Author: Clare Johnson

Clare Johnson serves as the Horticultural Therapy Services Manager and Design Consultant at the Chicago Botanic Garden. She is responsible for the planning, supervision, and delivery of horticultural therapy services at sites throughout the greater Chicago area. Johnson also provides consultation to facilities planning therapeutic gardens. This includes systematically discerning the needs, uses, and stakeholders in the project and providing conceptual designs based on that process.

The Benefits of Outdoor Spaces for the Elderly

A well-designed outdoor space can do wonders for seniors and those with Alzheimer’s disease. But how do these gardens differ from other outdoor spaces and why are they so important?

Housing for the elderly has been provided in many western cities since the Middle Ages. Facilities such as independent living centers, skilled nursing homes, dementia or memory care units, and hospice facilities have traditionally included some form of outdoor space.

PHOTO: Book cover. — *The Role of the Outdoors in Residential Environments for Aging*, published in 2006.

The majority of the elderly (over 65) reside in their own home or with relatives. Whether in a facility or at a personal home, particular symptoms of decreased quality of life begin to show during these stages. These symptoms are often displayed in the form of boredom, helplessness, and loneliness. Fortunately, many, if not all of these symptoms can be improved with gardening and exposure to outdoor spaces.

The keys (and often the greatest challenges) to successful aging are to remain physically active and socially engaged, and to retain a sense of self. There are many measureable health outcomes for seniors and the outdoors. Even a short visit in a garden can lower blood pressure, improve vitamin D absorption, improve stability, and help with better sleep patterns.

Boredom can be remedied with sensory stimulation and interaction with nature. Nature can aid the feeling of helplessness with providing a space for temporary escape (actual or visual), and the feeling of loneliness can be decreased in a garden that provides multiple places for socialization.

The benefits are endless. So how do we make sure these wonderful gardens are implemented properly so that they will be used by seniors?

PHOTO: An elderly woman smelling a yellow rose and smiling. — A senior engages with colorful and inviting roses at Elm Tree Gardens in Lansdale, Pennsylvania.

For today, we’ll concentrate on four factors of design: The entrance and exit to the outdoor space, plant material, pathways and ease of accessibility (circuit and materials), and seating.

The entrance/exit to an outdoor space—the threshold—is perhaps the most important factor to consider when designing an outdoor space for the elderly, and this largely comes down to one single detail: the door. Doorways are high on the list of residential complaints. Often they’re hard to open, or locked. They don’t have windows and therefore inhibit visitors from viewing the garden (…what’s the weather like?). Perhaps the door has a lip that makes it difficult for seniors in wheelchairs to cross the threshold on their own.

Another factor involving the threshold is the comfort (or perceived comfort) when entering or exiting the garden. Creating a transition or “comfort zone” between the indoor and outdoor space is key. Aging eyes have difficulty adjusting from indoor light to outdoor sunlight. Providing shade at the entrance/exit in the form of an awning or patio will increase the transitional comfort.

This brings us to the next factor: plant material. I didn’t mention a pergola with draping vines as a possibility for the transition space. That’s because it’s a detail that is strongly discouraged in outdoor design for seniors. A pergola or draped plant material creates patterned shadows on the ground. This is referred to as “visual cliffing” in design. Seniors react to changes in paving color, or deep shadows on a path as if they were a change in depth. This may lead to stumbles, fear, and discomfort. Simply avoiding structures such as arbors or trellises will alleviate this issue.

Plant selection for the garden is fairly straightforward. Use a variety of trees, shrubs, flowers, and vines and place them where they can be touched and smelled. Aging eyes can see highly saturated colors—such as oranges, reds, and yellows—more easily than blues, purples, and greens. Also, certain plant material such as herbs and traditional shrubs (hydrangeas, roses, etc.) help to stimulate memory as they often bring deep-rooted and cherished memories to mind for those with Alzheimer’s disease.

Color choices are not just important when it comes to plant material, they’re also important for paving, our third factor. Since aging eyes have trouble with glare, use non-glare paving surfaces such as tinted concrete. Other satisfactory surfaces include rubberized asphalt and stabilized decomposed granite.

