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Therapeutic horticulture as a potential tool of preventive geriatric medicine improving health, well-being and life quality – A systematic review Cover

Therapeutic horticulture as a potential tool of preventive geriatric medicine improving health, well-being and life quality – A systematic review

Open Access
|May 2022

Figures & Tables

Figure 1

Diagram showing combinations of terms and keywords used during the search process.
Diagram showing combinations of terms and keywords used during the search process.

Figure 2

Flow diagram of literature search and study selection process – diagram showing process of literature search.
Flow diagram of literature search and study selection process – diagram showing process of literature search.

Figure 3

Studies on the topic published in the years 2010–2021 – graph showing the number of studies on the topic published in the years 2010–2021.
Studies on the topic published in the years 2010–2021 – graph showing the number of studies on the topic published in the years 2010–2021.

Figure 4

Studies per country of performance – graph showing the number of studies on the topic published per country of performance.
Studies per country of performance – graph showing the number of studies on the topic published per country of performance.

The type of tests and measurements used in the analysed studies_

Test nameStudies that applied the test/measurement (%)Publications in which this type of test/measurement was used (according to Table 2)*
Physiological and functional testsDepression, anxiety and stressGDS – Geriatric Depression Scale113, 8, 11, 14
SAS – Zung Self-Rating Anxiety Scale612, 22
SDS – Zung Self-Rating Depression Scale612, 22
STAI – The State-Trait Anxiety Inventory332
PSS – Perceived Stress Scale335

Well-being, life satisfaction, quality of lifeLSI – Life Satisfaction Index623, 31
MLS – Meaning of Life Scale328
PWI – Personal Well-being Index38
QoL – Quality of Life311
SF-36 – Self-rated Health and Quality of Life919, 20, 21
SPWB – Ryff’s Scales of Psychological Well-Being312
SWL – Satisfaction with Life Scale312
WEMWBS – Warwick Edinburgh Mental Well-being Scale335
WHO-5 – World Health Organization Well-Being Index317

Cognitive functionsCDR – The Clinical Dementia Rating322
MMSE – Mini-Mental State Examination141, 11, 14, 16, 17, 22
MoCA – The Montreal Cognitive Assessment612, 27
VAS – Visual Analogue Scale622, 29

Socio-psychologicalFS – Friendship Scale912, 17, 22
IIS – Interpersonal Intimacy Scale328
LSNS – Lubben Social Network Scale98, 23, 31
PROS – Positive Relations with Others Sub-Scale612, 13
SES – Social Engagement Scale38
UCLA – UCLA Loneliness Scale63, 23

Happiness and attitudes to yourselfAAQ – Attitudes to Ageing Questionnaire114, 19, 20, 21
CHI – Chinese Happiness Inventory328
CN – Connectedness to Nature Scale335
HHI – Herth Hope Index34
POMS – Profile of Mood States67, 24
PRS – The Perceived Restorativeness Scale329
PSRS – The Positive Self-Respect Scale36
RSES – Rosenberg Self-Esteem Scale317
SHS – Subjective Happiness Scale38

Brain activity and emotionsBrain Nerve Growth Factors (BDNF, VEGF, PDGF)615, 16
Brain mapping (EEG and QEEG)97, 25, 32
PSQI – Pittsburgh Sleep Quality Index322
VibraImage 8 PRO39

Circulatory systemBlood pressure624, 32
HRV – heart rate variability624, 35
Pulse rate324

Endocrine system and biomarkersSAA – salivary amylase activity324
Biomarkers (IL-1, IL-6, sgp-130, CXCL12/SDF-1, CCL-5/RANTES, hs-CRP, cortisol, DHEA)912, 13, 26

Metabolic activityMetabolomics Study316
MNA – Mini-Nutritional Assessment38

Body compositionBMI614, 35
Fat mass614, 16
Height614, 16
Lean mass614, 16
Per cent fat316
Waist–hip ratio314
Weight614, 1

