor gardening programme as an exploration of strategies
to enhance the quality of life in nursing homes. The objectives
of the present study were to explore the activities of daily
living and psychological-well being of older people living in
nursing homes and to examine the effectiveness of an indoor
gardening programme in enhancing their socialisation and
life satisfaction, reducing their loneliness and promoting
activities of daily living.

Methods
Design and sample
This research was a quasi-experimental pre and posttest
control group design. After gaining approval from the Ethics
Committee of the university, an organisation operating
residential care homes for older people was approached and

 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 949958

Original article

Indoor gardening program

invited to participate in the study. This organisation operates


over 20 nursing homes in Hong Kong. Under this organisation, four nursing homes were randomly selected, two as
experimental groups and two as control groups. Their
residents were recruited by convenience sampling. Posters
were set up in the function rooms and hallways of the nursing
homes to inform and invite residents to join the study; also,
staff of the nursing homes recommended potential residents
for the researcher to approach.
Written consent was obtained from all participants. Inclusion criteria for the participants included being 60 years or
older, able to communicate in Cantonese and being cognitively intact based on the Mini-Mental State Examination
(score of 6) (Leung et al. 2007). In contrast, those who were
bed-bound, had a history of mental disorders and a history of
allergy to pollen, plant, seed and fertilisers were excluded
from the study.

Eight week indoor gardening programme


The researcher and research assistants visited the older
participants once a week for eight weeks, with the protocol
for the gardening programme as set out in Table 1. Posters
were set up in the nursing homes to invite and remind older
people to join the gardening programme and to water their
plants. In the first week, each participant received a planting
diary, which recorded the planting schedules and photos of
their own plants, taken each week. Various types of plants and
seedlings, suitable for gardening activities in the nursing home
Table 1 Protocol for gardening program
(experimental group)

environment, were introduced. There were seedlings of Globe


amaranth, Mimosa pudica, Radish Cherry Belle and lettuce
for the participants to choose and they could choose two out
of these four seeds for their own planting. All gardening
activities were carried out in the multiple function room of the
nursing homes; the plants of each participant were placed
along the window side of the multiple function room.
In the second week, pots, seeds and all gardening equipment were delivered to participants and the research team
carried out the gardening activities with them. From week 2
to week 8 and thereafter, each participant was responsible for
his or her own planting, while the research team would
facilitate and discuss the proper care of the plant and
demonstrate how to make natural pesticides using raw
materials that were easily accessible for older people.
Examples include mixing white vinegar with washing powder
to spray on the surface of the leaves every 45 days to
strengthen the resistance of the plants, the use of Kelp water
to spray on the root of the plant every 34 days to create a
special potion to dispel ants, the use of garlic water to spray
on the surface of the leaves to dispel orange and black beetles
and the use of green onion to spray on the plant twice every
three days to prevent wet rot (a disease that appears on leaves
under high temperature and humidity). Participants photos
were taken with their plants at the end of each week and
placed in the planting diary accordingly. Upon completing
the week 8 gardening activity, participants were invited to
share their planting diaries with each other and to share their
experiences with the research team.

Experimental group
Week

Content

Expected outcomes

Introduce gardening activity in the nursing


home environment via poster
Various types of plants and seedlings
introduced
Select seeds
Introduce the planting diary
Make entries in the planting diary
Distribute soil, tools and seeds according
to the choice of each participant
Make natural pesticides
Position and water plants
Take photos for planting diary
Entry for the planting diary
Discuss gardening skills
Make natural pesticides
Apply natural pesticides in their plants
Position and water plants
Take photos for planting diary
Entry for the planting diary