PHOTO: A brick garden path leads to a white gazebo in a circular garden. — A gazebo provides an easily accessible destination to garden visitors.

The pathway circuit is also pivotal. Creating interesting places to walk with shorter and longer loops, destinations points (such as a water fountain or gazebo), and changing vistas will encourage engagement and exercise. With these pathways, be sure to pay attention to safety. Pathways with edges or railings will ensure safety for wheelchair users or individuals with impaired sight.

It should be noted, however, that in a facility for those with Alzheimer’s disease, a destination point or wandering path should be adjusted so that its pathway circuit never takes an individual to a point where the entrance/exit is no longer visible. This may lead to the feeling of being “stuck” or agitated if confusion sets in. Not knowing which route to take or how to get back can be very stressful for someone with Alzheimer’s. Instead, create a series of large and small destinations and landmarks that will help users orient themselves in a space (flagpole, gazebo, group of chairs, etc.).

Lastly, think about seating. It is important to design different areas for seating to create options. Some may like an area to sit alone. Living with other people in a facility is a new experience for many residents and it can be stressful. A garden can provide a place for quiet contemplation. On the other side of the spectrum, there should also be places to sit with others. These spaces create socialization, either with visitors or among the residents.

PHOTO: A lush urban garden has raised beds which provide seating, and a riot of colorful plantings. — Lush planting, smooth pathways, and seating areas enhance the quality of the experience in—and use of—any garden.

Consider also the kind of seating to be provided. Wood, fabric, or hard plastic materials are preferred, as they are more comfortable than steel, aluminum, or concrete surfaces. When possible, provide seating with cushions to increase comfort. Using moveable seating is also very popular. Use of the overall space skyrockets when people of any age are able to move or manipulate their seat for optimal comfort and satisfaction. This enables garden users to feel in control, which may be lacking inside the building.

These factors as well as countless others help to create spaces that are inviting and engaging to the elderly. There are additional factors to consider in an outdoor space that relate to programmatic intentions on top of the physical design but we’ll visit those topics another day.

Outdoor spaces in facilities for the elderly and aging are immensely important. The next time you visit one, take a moment for a quick assessment. With these basic tips, everyone can be an expert and wonderful advocate for successful outdoor spaces and gardens for the elderly.

Gardening and Autism

Horticultural therapy has proven benefits for individuals with autism.

The integration of horticultural therapy and therapy gardens within health and human service agencies has grown exponentially in recent years. In senior centers, gardening and garden spaces are used to help with fine motor skills, socialization, and ambulatory movement. In veteran’s hospitals, gardening is used for exercise, vocational training, and education.

There is one population that, in my opinion, receives the most benefit from the incorporation of gardens and horticultural therapy in daily services. That population is found in the organizations, schools, institutions, and training centers that serve individuals on the autism spectrum.

PHOTO: Rimland horticultural therapy garden — Flowers like butterfly gaura (*Gaura lindheimeri)* can be observed with quiet fascination.

Autism spectrum disorder (ASD) and autism are general terms for a group of complex disorders of brain development. These disorders are characterized by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors.

In the spring and summer of 2013, I worked with two organizations and schools and led weekly horticultural therapy sessions in their outdoor gardens. We observed many benefits when engaging both children and adults on the autism spectrum. For today, I’ll discuss three primary benefits I observed: quiet fascination and stimuli reduction, the ability to follow direction, and tactile sensory integration.

The first benefit has to do with the physical garden space itself. I observed a sense of relief displayed by the participants when in the garden space. Gardens can serve as a welcome break from the classroom or facility environment, for clients and staff, and provide a space for “quiet fascination.”

Kaplan, Kaplan, and Ryan state that quiet fascination can “come from the setting itself, from the sound patterns, the motion, the intensity of forms and color” (69). An evaluation was designed at the beginning of the season and results demonstrated that 72 percent of participants were observed having slightly to significantly less anxiety when engaging in the garden and with horticultural therapy activities in comparison to other daily tasks.

