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Aims. To explore the activities of daily living and psychological well-being of older people living in nursing homes and also to
examine the effectiveness of a gardening programme in enhancing socilaisation and life satisfaction, reducing loneliness and
promoting activities of daily living for older people living in nursing homes.
Background. Life in nursing homes can mean very limited physical and social activity, leading to further decline in function for
many older people.
Design. This was a quasi-experimental pre and posttest control group design.
Methods. Older people from nursing homes were invited to join the eight week indoor gardening programme (experimental
group), while older people in other nursing homes were treated as the control group; they received regular care without the eight
week indoor gardening programme. There were 26 older people (25 female and one male; mean age 85 years) in the experimental group and 27 (20 female and seven male; mean age 82 years) in the control group. Demographic data including age,
gender, educational level and financial situation were collected, in addition to information regarding life satisfaction, loneliness,
physical activity and social network situation, before and after the eight week indoor gardening programme for both the
experimental and control groups. Also, details of experimental group subjects experience of the indoor gardening programme
were elicited using open-ended questions.
Results. There were significant improvements in life satisfaction and social network and a significant decrease in perception of
loneliness for older people in the experimental group after the eight week indoor gardening programme, while the activities of
daily living were unchanged for both groups after the programme.
Relevance to clinical practice. Given the positive effects of gardening activities, it is suggested that they be promoted more
widely among nursing home residents.
Key words: China, gardening programme, nurses, nursing, nursing homes, older people
Accepted for publication: 15 November 2008
Introduction
With the increase in average life expectancy, the impact of
disease and the increase in the prevalence of disabilities
(LEGCO Panel on Welfare Services 2005), older adults are in
increasing need of some form of alternative accommodation
and/or residential care facilities (Sandberg et al. 2001). In
Author: Mimi MY Tse, RN, PhD, Assistant Professor, School of
Nursing, The Hong Kong Polytechnic University, Kowloon, Hong
Kong
949
MMY Tse
Background
Moving to and living in a nursing home is a difficult
experience for many people. It is likely to be traumatic and
depressing for those already struggling with loss of health or
ill health, pain, dependency and limited social and material
resources (Grek 2008). The establishment of nursing homes
serves older individuals who are unable to function independently (Lassey & Lassey 2001). Nevertheless, nursing home
placement implies an alteration of living environment, which
can lead to reduced socialisation with family and community,
a decrease in physical activity and an increased perception of
loneliness (DAmico-Panomeritakis & Sommer 1999). It is
noted that levels of physical activity for older people living in
nursing homes are much lower compared with those of
community-dwelling older adults (Lee et al. 2005).
Apart from the change in physical environment and level of
physical activity, older people in nursing homes face changes
in their daily life routine, social networks and support
(Johnson 1996). Admission to a nursing home means a
discontinuation of customary lifestyles to the individual (Lee
et al. 2002). The older person may feel a great sense of loss at
leaving their beloved homes, family and neighbourhood
(Reed & Roskell Payton 1996, Lassey & Lassey 2001).
Nursing home residents have expressed loss of freedom,
loss of control, feelings of loneliness and a sense of failure at
having to stay in nursing homes (Kellett 1999, Tse 2007).
Living in a nursing home is regarded as living in a jail (Tse
2007, p. 913), where there was no freedom of movement, a
lack of privacy and a loss of control over many things
(Iwasiw et al. 1996, Wilson 1997). Residents also stressed the
feeling of loneliness in the nursing home and said that they
were by themselves and surrounded by strangers and sick
people (Sim & Leung 2000, Tse 2007). Such negative feelings
about life in a nursing home have detrimental effects on their
health status, leading to a poor quality of life.
The new paradigm for older people care focuses on the
primary and secondary prevention of functional morbidity
and premature mortality, as well as enhancing the quality of
950
Methods
Design and sample
This research was a quasi-experimental pre and posttest
control group design. After gaining approval from the Ethics
Committee of the university, an organisation operating
residential care homes for older people was approached and
Original article
Experimental group
Week
Content
Expected outcomes
Acquire information on
gardening activities
38
951
MMY Tse
Procedure
Demographic data, activities of daily living and psychological
parameters for participants that fit the inclusion criteria were
collected from the four nursing homes (two randomised as
experimental groups and the other two as control groups).