Acquire information on
gardening activities

38

 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 949958

Demonstrate and return


demonstration of gardening
skills

Gardening skills reinforced


Complete planting diary
Evaluate the gardening
program

951

MMY Tse

Procedure
Demographic data, activities of daily living and psychological
parameters for participants that fit the inclusion criteria were
collected from the four nursing homes (two randomised as
experimental groups and the other two as control groups).
Older people from the experimental groups were invited to
join the eight week indoor gardening programme, while older
people in the other two nursing homes were treated as the
control groups: they received regular care and visits each
week, but not the eight week indoor gardening programme.
Posttest measures were collected on the completion of the
eight week indoor gardening programme for all participants
and participants of the experimental groups were invited for
an interview regarding their experience of the programme.
Participants in the experimental groups were invited to
attend an interview conducted by the researcher at the end of
the eight week indoor gardening programme. The interviews
were conducted in the function rooms of the nursing homes.
Interview lasted from 1015 minutes. To create a warm and
safe atmosphere, some small talk was initiated before
proceeding to ask the participants about the gardening
experience.

Measures
Demographic data, including age, gender, educational level,
financial situation, length of stay in nursing homes and
gardening experience were collected. Also, measures of life
satisfaction (assessed by the Life Satisfaction IndexA Form),
loneliness (assessed using the Revised UCLA Loneliness
Scale), the social network situation (assessed by the Lubben
Social Network Scale) and activities of daily living (assessed
by the Modified Barthel Index) were used before and after the
eight-week indoor gardening programme for all participants
in the experimental and control groups.
The Life Satisfaction IndexA form scale consists of 18
questions related to five different components: zest, resolution and fortitude, congruence between desired and achieved
goals, positive self-concept and mood tone. Items scored 1
point for agree and 0 for disagree. Reverse scoring appropriate items provided a range of 018 scores, with the highest
scores indicating the greatest satisfaction. A Chinese version
of the Life Satisfaction Index-A form was used, with the
Cronbachs alpha 07 for reliability and split half value 062
for internal consistency (Chi & Boey 1992).
The Revised UCLA Loneliness Scale is a standard scale for
measurement of loneliness (Russell 1996). In version 3, there
are 20 items, including nine positively worded items and 11
negatively worded items. Interviewees are asked to rate how
952

frequently they feel as described, from never to often. Each


of the 20 items is rated on a scale of 1 (never), 2 (rarely), 3
(sometimes) and 4 (often). After reverse scoring appropriate
items, loneliness scores were calculated by summing all items.
The range of possible scores was 2080, with higher scores
signifying greater loneliness. Scores between 3040 are
considered a normal experience of loneliness, while scores
above 60 indicate that a person is experiencing severe
loneliness. Reliability testing indicates that the internal
consistency of this scale is Cronbachs alpha ranging from
089094 and the test-retest reliability is 073. A Chinese
version of the Revised UCLA Loneliness Scale was used
(Chou et al. 2005).
The Lubben Social Network Scale (LSNS) includes 10
items, of which three deal with family relationships (size of
active family network, size of intimate family network and
frequency of contact with a family member), another three
deal with relationships with friends and the remaining four
items focus on interdependent relationships, which is having
confidence and being confident. Each item scores from 05.
The total LSNS score ranges from 050 (Lubben 1998) and
scores below 20 indicate a limited social network. The
Cronbachs alpha is 080. The LSNS scale has been widely
used in studies on the older Hong Kong Chinese population
(Chou & Chi 1999, 2001).
The Modified Barthel Index assesses the self-care functional ability of participants, testing 10 items, such as feeding,
grooming, toileting, ambulation and bathing. The score
varies from item to item and the maximum total score is
100, indicating total independence. The interrater reliability
is greater than 095 and the test-retest reliability is 089
(Bowling 2005). A Chinese version of the Modified Barthel
Index was used (Leung et al. 2007).

