Green Island
The invasive colony of pennywort that I planted began to take over my water garden. With little open space to swim, the flourishing tadpoles that inhabited my pond were in danger of being constricted. I remedied the ecological imbalance by thinning out the spreading plants and ignorantly throwing them over our property fence into a concrete culvert.
As my pond once again flourished, I forgot about the network of life that I disposed of. As several weeks passed, I noticed that the nightly chorus of frogs that congregated in my water garden echoed from the dark abyss hatched into the suburban fabric. While watering my nursery, I peered down the twelve-foot embankment that secured a stream no more than an inch deep. I was surprised to see a flourishing island of green against the linear expanse of concrete gray.
As the green island’s alien beauty grasped my attention I began to worry. What if the invasive non-native pennywort overan the entire culvert? Could it colonize the more natural areas downstream, across the freeway?
I decided to climb down the Algerian Ivy that crept over the concrete slope in order to remove the green island. As I gathered the network of roots and put them in a plastic pot, invisible life leeched out. Tiny tree frogs leaped and garter snakes slithered away, caught in a streamline flow. In five minutes, the island oasis became a terrestrial mound left to decompose out of existence.
That night, I sat on a bench by my water garden listening to the chorus of frogs. But a silent echo drowned-out the melody.
Memory Gardens for Nursing Homes
Outdoor Environments at Nursing Homes
Over the last 20 years, nursing homes, assisted living facilities, and adult day care programs have constructed gardens that specifically support the physical, cognitive, emotional, and spiritual needs of aging residents. Studies in the 1970s and 80s by Behavioral Psychologist Powell Lawton greatly influenced this trend by concluding that the environment can have a major “prosthetic” impact on those with cognitive impairments [3]. A “memory garden” is a specifically designed outdoor space with pleasant visual, tactile, olfactory, and auditory stimuli for aging populations. When integrated into a nursing home’s program of care, a garden setting is therapeutic for seniors, families, and caregivers.
Alzheimer’s Disease and Loss of Identity
Loved ones with Alzheimer’s and their families cope with a progressive decline in mental function and selfhood. The disease process can leave emotions, thoughts, and memories confused or incomplete. Related cognitive diseases such as dementia may lead to language difficulty, short-term memory loss, poor judgment, disorientation, and irritability. Patients who suffered a stroke or aneurysm suffer similar cognitive effects. However, the ability to walk, conduct gentle movements, and respond to a stimulative outdoor environment usually remains intact. Physical activity and long-term memory can foster a sense of familiarity and control in older individuals.
Environmental Design Research on Memory Gardens Research suggests that well designed gardens can significantly ameliorate moods and behaviors associated with Alzheimer’s disease. In one study, residents with independent and escorted visits to a nursing home garden, twice a day, for half-hour periods expressed more pleasure and interest while experiencing lower anxiety and depression during the course of the day [1]. Those who pace and wander showed less agitation and pacing behavior after walking or sitting in a garden setting [1]. Outside cues as to time of day and weather have been shown to improve the body’s inner clock, sleep patterns, and agitation due to “sundowning.” Research by Dr. Joanne Westphal, suggests that Alzheimer’s patients who spend more than ten minutes a day engaged in independent garden activity show marked improvements in blood pressure, heart rate, weight, aggressive behavior, and requested medications [5].
Design Features for Memory Gardens
A memory garden supports a range of abilities and compensates for losses in a safe and secure environment. In a nationwide survey of 320 nursing homes, the outdoor features most valued by staff were furniture, gazebos, bird feeders, trees, raised gardens, and drinking fountains [2]. During the design process, the landscape architect, staff, patients, and donors collaborate to plan and coordinate such features with the existing healthcare protocol. The design should promote passive and active uses such as reality orientation, eating, parties, concerts, gardening, gentle exercise, rehabilitation, pets, crafts, reading, and storytelling.
A looping or continuous path with private and social spaces, activity zones, and wayfinding landmarks is particularly effective for pacing and mood patterns. A continuous path in a secure space allows wanderers to walk unimpeded without getting lost, increasing autonomy and reducing agitation. The freedom to explore a garden can improve resident sociability outside of structured programs. Outdoor activities such as raking leaves or picking flowers can stimulate long-term memories of home life and reduce the physical consequences of immobility such as urinary retention, muscle atrophy, and osteoporosis.
Residents also suffer from boredom, which can trigger disorientation, anxiety, and depression. A familiar garden setting that residents can care for and work-in fosters a sense of pride and reconnection with the “outside world.” An invigorating outdoor environment attracts visitors of all ages, including children, and facilitates family interaction. Positive views toward the surrounding neighborhood promote reality orientation and interest for residents confined to the facility.
An Integrated Philosophy
A memory garden is an integral extension of a nursing home’s program of care. A delightful outdoor setting benefits individuals with cognitive impairments, families and visitors, staff and volunteers, public relations, and marketing. Motivated healthcare providers, caregivers, and landscape architects must collaborate to ensure that planned features facilitate better health outcomes and meet the needs of residents over time.
[1] Cohen-Mansfield, J. & P. Werner. (1998). “Visits to an Outdoor Garden: Impact on Behavior and Mood of Nursing Home Residents Who Pace.” The Journal of Nutrition, Health & Aging, 26: 369-72.
[2] Cohen-Mansfield, J. & P. Werner. (1999). “Outdoor Wandering Parks for Persons with Dementia: A Survey of Characteristics and Use.” Alzheimer’s Disease and Associated Disorders, 13(2): 109-17.
[3] Lawton, M. P. (1977). “The Impact of Environment on Aging and Behavior.” Handbook of the Psychology of Aging. New York, NY: Van Nostrand Reinhold, pp. 276-301.
[4] Tyson, M. “The Therapeutic Garden: Outdoor Environments for People with Alzheimer’s Disease,” Ageless Designs, Inc., 1995.
[5] Westphal, J. (2002). “Shared Wisdom: A Doctor’s Diagnosis,” Landscape Architecture, 92 (12): 82-84.