Fitness and self-efficiencyADL-20 – The Activities of Daily Living Scale311
BI – Modified Barthel Index118, 22, 23, 28
FFI – The Fried Frailty Index the General Self-Efficacy Scale38
IADL – Lawton’s Instrumental Activities of Daily Living scale38
IPAQ-SF – The International Physical Activity Questionnaire-Short Form614, 16
PASE – The Physical Activity Scale for the Elderly331
TFI – The Tilburg Scale35
Scot-PASQ – Scottish Physical Activity Screening Question333
SFT – The Senior Fitness Test614, 16
Side-by-side/semitandem/full-tandem balance tests32
The Cup Stacking Test34
Timed walk test32
VI – Vitality index311
VIA-IS – VIA Inventory of Strengths36

Self-developed questionnaires or interviewsDemographic information questions93, 4, 26
Focus-group interviews92, 34, 35
Gardening activity inventory919, 20, 21
Garden questionnaire1117, 19, 20, 21
Individual interviews315, 10, 17, 19, 20, 21, 27, 30, 31, 33, 34

The type of people–plant interventions used in the analysed studies_

Interaction with clientActivity settingType of activityPercentage of studies that applied this interventionPublications in which this type of activity was used (according to Table 2)
Active*OutdoorGardenGardening (plant care, pruning, watering, weeding, etc.)402, 5, 8, 12, 13, 14, 15, 16, 18, 19, 20, 21, 22, 26
Garden design and planning1114, 16, 17, 27
Garden parties93, 9, 14, 16
ParkEnvironmental volunteering program331

IndoorCommon room, workshop, atelierIndoor gardening (seeding, propagating, transplanting, etc.)291, 3, 4, 7, 11, 17, 23, 25, 26, 28
Plant-related art (creating flower pockets, grass dolls, nature art collage, etc.)233, 6, 9, 12, 14, 22, 24, 27
Plant-related items (making soaps, teas, potpourri, etc.)144, 17, 22, 27, 28

Passive**OutdoorGardenFloristry classes231, 3, 4, 6, 7, 9, 22, 27
Garden visits (educational or sensory strolls in gardens)1113, 26, 29, 34
ParkGreen exercise335
Walking group333

IndoorCommon room, workshop, atelierPot plant visual stimulation630, 32

Main differences between TG, HT and TH_

TGHTTH
Client engagementActive and/or passive interaction with a gardenHorticultural-related activitiesActive and/or passive horticultural-related activities
ParticipantsAnyone who feels they may benefit from the involvementIdentified disability, illness or life circumstance requiring servicesIdentified disability, illness or life circumstance requiring services
FacilitatorProfessional or non-professional with training in horticultureHorticultural therapistHorticultural therapist or professional with training in horticulture
Aims and outcomesNot documented, generalDocumented, specific (an agreed treatment, rehabilitation, or vocational plan)Not documented, specific

Characteristics of included studies_

AuthorCountryParticipants (intervention group, control group)Study design and treatment regimenOutcome measurementsResults
Active people–plant interactions