Data analysis
Several statistical methods were used in data analysis.
Descriptive statistical analysis of the quantitative data was
conducted using the Statistical Package for the Social Sciences
(SPSS), version 15, 2006. The chi-square and MannWhitney
U-tests were employed to determine any differences in the
experimental and control groups, while the Wilcoxon Signed
Rank Test was used to examine differences between experimental groups. Spearmans Rho Correlations were used to
measure the relationships of net improvement in life satisfaction, loneliness and socialisation with age, educational level
and prior experience in gardening; p<005 was considered
statistically significant. Interviews regarding the experiences
of the gardening programme were audio-taped and transcribed verbatim. The transcribed text was analysed by

 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 949958

Original article

Indoor gardening program

qualitative content analysis (Berg 2001). The transcribed


interviews were read repeatedly to obtain an overall understanding of the data. Sentences or parts of sentences were
identified as meaningful units in each interview text. The
meaningful units were then categorised into themes. Themes
were compared and discussed to establish the credibility of
the interpretation. Data were organised into gardening
experience-related themes as follows: feeling of pleasure,
happiness and responsibility; engaging in social activity;
increased physical activity.

Results

of the participants were female (45 female and eight male).


The ages ranged from 6595 years, with the median age
ranging from 8089 years. The mean age was 85 years for
the experimental groups and 83 years for the control
groups. Besides, over 70% in both groups were widows
and over 50% had received no formal education. Prior
gardening experience was found to be low, with around
40% of participants in the experimental groups having no
such experience at all, while 70% of participants in the
control groups had no prior gardening experience. No
significant differences were found in any of the demographic characteristics between older people in the experimental and control groups (p < 005).

Demographic data
There were 53 older people who participated in the study,
with 26 older people in the experimental groups (in two
nursing homes, as Experiment 1 and Experiment 2) and 27
in the control groups (in two nursing homes, as Control 1
and Control 2). Table 2 shows the demographic data. Most

Activities of daily living and psychological parameters


of older people
Baseline (week 1) for experimental and control groups
There were no significant differences in the activities of daily
living and psychological parameters of participants in the two

Table 2 Demographic data: experimental and control group

Gender*
Female
Male
Age
Mean SD
Range
Marital status*
Single
Married
Divorced
Widowed
Education level*
No formal education
Old-style private school
Primary school
Secondary school
Financial status*
Old-age allowance
Supported by family
Self-support
Prior experience in
planting/gardening*
Yes
No

Experiment 1
(n = 11)

Experiment 2
(n = 15)

Experimental groups
(Experiment 1 +
Experiment 2)
(n = 26)

10
1

15
0

25
1

14
3

8573 377
8292

8487 614
7395

8523 (520)
7395

8374 812
6595

0
3
1
7

0
1
1
13

0
4
2
20

2
4
1
12

6
3
1
1

8
3
4
0

14
6
5
1

7
4
0

12
1
2

6
5

8
7

Control 1
(n = 19)

Control 2
(n = 8)

6
4

Control Groups
(Control 1 +
Control 2)
(n = 27)

p-value

20
7

0504

8300 (785)
6595

0094

0
1
0
7

2
5
1
19

0499

11
1
7
0

4
2
2
0

15
3
9
0

0361

19
5
2

12
6
1

4
4
0

16
10
1

0398

14
12

6
13

2
6

8
19

0181

8125 740
6588

*Chi-square test was used.


Independent t-test was used.
A p-value of < 005 was considered statistically significant.


 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 949958

953

a journey to grow them...

954

p-value*

415
233
280
239

1826
1156
4256
10711
100
060
007
100
678
316
261
285

1750
1138
4425
10713
257
198
261
232

1858
1163
4184
10716
796
324
818
556

1927
1173
4138
10719
010
062
008
020
1673 8.66
1209 3.42
3818 804
10909 202
713
320
756
688

Control group 2
n=8
Mean SD
Control group 1
n = 19
Mean SD
Experimental
group n = 26
Mean SD
Experimental
group 2 n = 11
Mean SD

*The MannWhitney U-test was used within the experimental groups (Experimental group 1 and Experimental group 2).
The MannWhitney U-test was used within the control groups (Control group 1 and Control group 2).

