Healthy Aging & Therapeutic Gardens in our Cities
By Karin Palmlöf Pavia
Humankind is entering an unparalleled time in its demographic history. The aging of populations in many nations will have dramatic sociological and economic effects, putting particular strain on healthcare systems. Maintaining the health and wellbeing of our beloved older generation is a top priority in dealing with the impact of this phenomenon, which has been brought into sharp view by the heart-rending effects of the COVID-19 pandemic. To guide this global response, WHO has released the ﬁrst World report on aging and health.
Living an active life is essential to stay healthy and it becomes more important than ever when we get older, as we tend to slow down and natural biological age related declines begin. These declines could be physical, maybe losing strength which could lead to falls, cognitive by feeling disoriented or losing memory or sensitive which leads to difficulties to hear, to see or to smell. Beyond these biological losses, older age frequently involves other significant changes. These include shifts in roles and social positions, and the need to deal with the loss of close relationships.
The use of nature based therapies as well as being outdoors can have a positive impact in people’s well-being. Preliminary studies have reported the benefits of horticultural therapy and therapeutic gardens in reduction of pain, improvement in attention, lessening of stress, modulation of agitation, lowering of PRN medications and antipsychotics and reduction of falls. These benefits are important factors in improving the quality of life and possibly reducing costs for long-term, assisted living and dementia unit residents. Research also shows that best achievements with garden therapies come from a combination of an individual attended service and a carefully designed environment that enable participants to be in contact with the garden and the nature experiences it provides. 1
The Therapeutic Garden “Los Sentidos”, Coslada, Spain
Los Sentidos (The Senses in English) is the first public therapeutic garden in Spain. This type of garden is fairly new in our country and especially in public spaces. Thus, opening this garden and providing sessions in it has been a long journey. Jardines Terapéuticos Palmlöf is the first company specialized in designing and managing therapeutic gardens in Spain. Our first garden, Los Sentidos, is based in Coslada borough (Madrid) with a population of 102,890 inhabitants. This garden provides weekly sessions to 200+ older adults. We aim to delay the entry of older adults (55+ years old) into dependence. Therefore, our goal is to improve their quality of life by maintaining their physical and cognitive skills as well as their mental health. However, since we opened the garden two years ago, our goals have increased. Nowadays we also focus in supporting them with unwanted loneliness and improve their sense of belonging to the garden through meaningful activities.
A well-structured system has been put in place to refer the people who most need or benefit from our services. As part of our commitment, we send a monthly report with the data (attendance, particular cases, assessments) that social services require from us. The next figure explains how clients are referred to us and how we assess them.
The main inspiration in our designs and methodology are based on the research by the University of Alnarp, Sweden. For the last 30 years, they have been detailing a QET (Quality Evaluation Test) for therapeutic gardens or health gardens, qualifying important characteristics of these “healing environments” such as:
- Proximity and easy access
- Safety and security
- Orientation and way finding
- Different options for different kinds of weather
- Contact with surrounding life Social opportunities
- Joyful and meaningful activities
- Culture and connection to past times
- Rich in species. Sensual pleasures of nature
- Seasons changing in nature
- Serene. Wild nature. Refuge.
Their aim is to highlight the importance of COMFORTING and an INSPIRING DESIGN to continue an active life.
Los Sentidos programme
In Los Sentidos our clients (older adults*, 55+) participate in a programme with a wide range of meaningful interventions in a garden environment that is close to their homes. They live within a radius of 200-1500m, most of them arrive by walking for their weekly therapies. The garden has become part of the landscape as well as the client’s routine.
Therapeutic Garden “Los Sentidos”, Coslada, Spain
The garden has been specifically designed to meet therapeutic needs. It occupies an area of approximately 1200 m2, where we have designed four different areas or modules focused on therapeutic purposes:
- Horticultural therapy: An area with a greenhouse and raised beds. The main focus is on improving social interactions and communication. Besides mental and physical health.
- Sensory stimulation: A quiet area surrounded with plants that provide different textures, scents, colours and taste. The main focus is in increasing concentration, mitigating pain, decreasing insomnia and sleep problems as well as reducing stress.
- Cognitive Stimulation Therapy and Reminiscence: An area with a water feature, using culture material in walls and furniture, common plants, flowers and trees. The focus of this area is in maintaining cognitive skills and creating positive/meaningful memories.