1.Bassi et al. (2018)Italy11 residents of a nursing home (both occupational activities and HTCrossover study with a baseline measureTwo cycles, 6 weeks × 1 × 60 min eachPsychological testsIncrease of cognitive and motivational variables, during both activities, and improved self-satisfaction in comparison with occupational therapy treatment. Horticulture was recognised as more challenging than occupational therapy treatment
2.Chen and Janke (2012)USA3237 seniors (clients gardeners, control nongardeners)At least 1 h per weekPhysiological and functional testsSelf-reported measure of health statusSignificantly better balance and improved gait were reported by gardeners, they also had fewer functional limitations and chronic conditions than nongardenersFalls in the past 2 years were rarer in the gardeners group than in the nongardeners group
3.Chen and Ji (2015)Taiwan10 residents of a nursing home (clients with indoor HT program)Preliminary study, combined quantitative and qualitative design10 weeks × 1 × 90 minBackground data sheetPsychological testsHT program resulted in encouragement of social connections and companionship, hope, anticipation and a sense of achievement. Levels of depression and loneliness significantly increased
4.Chu et al. (2021)Taiwan88 residents of nursing homes (clients horticultural activities, control leisure activities)Quasi-experimental, nonequivalent pretest-posttest control group design8 weeks × 1 × 120 min eachSociodemographic questionerPsychological testsPhysiological and functional tests‘Attitudes toward ageing’ and ‘sense of hope’ increased after the intervention. The experimental group significantly improved the time required to complete the cup stacking test
5.Freeman et al. (2019)New Zealand72 seniorsIn-depth, qualitative interviewsNot statedIndividual interviewsOlder adults highly value the direct engagement with nature, even when limited by health
6.Han (2017)Korea40 female members of I Church (clients with HT program, control no intervention)Quasi-experimental, nonequivalent pretest-posttest control group design8 weeks × 1 × 90–120 minPsychological testsPhysiological and functional testsSignificant pre-post improvement in all sub-factors of self-respect and in all sub-factors of personality and talent in the experimental group
7.Kim et al. (2021)South Korea58 seniors (both horticultural and non-horticultural activities)Cross-over experimental design1 day × 8 × 2 minPsychological testsPhysiological and functional testsThe results of the POMS showed that during horticultural activities the total mood disorder score was lowered. Brain activity of older adults may be increased by activities such as washing leaves, transplanting, and reading news and that has a positive effect on their cognitive function
8.Lai et al. (2018)China111 residents of nursing homes (clients with HT program, control no intervention)RCT8 weeks × 1 × 60 minPsychological testsPhysiological and functional testsSignificant increase in the subjective happiness after the HT program
9.Lee (2019)Korea58 residents of a nursing home (clients with HT program, control no intervention)Quasi-experimental, pretest-posttest control group design10 weeks × 1 × 50 minPhysiological and functional testsSignificant pre-post decrease in the positive domain in the control group and non-significant in the experimental groupSignificant pre-post decrease in mean score of neuroticism and physiological domain in the experimental group
10.Lo et al. (2019)China22 residents of nursing homes (clients with HT program)RCT with a qualitative descriptive approach8 weeks × 1 × 60 minIndividual semi-structured interviewsClients of nursing homes saw HT as an enjoyable activity and a good pastime, which made them happier.Horticultural activities resulted in socialisation among the residents
11.Masuya et al. (2014)Japan18 residents of a nursing home (clients with HT program, control no intervention)Quasi-experimental, nonequivalent pretest-posttest control group design6 weeks × 1 × 30–40 minPsychological testsPhysiological and functional testsSignificant improvement in satisfaction with life and a significant decrease in GDS score after the interventionNo significant pre-post change in vitality Index, Activities of Daily Living Scale, and MMSE scores in both groups
12.Ng et al. (2018)Singapore59 seniors recruited from the neighbourhood (clients with HT program, control no intervention)RCTStage 13 months × 1 × 60 min Stage 23 months × once a month × 60 minPhysiological and functional testsPsychological testsA significant reduction in plasma IL-6 level in the HT intervention groupSocial connectedness significantly improved in the HT groupSignificant reductions in plasma CXCL12 (SDF-1), CXCL5 (RANTES) and BDNF in the control group
13.Ng et al. (2021)Singapore59 seniors (clients HT intervention, control waitlist)Secondary analysis of an RCTStage 13 months × 1 × 60 minStage 23 months × once a month × 60 minPsychological testsPhysiological and functional testsSocial connectedness significantly increased and Log10 IL-6 levels significantly decreased after HT.
14.Park et al. (2016)South Korea50 seniors recruited from senior community centres (clients with gardening intervention, control no intervention)Quasi-experimental, nonequivalent pretest-posttest control group design3 months × 2 × 50 minPhysiological and functional testsSociality surveyPsychological testsSignificant pre-post improvement in hand dexterity, aerobic endurance, muscle mass, cognitive ability, and decreased waist circumference in the gardening group. Significant pre-post decrease in agility and muscle mass, and a significant increase in depression in the control group.