Older people from the experimental groups were invited to
join the eight week indoor gardening programme, while older
people in the other two nursing homes were treated as the
control groups: they received regular care and visits each
week, but not the eight week indoor gardening programme.
Posttest measures were collected on the completion of the
eight week indoor gardening programme for all participants
and participants of the experimental groups were invited for
an interview regarding their experience of the programme.
Participants in the experimental groups were invited to
attend an interview conducted by the researcher at the end of
the eight week indoor gardening programme. The interviews
were conducted in the function rooms of the nursing homes.
Interview lasted from 1015 minutes. To create a warm and
safe atmosphere, some small talk was initiated before
proceeding to ask the participants about the gardening
experience.
Measures
Demographic data, including age, gender, educational level,
financial situation, length of stay in nursing homes and
gardening experience were collected. Also, measures of life
satisfaction (assessed by the Life Satisfaction IndexA Form),
loneliness (assessed using the Revised UCLA Loneliness
Scale), the social network situation (assessed by the Lubben
Social Network Scale) and activities of daily living (assessed
by the Modified Barthel Index) were used before and after the
eight-week indoor gardening programme for all participants
in the experimental and control groups.
The Life Satisfaction IndexA form scale consists of 18
questions related to five different components: zest, resolution and fortitude, congruence between desired and achieved
goals, positive self-concept and mood tone. Items scored 1
point for agree and 0 for disagree. Reverse scoring appropriate items provided a range of 018 scores, with the highest
scores indicating the greatest satisfaction. A Chinese version
of the Life Satisfaction Index-A form was used, with the
Cronbachs alpha 07 for reliability and split half value 062
for internal consistency (Chi & Boey 1992).
The Revised UCLA Loneliness Scale is a standard scale for
measurement of loneliness (Russell 1996). In version 3, there
are 20 items, including nine positively worded items and 11
negatively worded items. Interviewees are asked to rate how
952
Data analysis
Several statistical methods were used in data analysis.
Descriptive statistical analysis of the quantitative data was
conducted using the Statistical Package for the Social Sciences
(SPSS), version 15, 2006. The chi-square and MannWhitney
U-tests were employed to determine any differences in the
experimental and control groups, while the Wilcoxon Signed
Rank Test was used to examine differences between experimental groups. Spearmans Rho Correlations were used to
measure the relationships of net improvement in life satisfaction, loneliness and socialisation with age, educational level
and prior experience in gardening; p<005 was considered
statistically significant. Interviews regarding the experiences
of the gardening programme were audio-taped and transcribed verbatim. The transcribed text was analysed by
Original article
Results
Demographic data
There were 53 older people who participated in the study,
with 26 older people in the experimental groups (in two
nursing homes, as Experiment 1 and Experiment 2) and 27
in the control groups (in two nursing homes, as Control 1
and Control 2). Table 2 shows the demographic data. Most
Gender*
Female
Male
Age
Mean SD
Range
Marital status*
Single
Married
Divorced
Widowed
Education level*
No formal education
Old-style private school
Primary school
Secondary school
Financial status*
Old-age allowance
Supported by family
Self-support
Prior experience in
planting/gardening*
Yes
No
Experiment 1
(n = 11)
Experiment 2
(n = 15)
Experimental groups
(Experiment 1 +
Experiment 2)
(n = 26)
10
1
15
0
25
1
14
3
8573 377
8292
8487 614
7395
8523 (520)
7395
8374 812
6595
0
3
1
7
0
1
1
13
0
4
2
20
2
4
1
12
6
3
1
1
8
3
4
0
14
6
5
1
7
4
0
12
1
2
6
5
8
7
Control 1
(n = 19)
Control 2
(n = 8)
6
4
Control Groups
(Control 1 +
Control 2)
(n = 27)
p-value
20
7
0504
8300 (785)
6595
0094
0
1
0
7
2
5
1
19
0499
11
1
7
0
4
2
2
0
15
3
9
0
0361
19
5
2
12
6
1
4
4
0
16
10
1
0398
14
12
6
13
2
6
8
19
0181
8125 740
6588
953
954
p-value*
415
233
280
239
1826
1156
4256
10711
100
060
007
100
678
316
261
285
1750
1138
4425
10713
257
198
261
232
1858
1163
4184
10716
796
324
818
556
1927
1173
4138
10719
010
062
008
020
1673 8.66
1209 3.42
3818 804
10909 202
713
320
756
688
Control group 2
n=8
Mean SD
Control group 1
n = 19
Mean SD
Experimental
group n = 26
Mean SD
Experimental
group 2 n = 11
Mean SD
*The MannWhitney U-test was used within the experimental groups (Experimental group 1 and Experimental group 2).