Installing an edible garden with a client from Rimland non-for-profit organization — Installing an edible garden with a client from the nonprofit Rimland Services

The second benefit was the participant’s ability to follow directions with multiple steps. Individuals with autism spectrum have greater difficulty shifting attention from one task to another or changing routine. During horticultural therapy activities, participants would be asked to follow steps in order to complete the activity. For example, when planting the garden, instructions were to dig a hole, take the plant out of the plastic, place it in the soil, gently push the soil back around the base, and repeat. The hand-over-hand technique was often used to aid in the task and 77 percent of participants were observed being slightly to significantly more responsive to a multiple-step process and able to repeat without instruction.

The last benefit dealt with sensory integration with a focus on the tactile system. When engaging participants in garden activities, dysfunction in the tactile system prompted actions such as withdrawing when being touched or helped, and overall avoidance of getting one’s hands dirty. With assistance from facility staff, we worked with participants to slowly introduce the sensation of soil, plant material, and water to participants. Each week, we’d encourage participants to touch, rub, and smell numerous plants with interesting textures and aromas along with the soil and water. As the weeks went on, it was observed that participants were not only less reserved but also were fascinated with the soil and plants.

rimland 2013jun07_3279 — With assistance from staff and horticultural therapist, participants were encouraged to plant with their own hands.

The integration of gardens and garden-based activities in health and human service agencies is expanding year after year. If you know an individual or organization who could benefit from a garden, share some of the information you learned in this blog. It’s often in those conversations, filled with factual evidence and interest, that new ideas are planted and grown.

Source: Rachel, Stephan Kaplan and Robert Ryan. With People in Mind: Design and Management of Everyday Nature. Washington D.C.: Island Press, 1998. Print.

Fight your Winter Blues!

As I stepped out of my house this morning, I thought: “I can smell winter.” It’s that subtle shift that you feel as the days click on, and we are led farther away from the beloved fall season.

The days continue to get shorter, and the sun doesn’t seem to shine quite as bright so naturally; moods shift, and energy becomes muted. I have a number of friends and family members who suffer from Seasonal Affective Disorder, or SAD. Its abbreviation says it all: lackluster moods, low energy, and even mild depression.

Seasonal Affective Disorder is defined as depression associated with late autumn and winter, thought to be caused by a lack of light. Most people with seasonal affective disorder have symptoms that start in the fall and continue through the winter months, which in the Midwest, can seem endless. Lucky enough, there are many ways to remedy this SAD state of mind.

Simmering Spices supply list — HT ‘Simmering Spices’ supply list for 15 participants

Let’s begin by talking about a few winter-themed Horticultural Therapy (HT) activities that will fill your home or office with the sights and smells of the season.

One of my favorite HT activities to do this time of year is our ‘Simmering Spices’ project. During this activity, participants mix together a wide array of spices to create a holiday sachet to use in their home or office, or give as a gift. This activity serves as therapy on multiple levels. It encourages participants to engage their fine motor skills as they measure, mix, and create the sachets. Perhaps more meaningful, however, are the vivid and wonderful memories that are brought forth with the smells of the spices.

Scent triggers the area of the brain that is connected to the experience of emotion as well as emotional memory. I see this time and time again in my sessions; a participant smells a spice such as rosemary and become engulfed with memories of his or her mother’s roast turkey during the holidays. Socialization plays a large role in horticultural therapy, and it’s a joy to share in the memories with my many participants; young and old.

Another fun, and inexpensive, activity is our ‘Holiday Greens Ornament’ project. For this activity, participants get the opportunity to create a beautiful ornament out of fresh, seasonal greens. When I bring this activity to one of my school classrooms, I like to incorporate a garden walk as part of the session. The students, teachers, and I take a quick (and if it’s cold, very quick) walk around the school gathering small acorns and pine cones to add more interest to the ornaments.

Most of the craft supplies for the activity can be found at your local craft store. I use clear, plastic ornaments, fake snow, and ribbon to add additional visual appeal to the greens. These ornaments make a beautiful addition to any tree or gift to a loved one.

My final recommendation to combat those winter blues is to fully embrace the beauty of the season. Winter is not always the easiest season to get along with; that much I’ll admit. It’s cold and gray and seemingly endless, but it’s also fascinating and full of unique beauty.