15.Park et al. (2019)South Korea41 seniors recruited from community and welfare centres (clients with gardening intervention)Quasi-experimental, one group pretest-posttest design1 day × 1 × 20 minPhysiological and functional testsSignificant increase in levels of PDGF and BDNF after the gardening activity
16.Park et al. (2020)South Korea40 seniors recruited from the senior welfare centre (clients with gardening intervention, control no intervention)Quasi-experimental, nonequivalent pretest-posttest control group design12 weeks × 2 × 60 minPhysiological and functional testsPsychological testsSignificant pre-post improvements in BDNF levels, hand dexterity, better cognitive ability and improvements in cognitive health in the gardening groupSignificantly higher scores in MMSE of the gardening group after the programNone of the groups showed significant differences in the pre-/post-scores of all SFT items
17.Perkins (2012)USA31 seniors recruited from independent, community-based, age-restricted residences (clients with HT program, control no intervention)Quasi-experimental, pretest-posttest control group design6 weeks × 1 × 90 minPsychological testsGarden Questionnaire developed by the investigatorSignificant variance in self-esteem and garden knowledge between the groupsNo significant differences in psychological well-being, garden experience, or social connectedness between the treatment group and the control groupMost helpful parts of classes were learning about herbs and their uses, growing and using herbs, participating in the class (the social aspect)
18.Robbins and Seibel (2019)USA27 older African AmericansIn-depth, qualitative interviewsNot statedIndividual interviewsGardening lay a part in the well-being of older adults.Plants and gardening practices provided perspectives on the transformations of social dimensions
19.Scott et al. (2014)Australia331 senior gardenersA self-administered surveyMedian time per week – 8 hGardening benefits questionnaireGardening activity inventoryPsychological testsParticipants felt that gardening was more than a casual leisure activity, they emphasised it as crucial to their psychological and physical wellbeingThey reported that gardening has numerous psychological, physiological and tangible benefits
20.Scott et al. (2016)Australia331 senior gardenersA self-administered surveyMedian time per week – 8 hGardening benefits questionnaireGardening activity inventoryPsychological testsLeisure gardening derived numerous benefits for the participants. Gardening was seen as a crucial activity to their well-being and to ageing positively
21.Scott et al. (2019)Australia331 senior gardenersA self-administered surveyMedian time per week – 8 hGardening benefits questionnaireGardening activity inventoryPsychological testsPositive ageing self-perceptions were mostly influenced by restoration and physical benefits of gardeningMore physical and social benefits were reported by gardening group members than non-members
22.Sia et al. (2020)Singapore47 seniors recruited from senior day care centres (clients with HT program)Experimental, one group pretest-posttest design24 weeks × 1 × 60 minPsychological testsPhysiological and functional testsSignificant increase in cognitive functions and mean happiness. Reduction in anxiety. Sustained psychological health and sleep patterns
23.Tse (2010)China53 residents of a nursing home (clients with indoor gardening program, control no intervention)Quasi-experimental, nonequivalent pretest-posttest control group design8 weeks × not statedPsychological testsPhysiological and functional testsLife satisfaction and social network significantly improved and perception of loneliness significantly decreased in the experimental group after the intervention
24.Tu et al. (2020)Taiwan27 seniors who attended Fooyin University Senior Citizens Learning Camp (clients with HT program)One group pretest-posttest design2 weeks × 2 × 60 minPhysiological and functional testsPsychological testsSignificantly lower SAA and pulse rate after activities Mood states significantly improved for Rocky Leaf Prints and Herb Tasting and Smelling
25.Widodo et al. (2019)Indonesia14 senior residents of Batu City (clients with the gardening program, control no intervention)Quasi-experimental, pretest-posttest control group design6 months × daily × not statedPhysiological and functional testsPre-post improvement in anxiety and stress levels in the experimental group (42.9%) and in the control group (28.6%)
26.Wong et al. (2021)Singapore59 seniors (clients HT intervention, control waitlist)RCTStage 13 months × 1 × 60 minStage 23 months × once a month × 60 minSociodemographic questionerPhysiological and functional testsReduction in the levels of biomarkers that indicates the extent of T-cell exhaustion and inflammation in older adults is associated with HT. Pre-post reduction of IL-6 levels
27.Wu et al. (2020)Taiwan17 seniors recruited from a community care centre for the elderly (clients with HT program)Quasi-experimental, one group pretest-posttest design12 weeks × 1 × 120 minPsychological testsSemi-structured interviewsImmediate and significant improvement in overall cognitive function after the HT program.Interviews revealed that: ‘the HT program was meaningful and encouraged the elderly to be engaged in the activities and recall the past, improved enjoyment and learning motivation and ensured new planting experience
28.Yao and Chen (2017)Taiwan85 senior residents of nursing homes (clients with HT program, control no intervention)Quasi-experimental, pretest-posttest control group design8 weeks × 1 × 60 minPsychological testsPhysiological and functional testsSignificant pre-post improvement in physical abilities, happiness, meaning of life, and interpersonal intimacy in the experimental group

