The objective of this study is to determine whether horticultural therapy would improve the psychological well-being of the older adults. 70 healthy elderly were randomized into the active horticultural therapy or the waitlist control group. Sessions will be conducted weekly for 12 weeks, and monthly for 3 months. Participants would be assessed at 3 time-points: at the start, at 3-months and at 6-months. It was hypothesized that as compared to the waitlist control group, participants in the active horticultural therapy will have (1) lower depression and anxiety symptomatology; (2) higher life satisfaction; (3) feel more socially connected; and (4) improved cognitive functioning.
Participants Study participants are community-dwelling elderly. Assessments Demographic data will be collected at the start. Psychological tests for depression, anxiety and psychological well-being as well as neuropsychological tests of cognitive functioning will be done at the start, at 3-months and at 6-months. Blood samples will also be collected at all three time points. Intervention Sessions This is an intervention study with a waitlist control group design. The strength of this design is its experimental nature with randomization. The Horticultural Therapy intervention is delivered by a trained practitioner at various locations and consists of 1 hour sessions weekly for first 3 months, followed by monthly session for the next 3 months. The extension of monthly sessions for 3 months is to determine sustainability and longer-term changes. The intervention is designed to cultivate an interest in gardening and promote relaxation. This will be achieved in stages, facilitated by trained volunteers and practitioners. The plant would be selected based on subjects' profiles e.g. familiarity, preference, safety and its maintenance would be followed up every fortnight. Park venues were selected based on patients profiles and park features e.g. familiarity, comfort under weather, safety. The control group will be placed on a waiting list and only be contacted for assessments. They will receive intervention after the active treatment group at a later date. The horticultural therapy is conducted solely for the purpose of this research.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Masking
SINGLE
Enrollment
69
The Horticultural Therapy intervention consists of 1 hour sessions weekly for first 3 months, followed by monthly session for the next 3 months. They will be taught on the basic gardening techniques such as sowing, weeding and fertilization during the hands-on sessions. They will also be taken on walks to the various parks to enjoy the therapeutic effect of the park greenery
Training and Research Academy; Jurong Point Shopping Centre
Singapore, Singapore, Singapore
Change from baseline Zung Self-Rating Depression Scale (SDS) at 3-months and 6-months
The SDS (Zung, 1965) is a 20-item quantitative measurement of symptoms of depression. Participants rate each item regarding how they felt during the week preceding using a 4-point scale that ranges from 1 (a little of the time) to 4 (most of the time). A total raw score computed by summing the scores on the individual items will be converted into a percentage (the SDS index); the higher the SDS index, the greater the severity of depressive symptoms. Several studies have established the SDS as a reliable and valid instrument for measuring depressive symptoms (Biggs et al., 1978; Gabrys and Peters, 1985; Agrell and Dehlin, 1989).
Time frame: baseline, 3-months, 6-months
Change from baseline Zung Self-Rating Anxiety Scale (SAS) at 3-months and 6-months
The SAS (Zung, 1971) will be used to measure anxiety of the participants in the preceding week. It is a 20-item self-report assessment designed to measure anxiety levels, based on cognitive, autonomic, motor and central nervous system symptoms. Each question is scored on a Likert-type scale of 1-4 (a little of the time) to (most of the time). Some questions are negatively worded to avoid the problem of set response. Overall assessment is done by total score. The total raw scores range from 20-80. The raw score then needs to be converted to an "Anxiety Index" score; the higher the SAS index, the greater the severity of depressive symptoms.
Time frame: baseline, 3-months, 6-months
Change from baseline Ryff's Scales of Psychological Well-being at 3-months and 6-months
The Ryff Scales of Psychological Well-Being (Ryff and Singer, 1998) is an 18-item questionnaire which reflects the six areas of psychological well-being: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Respondents rate statements on a scale of 1 to 6, with 1 indicating strong disagreement and 6 indicating strong agreement.
Time frame: baseline, 3-months, 6-months
Change from baseline Satisfaction with Life Scale (SWLS) at 3-months and 6-months
Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen and Griffin, 1985) will be administered. SWLS is a 5-item scale designed to measure global cognitive judgments of one's life satisfaction (not a measure of either positive or negative affect). It is a psychometrically sound measure (Larson, Diener and Emmons, 1985) and has been validated in a geriatric population (Diener et al., 1985). Participants indicate how much they agree or disagree with each of the 5 items using a 7-point scale that ranges from 1 (strongly disagree) to 7 (strongly agree). Total scores were computed by summing the scores on the individual items and ranged from 5 to 35, with higher scores indicating higher level of satisfaction with life.