The MannWhitney U-test was used for the experimental groups vs. control group.
A p-value of <005 was considered statistically significant.

such a pleasurable experienceeach daylike it was daily work and

Participant A: I am so happy.when growing the plantsand it is

2113
1147
4337
10580

Feelings of pleasure, happiness, and responsibility


Feelings of pleasure and happiness were expressed by the
majority of participants. They were happy to be involved in
the care of their plants, which gave them pleasure in the
planting journey. Also, they felt a responsibility to care for
their plants, to water them and to put them in the sun for
exposure to sunlight:

Experimental
group 1 n = 15
Mean SD

Gardening experience-related themes: feeling of pleasure,


happiness and responsibility; engaging in social activity;
increased physical activity
Their general impression of the gardening experience was
very positive as stated by participants in the interviews. They
included feelings of pleasure, happiness, responsibility,
engaging in social activity and an increased level of physical
activity.

Table 3 Comparison of experimental groups and control groups: baseline (week 1)

Net improvement and correlations of psychological


parameters
Table 6 shows net improvements in socialisation, life satisfaction and loneliness, which showed no significant correlation with age, educational level, financial situation and prior
experience in gardening as shown in Table 7 (p>005). As
such, age, educational level, financial situation and prior
experience in gardening did not seem to be related to
increases in psychological parameters for participants in the
present study.

p-value

Postintervention (week 8) for experimental and control


groups
There were significant improvements in all psychological
parameters for the experimental groups postintervention (in
week 8) compared with the baseline (week 1) (p<005)
(Tables 4 and 5), but no such improvements for the control
groups. As such, there were significant increases in life satisfaction and socialisation and reductions in loneliness for the
experimental groups. However, there were no changes in
activities of daily living in both groups at the postintervention
time (p>005).

Social network
Life satisfaction
Loneliness
ADL

Control group
n = 27
Mean SD

p-value

experimental and two control groups (p < 005), or between


the two experimental and two control groups (p<005) at the
baseline (week 1) (Table 3). As such, both groups were found
to be identical in their perceptions of life satisfaction,
loneliness, socialisation and engaging in activities of daily
living.

077
039
032
006

MMY Tse

 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 949958

Indoor gardening program

000*
000*
000*
006

itputting them in the sun

416
225
298
239

Participant C: for sure, I got great pleasure from the gardening

programme. I am happy I could watch my plants growing


everyday

1833
1167
4244
10711
094
068
007
100
1750
1138
4425
10713

Engaging in social activity


The indoor gardening programme gave the participants
chances to engage in social activity, as well as sharing
knowledge and skills with each other in the care of their
plants. Examples include making natural pesticides and
applying them to their plants and various positions and rotation of the plants to receive maximum exposure to sunlight:

Participant 1: I thought gardening .meant growing plants and


*The MannWhitney U-test was used within the experimental groups (Experimental group 1 and Experimental group 2).
The MannWhitney U-test was used within the control groups (Control group 1 and Control group 2).

The MannWhitney U-test was used for the experimental group vs. the control group.
A p-value of <005 was considered statistically significant.

chatting to others.a place of social interaction between my

258
184
285
232

1868
1179
4168
10716
669
171
754
556

2477
1573
3546
10719
045
091
038
020
549
207
727
202

2382
1555
3400
10909
756
146
780
688

2547
1587
3653
10580
Social network
Life satisfaction
Loneliness
ADL

p-value*

sense of responsibility to care for my plants and, wellI could do

678
316
261
285

p-value
Control
group 1 n = 19
Mean SD
Experimental
group n = 26
Mean SD
Experimental
group 2 n = 11
Mean SD
Experimental
group 1 n = 15
Mean SD

Table 4 Comparison of experimental groups and control groups: postintervention (week 8)

Participant B: it was something happy and pleasurable.I have a

Control
group 2 n = 8
Mean SD

Control
group n = 27
Mean SD

p-value

Original article

neighbours
Participant 2: I was no longer alone; now I had become a team member
in this gardening activityI met new friends and we talked
Participant 3: we shared our methods for making natural
pesticidessee, all are natural and there is no wastageand applying
them to our plants...
Participant 4: ...There are plenty of topics, such as rotation and
positioning of our plants; it is important for them to be exposed to as
much sunlight as possible; this is good for their growth