Passive people–plant interactions

29.Dahlkvist et al. (2016)Sweden290 residents of nursing homes (self-motivated garden visits)Multi-level, cross-sectional, correlational design Not statedPsychological testsPositive and significant effect of greenery on self-perceived healthHealth appears to be affected by garden greenery by providing possibilities to experience the outdoor environment as interesting and encouraging and enhancing a sense of being away
30.Finlay et al. (2015)Canada141 community-dwelling older adults (everyday experiences with green spaces)In-depth, qualitative interviewsNot statedIndividual interviewsGreen and blue spaces have an influence on physical wellbeing (motivation for physical activity), mental wellbeing (sense of improvement, feelings of renewal, restoration, rejuvenation, relaxation and stress reduction) and social wellbeing (social interactions, multi-generation enjoyment)
31.Gagliardi et al. (2020)Italy19 seniors who joined the environmental volunteering and socialising activities in a city park program (park restoration and social activities)Quasi-experimental, one group pretest-posttest design1 year × 2 × depends on participantsPhysiological and functional testsPsychological testsIndividual interviewsVolunteers increased their weekly engagement in gardening activities and time spent performing voluntary work. They also cared for other people more and had better life satisfaction
32.Hassan et al. (2019)China50 women residents of a nursing care facility (clients with visual stimulation with a money plant, control visual stimulation without any plant)Quasi-experimental, pretest-posttest control group design2 days × 2 × 5 minPhysiological and functional testsPsychological testsSignificant pre-post decrease of systolic blood pressure and total state-trait anxiety scores in the experimental groupNo change in diastolic blood pressure between conditions.Variations in both high alpha and high beta brainwaves in the experimental group
33.Irvine et al. (2020)UK13 seniors recruited from Group Outdoor Health Walk Program (outdoor walks)Observational pretest–posttest study with convergent mixed methods design12 weeks × depends on the routePhysiological and functional testsPsychological tests Individual interviewsSelf-reported physical activity improved during the study. Participants experienced more positive emotions and felt they had more energyClinically relevant changes in experiencing vibrant senses, feeling energised, focused, joyful and calm, as well as sleeping well
34.Reynolds (2016)USA32 residents of facilities (independent living, assisted living, personal care) (garden use)A qualitative study of participant observations with behaviour mapping and individual and focus-group interviews, using a grounded theory methodologyDepends on participantsParticipant observationsIndividual interviewsHigh value for nature reported by all participants (essential to their well-being)Nature was valued as an affinity for life, and plants almost as people
35.Wood and Smyth (2020)UK45 healthy participants recruited from the University of the Third Age (Green exercise)Pilot study24 hPhysiological and functional testsPsychological testsNature exposure and Green Exercise in childhood significantly predicted nature exposure and Green Exercise in adulthoodCN was negatively linked to stress and positive linked to HRV during sleepHigher CN was correlated with less stress reactions and higher rate variability during sleep which both are indicators of health
DOI: https://doi.org/10.2478/fhort-2022-0008 | Journal eISSN: 2083-5965 | Journal ISSN: 0867-1761
Language: English
Page range: 85 - 104
Submitted on: Jan 12, 2022
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Accepted on: Mar 23, 2022
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Published on: May 13, 2022
In partnership with: Paradigm Publishing Services
Publication frequency: 2 issues per year

© 2022 Anna Heród, Bożena Szewczyk-Taranek, Bożena Pawłowska, published by Polish Society for Horticultural Sciences (PSHS)
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.