If you’re feeling blue, bundle up and take yourself on a walk around your neighborhood, and appreciate our region and its four distinctly different and beautiful seasons. As you walk, gather some pine cones, and create a fresh wreath using natural supplies. Activities like these will turn a SAD state of mind to a glad one, with just a bit of effort. And of course, if all else seems gray, a nice hot cup of hot cocoa (which always tastes better in the winter) and some whipped cream will surely add a bit more enjoyment to any activity or winter’s day.

Happy holidays!

Spring Activities for Horticultural Therapy

Although it may not look like it, spring is on its way, which means it’s time to start prepping for the anticipated spring planting season. This is a great time of year for horticultural therapy contracts. Everyone is itching to start planning and prepping for a successful horticultural therapy outdoor garden program, and our excitement level is right there with them.

Sunflower seedlings — The emergence of the radicle through the seed coat of a sunflower seed.

I am frequently asked, “what kinds of activities do you do in the early spring to engage participants in horticultural therapy?” I turn to garden prep activities for both engaging and therapeutic plant-based sessions this time of year. The possibilities are endless with the added perk of being very affordable and therapeutically significant.

When gearing up for gardening season, I focus my horticultural therapy activities on three topics: seed plantings, propagation, and transplanting. All three topics not only have a wonderful educational component, but also serve as meaningful therapeutic activities.

Planting Seeds

Seed planting, or seed germination, activities serve an educational and therapeutic purpose. For the educational component, focus on the life cycle of a seed with the group of participants. Visuals, such as a seed germination chart, help participants understand the process of seed germination. It never ceases to amaze at least one participant (especially young students) that plants, even those as great as sunflowers, start out as tiny seeds.

Therapeutic significance

Seed germination activities allow horticultural therapists to connect the importance of seed germination and plant care to the care of oneself or others. In health care facilities or special education programs, many individuals are taken care of around-the-clock due to an inability to solely provide for themselves. Something as tiny as a seed carries great significance because it allows anyone the opportunity to care for a living thing. Participants are educated on appropriate sun exposure (typically on a light cart or windowsill) and watering techniques to guarantee the plant’s health and success. Each participant receives a variety of seedlings to tend to as we approach the planting season. The intent is to enable each individual to care for their own plant so that, when the time comes, it can be combined with other plants to create a beautiful, outdoor therapy garden.

Plant Propagation

Plant propagation is another great activity for a group of any size or ability. All that is needed are containers, soil, a mother plant and some snips. Some of my favorite plants for plant propagation also add a wonderful sensory component to the activity. Coleus are great plants for propagation and they come in a variety of beautiful colors; succulents propagate easily and create fun talking points pertaining to desert plants; lipstick plant (Aeschynanthus radicans) adds a tropical element as well as the excitement of a potential beautiful red bloom.

Therapeutic significance

Plant propagation activities can be used to teach valuable lessons in a health care setting. They teach a lesson about taking something old or overgrown to start something fresh and new. This activity can also be paired with a pruning activity to add to its therapeutic benefits. The concept of taking away or lessening a load in order to become more healthy is a theme that resonates with many horticultural therapy participants.

Transplanting Activity

When the time comes to begin planting in the garden, a lesson on transplanting can greatly enhance the garden’s immediate beauty while increasing the feeling of ownership among the participants. Ideally, the seedlings and cuttings that were previously done have developed into mature, healthy plants that are ready to transplant into garden beds/containers. Each participant has the opportunity to place their plant(s) in an area of the garden to continue to watch it flourish throughout the growing season.

Shriners_People — An HT participant at Shriners Hospital for Children, collecting flowers for the days activity.

Therapeutic significance

The feeling of ownership or pride over a space greatly enhances the success of a garden and horticultural therapy program. When participants get the opportunity to place their own plants within a shared space, their individual ownership and care over the space is heightened. They feel a sense of responsibility, not only for their plant, but for the entire garden. On numerous occasions, I have seen participants pull family members or friends out to “their” garden to show what they’ve planted.

While we all continue to stay busy, start thinking of all the different activities and ways in which to engage enthusiastic gardeners with easy, horticultural therapy activities. If Punxsutawney Phil thinks spring is just around the corner then we better be ready! Until then, get those seeds going, stay warm, and dream of snow drops, crocuses, and early spring showers.