The MannWhitney U-test was used within the control groups (Control group 1 and Control group 2).
The MannWhitney U-test was used for the experimental groups vs. control group.
A p-value of <005 was considered statistically significant.
2113
1147
4337
10580
Experimental
group 1 n = 15
Mean SD
p-value
Social network
Life satisfaction
Loneliness
ADL
Control group
n = 27
Mean SD
p-value
077
039
032
006
MMY Tse
000*
000*
000*
006
416
225
298
239
1833
1167
4244
10711
094
068
007
100
1750
1138
4425
10713
258
184
285
232
1868
1179
4168
10716
669
171
754
556
2477
1573
3546
10719
045
091
038
020
549
207
727
202
2382
1555
3400
10909
756
146
780
688
2547
1587
3653
10580
Social network
Life satisfaction
Loneliness
ADL
p-value*
678
316
261
285
p-value
Control
group 1 n = 19
Mean SD
Experimental
group n = 26
Mean SD
Experimental
group 2 n = 11
Mean SD
Experimental
group 1 n = 15
Mean SD
Control
group 2 n = 8
Mean SD
Control
group n = 27
Mean SD
p-value
Original article
neighbours
Participant 2: I was no longer alone; now I had become a team member
in this gardening activityI met new friends and we talked
Participant 3: we shared our methods for making natural
pesticidessee, all are natural and there is no wastageand applying
them to our plants...
Participant 4: ...There are plenty of topics, such as rotation and
positioning of our plants; it is important for them to be exposed to as
much sunlight as possible; this is good for their growth
Discussion
The present study demonstrated the therapeutic effects of a
gardening programme in enhancing life satisfaction and social
955
MMY Tse
Table 5 Comparison of experimental groups and control groups: baseline (week 1) vs. postintervention (week 8)
Control Groups n = 27
Experimental Groups n = 26
Social network
Life satisfaction
Loneliness
ADL
Baseline (Week 1)
Mean SD
Postintervention
(Week 8)
Mean SD
1927
1173
4138
10719
2477
1573
3546
10719
798
324
818
556
669
171
754
556
p-value
Baseline (Week 1)
Mean SD
Postintervention
(Week 8)
Mean SD
p-value
000*
000*
000*
100
1826
1156
4256
10711
1833
1167
4244
10711
016
008
008
100
415
233
280
239
416
225
298
239
Range of Improvement
Instruments (minimum and
maximum of scale)
Net improvement
(Mean SD)
Baseline
(week 1)
Postintervention
(week 8)
+6.12
+400
558
0
537
315
2557
92110
1238
1018
2449
92110
391
235
559
000
Significance
(two-tailed)
0308
0065
0191
0255
0126
0754
0351
0209
0114
0147
0179
0212
0578
0473
0382
0298
0027
0031
0027
0349
0894
0879
0894
0081
Original article
Acknowledgements
The author would like to thank all the study participants. The
Hong Kong Polytechnic University supported the study. No
financial arrangements had been made with any organisation
or company at the time of this papers submission.
Contributions
Study design, data collection and analysis and manuscript
preparation: MYMT.
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