By Maria Cecilia Esposito
Let me introduce you to Maria Cecilia Esposito from Mar del Plata, Argentina. She is an agricultural engineer from the University of Morón, Buenos Aires, Argentina and she specializes in aromatic plants. She has 30 years of experience in education in many areas, always related to plants, and with different population groups, including people with special needs. A few years ago, she took an introductory course in horticultural therapy in Argentina. Eight years ago, she was commissioned to implement a vegetable garden for a geriatric institution. Her passion for plants and older adults motivated her to continue her self-taught path in horticultural therapy. In this blog, she shares with us her experience working with older adults.
A Spanish-language version of this blog is available here.
Daniela Silva-Rodriguez Bonazzi
Ideas open like Fans
When I started offering gardening workshops in a geriatric institution, I imagined them as linear and routine activities where I would quickly run out of ideas and after a few months, I would no longer know what to propose. Yet, the very exercise of the activity began to generate an inexhaustible source of ideas that opened like fans. The experience gained in the eight years of work is very valuable to me and I hope they are useful to other professionals who practice in nursing homes or other institutions. Knowing that this therapeutic modality is beneficial and rewarding, trusting nature, and being prepared is the key to this practice.
A horticultural therapy program for older adults who reside permanently in an institution has an unsuspected value and involves a great professional commitment, mainly because of the emotional bond and the necessary “transfer” that occurs over time. Beyond the specific issues, each resident has, regardless of the value judgment and prejudice we may have about nursing homes, we know that we can help improve the quality of life of the residents through horticultural therapy.
The guiding value must be respect for the human person who is the object of our work and even more so because we are dealing with the elderly, who are socially vulnerable. They might also have been abandoned by their families or with some physical or intellectual disability and a high degree of sensitivity.
For the reasons mentioned above it is necessary to consider aspects of this population, which I have observed, can be summarized in the following list:
- Many elders are admitted at the institutions with great cognitive impairment.
- Some elders never feel at ease and reject the activities offered by the therapists – they show anger or lack of interest.
- Psychophysical deterioration is progressive and isolation during these years of the COVID19 pandemic have exacerbated this condition.
- They gain or lose interest in activities as their pathologies progress.
- The loss of peers or roommates have a strong impact.
- There are active, creative, and productive groups, as well as passive, less participative groups.
- Older adults often have worries about their children, sad and recurrent thoughts.
- Many others are cheerful, resilient, positive, prepared, highly educated and curious.
- They all need affection and if possible physical contact (hands, face, shoulders).
- Some complain about their lives, and many are thankful to be alive.
- Almost all of them want to keep learning every day. Horticultural therapist practitioners must have the skills to keep their curiosity alive.
With all these characteristics in mind, it is important to know the target group in order to be able to offer beneficial, attractive and feasible activities in the time allotted for the sessions. The ideal time frame should be between breakfast and lunch or between the afternoon snack and dinner because they need a break at noon to get active again in the afternoon. The size of the group should not be large, as this allows the horticultural therapist to be attentive to all participants and all the details.
Memory Activation and Conversation
Program goals, activities, and benefits:
Older adults often worry about memory loss, which is a real aging issue. When routines are left behind and dialogues are turned off, even words are forgotten. It is beneficial to offer tasks that promote contact with activities that were familiar, simple, and daily for them.
Slowing Down Cognitive Decline
We should always offer activities that keep their interest alive, promote socialization and conversation, and avoid activities that provoke frustration. As an example, a basket of assorted vegetables is a simple and effective resource, everyone can talk about personal tastes, or the different varieties of vegetables, or their growing experiences and share their recipes. It is a topic everyone feels comfortable with and included. Sensory and cognitive stimulation comes through describing the colors in each vegetable; cutting them in half and describing their internal structure, counting the seeds, touching and storing them; comparing sizes and weights, cooking methods, and their nutritional benefits; or tasting and smelling the vegetables. Each of these simple actions helps the elderly remember daily routines. On many occasions, participants express surprise and joy because they are still learning and can express their feelings.
It has become clear to us that we are not always looking for long-term results, we cannot always expect the pathologies to improve, but we help in other therapeutic treatments related to cognitive stimulation: memory, language, sensory stimulation, and judgment. The stimuli are diverse, and the results are measured in momentary responses. When we discover a stimulus to be positive, we reinforce it and repeat it several times. Participants often suffer relapses or go through different cognitive states, thus we must be aware of these changes periodically because, for example, they might put dirt in their mouths or keep everything they find for themselves. We try to create moments in which they can connect with a specific task, even if they are for a brief period. The satisfaction of small achievements improves their self-esteem and predisposes them positively for the rest of the day.
Participants with advanced Alzheimer’s disease connect with the present moment with a garden activity
Movement and Coordination
Most of our participants are in wheelchairs and our main goal is to maintain or improve hand movement and coordination. Few participants can work in the raised bed outdoors. Most of the activities we offer are passive and indoors. We work with soil, spoons and pots, plant cuttings, or scissors to cut leaves. Kneading edible dough with chopped herbs or kneading cold porcelain to create flowers or fruits are great activities to keep participants connected to nature. Herbal incense or bouquets of aromatic herbs are created for different purposes. We have seen notorious hand improvements in participants who have suffered a stroke. Movements like the handling of utensils and grip tension are practiced. All handicrafts that can be linked to the orchard and the garden are welcome, such as decorating flowerpots or posters, or recycling containers for flower arrangements. Natural scents, mothproof aromatic bouquets, thinning onion seedlings for fine motor skills or rehabilitation.
The Smells of Memories
Contact with nature produces positive emotions, offering several tools to achieve psychophysical well-being. The smell of plants has been fixed in the emotional memory throughout life, so it is very common to remember events that have happened in the distant past with total clarity. The scent of a rose, jasmine, mint, or lavender awakens happy memories which return to the mind generating smiles, brightness in the eyes, and pleasant moments. In a horticultural therapy setting, memories find a platform to be verbalized, to be told to peers, to release emotions, and rescue happy memories such as scenes of family life or childhood. Participants need to relive and retell those stories again and again. It is very important for horticultural therapy practitioners to have the time to listen to those stories and make others listen to them.
Olfactory stimulation can be applied during every horticultural therapy session with all kinds of elements like lavender spikes to shuck and make aromatic sachets to flower bouquets to be used as centerpieces. Basil can be used to make pesto or fruits and vegetables for cooking. These stimuli encourage the desire to eat, which is greatly appreciated by nutritionists.
To be in Tune with Nature
While life goes on slowly behind the windows, outside nature continues to pulsate without pause. The seasons of the year mark a vital rhythm with their changing temperatures and length of day, with its changing colors, flowers, and fruit. Raising awareness of the seasonal changes among our participants in our horticultural therapy sessions is crucial to help them see themselves in the present moment and long for a near-future time where nature will offer them their favorite flower or fruit. It helps them to perceive the passage of time and that every day is different. The rhythms of nature are conducive to relating healing metaphors about the stages of life, which for older adults acquire great symbolism. For example, the growth of plants and their maturity, their longevity; the birds and their empty nests; the flower that dies to become a fruit; the seeds and their dispersion; vegetable plant adaptations, the beauty of diversity.
Elders have taught me that even with great physical or intellectual limitations they have the capacity to enjoy, learn, teach, tell stories, laugh, and be happy. They know that they are in the final stretch and therefore want to make the most of every day of life. Each shared moment is unique and unrepeatable and they value the care with which each horticultural therapy session is prepared for them.