Time frame: baseline, 3-months, 6-months
Change from baseline Friendship Scale (FS) at 3-months and 6-months
Social connectedness scale will be measured using the Friendship Scale (Hawthorne, 2006). It is a 6-item questionnaire that measures both social isolation and social connectedness. Participants were asked to rate the frequency in which each statement describes them during the past four weeks on a 5-point Likert scale ranging from 0 (almost always) to 5 (not at all). Total scores were computed by summing the scores on the individual items and ranged from 0 to 24, with higher scores indicating higher level of social connectedness. The Friendship Scale was developed as a short, user-friendly, stand alone scale measuring perceived social isolation. It was validated with older adults with excellent internal structures, reliability and validity (Hawthorne, 2006; Hawthorne, 2008).
Time frame: baseline, 3-months, 6-months
Change from baseline Interleukin 6 (IL-6) at 3-months and 6-months
10ml of fasting blood will be collected using CPT tube
Time frame: baseline, 3-months, 6-months
Change from baseline Interleukin-1 beta (IL-1β) at 3-months and 6-months
10ml of fasting blood will be collected using CPT tube
Time frame: baseline, 3-months, 6-months
Change from baseline C-reactive protein (CRP) at 3-months and 6-months
10ml of fasting blood will be collected using CPT tube
Time frame: baseline, 3-months, 6-months
Change from baseline Cortisol at 3-months and 6-months
10ml of fasting blood will be collected using CPT tube
Time frame: baseline, 3-months, 6-months
Change from baseline Brain-derived neurotrophic factor (BDNF) at 3-months and 6-months
10ml of fasting blood will be collected using CPT tube
Time frame: baseline, 3-months, 6-months
Change from baseline Dehydroepiandrosterone sulphate (DHEAS) at 3-months and 6-months
10ml of fasting blood will be collected using CPT tube
Time frame: baseline, 3-months, 6-months
Change from baseline Montreal Cognitive Assessment (MoCA) at 3-months and 6-months
Montreal Cognitive Assessment (MoCA) (Nasreddine, Phillips, Bedirian, Charbonneau, Whitehead, Collin, et al., 2005) will be administered by trained research assistants and/or research nurses as global measures of cognitive function.
Time frame: baseline, 3-months, 6-months
Change from baseline Clinical Dementia Rating (CDR) at 3-months and 6-months
Clinical Dementia Rating (CDR ) is a 5-point scale used to characterize six domains of cognitive and functional performance applicable to Alzheimer disease and related dementias: Memory, Orientation, Judgment \& Problem Solving, Community Affairs, Home \& Hobbies, and Personal Care.
Time frame: baseline, 3-months, 6-months
Change from baseline Rey Auditory Verbal Learning Test (RAVLT) at 3-months and 6-months
Rey Auditory Verbal Learning Test (RAVLT) evaluates declarative verbal learning and memory.
Time frame: baseline, 3-months, 6-months
Change from baseline Digit Span Task at 3-months and 6-months
Digit Span Task, which consists of a Digit Span Forward (DSF) and a Digit Span Backward (DSB) task is used to assess attention and verbal working memory.
Time frame: baseline, 3-months, 6-months
Change from baseline Colour Trails Tests (CTT) at 3-months and 6-months
Colour Trails Tests (CTT) 1 and 2 assesses sustained attention and sequencing.
Time frame: baseline, 3-months, 6-months
Change from baseline Block Design at 3-months and 6-months
Block Design is a subtest that is administered as part of several of the Wechsler Intelligence tests, and it primarily measures visual-spatial and organizational processing abilities, as well as non-verbal problem-solving skills.
Time frame: baseline, 3-months, 6-months
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Change from baseline Semantic Verbal Fluency at 3-months and 6-months
Semantic Verbal Fluency taps lexical knowledge and semantic memory organization.
Time frame: baseline, 3-months, 6-months
Change from Basic Health Screen (composite) at 3-months and 6-months
Blood pressure, Pulse rate, Height and Weight will be measured
Time frame: baseline, 3-months, 6-months