Nature-based Therapy, such as forest bathing and horticultural therapy, has been shown to have physical, psychological and emotional health benefits. We posit that personalised and guided Nature-based Therapy, which leverages the benefits of therapeutic gardens in an urban hospital setting, improves the overall wellbeing of elderly inpatients with dementia (aged \>65 years old) and their caregivers, as well as patients undergoing inpatient rehabilitation. To determine the effectiveness of Nature-based Therapy for these two inpatient populations, we designed a pilot study, TGIF, to be conducted at the dementia and rehabilitation medicine wards at Changi General Hospital in Singapore.
TGIF consists of two concurrent trials targeting two patient populations: elderly inpatients with dementia admitted to the dementia ward, and inpatients undergoing inpatient rehabilitation at the rehabilitation wards in a tertiary teaching hospital in Singapore. At the dementia wards, we aim to determine if Nature-based Therapy improved the neuropsychiatric symptoms such as agitation, restlessness and aggression among elderly inpatients living with cognitive impairment, defined as either delirium or dementia or both. Concurrent with the improved neuropsychiatric symptoms, the study team will also study the improved quality of life among the family, caregivers and hence reduced caregiver burden. At the rehabilitation medicine wards, we aim to determine if Nature-based Therapy improves mood, physical function, and quality of life.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
TRIPLE
Enrollment
1,600
During the length of inpatient stay at Changi General Hospital (CGH), which ranges from 5 to 10 days, the patients and caregivers will be enrolled for a set of 3 nature-based sessions. Each session will be conducted in groups of 4 to 6 patients incorporating a relational multi-sensory experience as well as mind-body connectedness while spending time in nature. Each of the 3 sessions will be 45 minutes each. The nature-based therapy/green social prescription plan will be conducted in groups guided by a trained CGH staff (Allied Health Professionals/Nurse). This Green social prescribing plan (Playbook) will be integrated into inpatient's care plan. Caregivers of the enrolled patients will also be part of the therapy group following the necessary consent.
Changi General Hospital
Singapore, Singapore
Pittsburg Agitation Scale
The Pittsburgh Agitation Scale (PAS) is a quick, observational tool used to assess the severity of agitation in dementia patients, focusing on four behavioral dimensions: aberrant vocalizations, motor agitation, aggressiveness, and resistance to care
Time frame: Baseline and at the end of intervention, an average 7 days
DASS-21
The DASS-21 (Depression, Anxiety, and Stress Scale - 21 Items) is a self-report questionnaire designed to measure the severity of symptoms related to depression, anxiety, and stress in adults. It consists of 21 questions, with seven questions for each of the three scales: depression, anxiety, and stress.
Time frame: Baseline and at the end of intervention, an average of 7 days
EQ-5D-5L
The EQ-5D-5L is a generic, self-completed questionnaire that assesses health-related quality of life (HRQoL) across five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) with five levels of severity for each dimension, and includes a visual analogue scale (EQ VAS).
Time frame: Baseline and at the end of intervention, an average of 7 days
Zarit Burden Interview
The Zarit Burden Interview (ZBI) is a widely used tool to assess the level of caregiver burden experienced by individuals who care for people with chronic illnesses. It is a self-report questionnaire that evaluates the physical, emotional, and social impact of caregiving on the caregiver's well-being.
Time frame: Baseline and at the end of intervention, an average of 7 days
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