Increased physical activity


Most of the participants stated that they had increased their
level of physical activity in terms of more hand movement in
transferring the seedlings into bigger pots, positioning the
plants, more walking exercise in carrying their plants from
the hallway to the canteen and function room and vice versa,
where there are windows to maximise the sunlight exposure
in the daytime:
Participant A: I need to use both hands to hold the seedlings, they are
so small and so fragileand I transfer those seedlings into a bigger
pot
Participant B: I have to move my pots frequently to make sure they
receive more sunlight; yes, I move them along, following the sunlight
Participant C: I walk more often, I need to water my plants.
Participant D: I was more motivated to move aroundto exercise
more with the gardening thing

Discussion
The present study demonstrated the therapeutic effects of a
gardening programme in enhancing life satisfaction and social

 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 949958

955

MMY Tse
Table 5 Comparison of experimental groups and control groups: baseline (week 1) vs. postintervention (week 8)
Control Groups n = 27

Experimental Groups n = 26

Social network
Life satisfaction
Loneliness
ADL

Baseline (Week 1)
Mean SD

Postintervention
(Week 8)
Mean SD

1927
1173
4138
10719

2477
1573
3546
10719

798
324
818
556

669
171
754
556

p-value

Baseline (Week 1)
Mean SD

Postintervention
(Week 8)
Mean SD

p-value

000*
000*
000*
100

1826
1156
4256
10711

1833
1167
4244
10711

016
008
008
100

415
233
280
239

416
225
298
239

*A p-value of <005 was considered statistically significant.



The MannWhitney U-test was used.

Range of Improvement
Instruments (minimum and
maximum of scale)

Net improvement
(Mean SD)

Baseline
(week 1)

Postintervention
(week 8)

Social network (050)


Life satisfaction (018)
Loneliness (2080)
ADL (0110)

+6.12
+400
558
0

537
315
2557
92110

1238
1018
2449
92110

391
235
559
000

networking, reducing loneliness and increasing activities of


daily living among older people living in nursing homes.
It is worrying to find that participants in both the
experimental and control groups had a low social network
score and a moderately high score in loneliness at the
baseline. The Lubben Social Network Scale was 19 for the
experimental groups and 18 for the control groups, which
is considered to be a limited social network in terms of
family-and-friends relationships and interdependent relationships. The loneliness scores of 41 and 43 among the
experimental and control groups also indicate experiences
of loneliness as well. These findings were consistent with
the literature suggesting that residents in nursing homes
experienced relational losses including loss of spouse,
relatives and friends; and that these losses may lead to
social isolation and loneliness (Drageset 2004). As such,
nursing home residents are found to be socially isolated
and feeling very lonely (Sim & Leung 2000, Lee et al.
2002).
Social interaction or the ability to relate to others is one of
the basic needs of all human beings and continues to be
critical to the well-being of older people (Carstensen 1991).
The importance of social relationships is considered in
Maslows hierarchy of needs, which places the human need
for affiliation second only to survival and safety (Maslow
1954). To maintain functional and mental health, therapeutic
care and activities are highly indicated for frail nursing home
residents.
956

Table 6 Net improvement of physical


and psychological parameters upon
completion of the gardening programme

Table 7 Relation of net improvement of psychological parameters,


and age, educational level, financial situation and prior experience in
gardening
Spearman
correlation
coefficient
Net improvement in socialisation
Age
Educational level
Financial situation
Prior experience in gardening (years)
Net improvement in life satisfaction
Age
Education level
Financial situation
Prior experience in gardening (years)
Net improvement in loneliness
Age
Educational level
Financial situation
Prior experience in gardening (years)

Significance
(two-tailed)

0308
0065
0191
0255

0126
0754
0351
0209

0114
0147
0179
0212

0578
0473
0382
0298

0027
0031
0027
0349

0894
0879
0894
0081

The net improvement in socialisation, life satisfaction, loneliness was


correlated by Spearman correlation coefficient.
A p-value of <005 was considered statistically significant.