- Physical activities: A sloped garden with grass surrounded by a circular path. The focus is to improve strength, self-control and endurance.
Our gardens are run by a multidisciplinary team including occupational therapists that provide interventions, which are well connected with the natural changes of the garden throughout the year. Plants have been specifically chosen to keep a year round interest and can be easily identified by our clients. As part of our programme we include holiday events and seasonal celebrations such as a harvest festival. Here is an example of our approach when performing the task of harvesting our olives:
- Cognitive stimulation: we get around the olive tree and we talk about the different olive varieties (e.g. picudo, manzanilla, arbequina, etc.). Then we pick some olives and observe their form, colour and size. Most people in Spain are linked somehow to the olive culture, considered an important source of income and a symbol of its culture and gastronomy. Our clients always have a story to share with the rest of the group.
- Horticultural tasks: the group is responsible for harvesting the olives. We focus on their motor skills and social interaction. It’s amazing how they collaborate taking turns to pick and clean the olives. Our clients find this task very rewarding, especially the ones that feel socially isolated.
- Sensory stimulation: we produce our own olive oil, which can then be used for a soft hand massage or for a salad dressing, when we harvest our first lettuce.
- Mindfulness, anti-stress and other relaxing techniques: our clients look for scented leaves, flowers or fruits that can be added to the oil. Bay leaves or lemon zest are the preferred scents. We perform this activity indoors, in the greenhouse, giving the entire space a delicious perfume. This activity is ideal for the mindfulness session, which is guided by the occupational therapist.
Los Sentidos in numbers
The first surveys carried out showed a very positive impact in our clients. Their feedback was directly linked with a better sleep and a lower use of anxiolytics. As well as increasing social interactions, improving physical health, mood and concentration. So far, we are very proud of what we have achieved. What is even more interesting is that none of our participants have been infected with COVID19, which proves how nature-based therapies improves the immune system among older adults.
Since we opened the garden until January 2020:
- 743 clients participated in our therapeutic programs
- 211 clients regularly attend our sessions
- 39 clients have been referred by local associations
- 493 people have participated in a one-off intervention program
The near future
Recent studies show the beneficial effects of urban green spaces on our health, particularly on our mental and physical health. Like this recent research article, which concludes that: “People in urban neighbourhoods that are characterised by lower income and older age populations are disproportionately healthy if their neighbourhoods contain accessible, good quality public green-space”.
The United Nations General Assembly declared 2021-2030 the Decade of Healthy Aging. Jardines Terapéuticos Pamlöf will actively support the Decade’s goals throughout our Therapeutic Gardens, sharing all the benefits that our gardens provide for active aging, which has a very positive impact on the healthcare system too. We will also carry on training horticulture therapists and other professionals, who are interested in this practice, in collaboration with the Spanish Association of Social and Therapeutic Horticulture (AEHJST). Let’s join together and support this decade of healthy aging. I’m sure we can make a huge difference. Now is our moment!
About the author: Karin Palmlöf Pavia
- Master of Science in Agriculture at SLU, Uppsala (Sweden).
- Master in Landscape architecture at Polytechnic University, Madrid (Spain).
- Outdoor Environments for Health and Well-being – Master’s Program SLU, Uppsala (Sweden).
- Healthcare Garden Design Certificate Program, Chicago Botanic Garden (USA)
- CEO of Jardines Terapéuticos KDJ S.L., a company that implements therapeutic gardens for healthy ageing.
For the past 10 years, she has designed and executed health gardens/ therapeutic gardens at hospitals, care homes and public spaces, following the Scandinavian philosophy and sometimes in collaboration with Alnarp therapeutic gardens (Sweden).
Some of her projects are:
- “Centro de Rehabilitación del Norte (CRN)”, Porto (Portugal)
- “12 de Octubre Hospital”, Madrid
- National Reference Center for Alzheimer – Salamanca (Spain)
- Mark B. Detweiler, Taral Sharma, Jonna G. Detweiler, Pamela F. Murphy, Sandra Lane, Jack Carman, Amara S. Chudhary, Mary H. Halling and Kye Y. Kim (2012) ‘What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly?’, Korean Neuropsychiatric Association, ( ISSN 1976-3026), pp. 100 [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372556/pdf/pi-9-100.pdf (Accessed: 04/01/2021).