GARDENS FOR PEOPLE WITH DEMENTIA
How can we enrich the quality of everyday life for people with dementia through sensory experience?
After the interviews, I started doing more in-depth research into the specifics of designing the outdoor space for people with dementia. I stumbled upon various guidelines and articles that helped me better understand everyday struggles of people living with dementia as well as the challenges of providing proper care for them.
Many experts support the long-held view that our natural surroundings can have a profound effect on people’s health and well-being. Outdoor environments are therefore being increasingly re-introduced as an important support tool in the care and behaviour management, contributing to the quality of life of people with dementia. Gardens created specifically to support people with dementia provide an opportunity for therapeutic activities designed to maximise retained cognitive and physical abilities, and lessen the confusion and agitation often associated with the condition.
There are quite a few guidelines regarding garden design for people with dementia. The space should be designed as sustainably as possible, with undemanding, self-sufficient plants and the collection of rainwater and compost, which can be used for watering and fertilizing. The garden design should include clear markings for entrances and exits, in different colours for different parts of the garden, and allow the staff to have constant control over what is happening. The paths should be slip resistant, wide enough for wheelchairs to pass one another easily and shaped in circles, as this encourages walking, reduces confusion and gives the impression of a larger space. For additional orientation, various recognizable and colourful objects can be used. A garden that enables users to orient themselves through visual cues gives the residents the opportunity to gain a sense of control and in turn self-confidence. Along the paths, there should be handrails, adequate lighting and a place to rest with suitable seats and shade.
People with early onset of dementia still have the energy and desire to remain active and involved in the world around them. Throughout our lives, we develop activities and interests, hobbies, skills and talents that give our life structure and meaning, and provide a sense of worth. We should therefore encourage various activities in the garden and attract people to interact with nature on a daily basis. One way to achieve this is to build raised garden beds, which make gardening, an activity familiar to most residents, easier for the elderly and people in wheelchairs. It is always good to involve animals as research shows they have many therapeutic effects on people with dementia. Apart from scheduled dog visits, ponds and bird feeders can also prove beneficial.
With various safe, fragrant plants and water fountains we can add sensory stimulation to the garden. It is good to use some familiar objects, such as an old wheelbarrow planted with flowers. The garden is also a place to socialize, so we can include several areas in the shade with tables and chairs, where various connecting activities can take place in spring and summer.
Two of the best examples of such gardens can be seen in the pictures below: the award-winning gardens Sensory Dementia Garden in Westcliff-on-Sea, Essex and William E. Carter School Sensory Garden (although made for people with special needs, it follows the guidelines that are similar to those for dementia gardens).
Examples of gardens for people with dementia.
After reviewing the literature on designing gardens for people with dementia, I started the process of designing the two inner gardens in the new care home. Since both gardens can be entered from all sides, I suggested circular paths around the garden, surrounded by lower mixed hedges on each side, so that the residents could enjoy the view from their rooms. I proposed the use of evergreen plants to encourage outings also in the winter months, and soft illumination throughout the entire garden to create a pleasant atmosphere at night and to avoid any fear and confusion that could be caused by shadows in the dark.
Ideas for the gardens.
I suggested the use of a special synthetic surfacing, Tartan, for the intertwining paths in the garden, as it is pleasant to walk on, slip resistant, available in several colours and it can mitigate falls. Along all paths, there should be illuminated handrails for better orientation at dusk and some benches so that one can take a rest during walking.
I also proposed several raised garden beds with benches and trees to provide shade around them. Next to the sensory room, I imagined a smaller pond with colourful fish, which would offer the residents relaxing activities of observing and feeding the fish. Another idea was to put various bird feeders and birdhouses around the garden.
Garden floor plan.
I presented the garden layouts to the director, partners and the landscape architect, and they were well received. Everyone liked the idea of including animals, circular paths, and sensory and evergreen plants. They stressed the importance of wide walkways so that two wheelchairs could pass one another with ease. After taking the safety and maintenance concerns into consideration, we also decided to go with the fountain instead of the pond but include a big aquarium inside the residence facility. After adjusting the plans to the exact measurements, I made some changes to the layout because after the widening of the paths there were not enough green surfaces left. When we showed a rough 3D render to the other advisors on the project, they were really pleased and approved the garden layout plan. The next step will be collaboration with horticulture experts to include the right plants (in many respects) for the fairy-tale garden we hope to build for people with dementia.
Cochrane, T. G. (2010) Gardens that care: planning outdoor environments for people with dementia. Australia: Alzheimer’s Australia SA.
Hernandez, R. O. (2007) Effects of therapeutic gardens in special care units for people with dementia: Two case studies. Journal of Housing for the Elderly, 21(1-2), 117-152.
Mitchell, L., and Burton, E. (2006) Neighbourhoods for life: Designing dementia‐friendly outdoor environments. Quality in Ageing and Older Adults.
Whear, R., Coon, J. T., Bethel, A., Abbott, R., Stein, K. and Garside, R. (2014) What is the impact of using outdoor spaces such as gardens on the physical and mental well-being of those with dementia? A systematic review of quantitative and qualitative evidence. Journal of the American Medical Directors Association, 15(10), 697-705.
White, P. C., Wyatt, J., Chalfont, G., Bland, J. M., Neale, C., Trepel, D. and Graham, H. (2018) Exposure to nature gardens has time-dependent associations with mood improvements for people with mid-and late-stage dementia: Innovative practice. Dementia, 17(5), 627-634.
Cube 1994. (2020) BALI Award Winning Sensory Dementia Garden – Cube 1994. Available at: <https://www.cube1994.com/portfolio/bali-award-winning-sensory-dementia-garden/> (Accessed 3 August 2020).
Db-la.com. (2020) W.E. Carter School Sensory Garden. Available at: <http://www.db-la.com/w.e.%20carter%20school.htm> (Accessed 5 August 2020).
Wheeler, K. (2014) Wooden Wheelbarrow Planter. Available at: <https://fineartamerica.com/featured/wooden-wheelbarrow-planter-dr-keith-wheelerscience-photo-library.html?product=canvas-print>(Accessed 7 August 2020).