Older adults are found to live longer and respond better to


healthcare interventions when they have social support and
relate closely with their care providers and their fellow older
people (Kiely et al. 2000). Participants in the present study

 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 19, 949958

Original article

described the opportunities created via gardening activities in


terms of socialising and sharing with each other in caring for
their plants in the nursing home environment. The gardening
activities also provided a sense of responsibility in the daily
care of their plants.
Good mental health means normal mental status without
disease or disorder, enabling the older individual to think and
manage him/herself while interacting comfortably with others (Lassey & Lassey 2001). In the absence of disorder, our
general mental ability continues throughout life, despite the
fact that advancing in age does lead to deterioration of
sensory and cognition function to some extent. Mental health
is thus one of the keys to optimal ageing (Porello et al. 1995,
Lassey & Lassey 2001). Our overall mental capacity is
partially structured by genetic factors. The brain has the
capacity to compensate for minor loss of neurons. Older
people can maintain their mental health and overall mental
ability by effective socialisation, education and other forms of
planned activities and training (Cotman 1990, Scott 1995).
It is a concern when more than 50% of older people living
in nursing homes suffer from some form of minor or major
mental disorder (Vaczek 1994). The findings of the present
study at the baseline illustrated a situation of poor social
network and loneliness among older people living in nursing
homes and such people are more prone to mental issues when
no further action is taken in a timely fashion. The indoor
gardening programme is, therefore, an appropriate activity to
enhance mental health and overall mental ability for older
people living in nursing homes.
We found no difference in improvements in socialisation,
life satisfaction and loneliness with age, educational
level, financial situation and prior experience in gardening.
These suggest that the current study has broad potential
applications. Indoor gardening programmes may be effective
in enhancing socialisation, life satisfaction and loneliness
regardless of age, educational level, financial situation and
the presence or absence of prior experience in gardening.
It was interesting to find that there was no change in
physical activity level for participants in either group.
Activities of daily living are basic to daily life, including
bathing, dressing, transferring from bed to chair, toileting
and continence and feeding. One possible reason might be
that participants had a high level of activities of daily living at
the baseline for both groups, thus no changes were found in
the Barthel Index. However, the participants did express an
increase in level of physical activity, including transferring the
pots frequently to capture the sunlight, moving around and
exercising more.
Successful ageing is regarded as not only physical and
functional health, but also high cognitive functioning and

Indoor gardening program

active involvement in society (Rowe & Kahn 1997). The


sample size of 53 participants constitutes a limitation in
this study. In addition, data including medical condition
and the presence of chronic illness are also needed in
further studies exploring the effects of gardening experience on older people. In conclusion, the present study
demonstrates the therapeutic effects of an indoor gardening programme. Findings provide evidence for the
inclusion of an indoor gardening programme in nursing
home care practice with older people.

Relevance to clinical practice


For many older people, living in a nursing home is related
to a reduction in physical activity, lack of stimulation,
reduced socialisation with family and community members
and loneliness (DAmico-Panomeritakis & Sommer 1999).
It is noted that people with good health habits live longer
and healthier, reducing their chances of having to rely
on the medical system (Hong Kong Policy Research
Institute Ltd 2006). As such, indoor gardening programmes
could be a good form of therapeutic care to enhance
life satisfaction and social networks, reduce loneliness
and increase physical activity for older people living in
nursing homes. To meet the needs of frail nursing home
residents and to promote psychological well-being, an
indoor gardening programme is highly recommended in
the nursing home environment.

Acknowledgements
The author would like to thank all the study participants. The
Hong Kong Polytechnic University supported the study. No
financial arrangements had been made with any organisation
or company at the time of this papers submission.

Contributions
Study design, data collection and analysis and manuscript
preparation: MYMT.

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