Effectiveness of geriatric horticulture therapy (GHT) among the inmates of care home : a case study based action research in Thiruv Anathapuram district

Abstract

The present study, entitled “Effectiveness of Geriatric Horticultural Therapy (GHT) among the inmates of the care home: A case study based action research in Thiruvananthapuram District,” was conducted with the objective of developing a protocol for geriatric horticultural therapy and studying its impact on the cognitive, psychological, physical, and social well-being of the inmates of the care home”. The study also identified the reasons for joining the care home and the constraints faced by the inmates during their stay at the care home. The study was conducted in pre-test and post-test experimental designs at the government care home in Pulayanarkotta, under the Department of Social Justice, Government of Kerala, in Thiruvananthapuram district. This was purposefully selected as the study required the constant physical presence of the researcher, and care home Pulayanarkotta was the only government old age home in Thiruvananthapuram district having facilities for initiating small gardens. Out of the total 158 inmates, 31 who had a history of severe psychiatric conditions like schizophrenia, bipolar disorder, dementia, very significant visual or hearing impairment, major upper and lower limb motor difficulties (bedridden), and suffered from severe medical conditions were excluded from the study. A baseline survey was conducted for the remaining 127 inmates, and a sample of 60 inmates with the highest scores in the baseline survey was selected for this experimental study after obtaining their consent. Pre-intervention data was collected through interview schedules and other secondary sources of data obtained through staff support before and after the intervention. The effectiveness of GHT was measured in terms of the cognitive, psychological, physical, and social well-being of inmates in care homes. The Mini Mental State Examination (MMSE), the Ryff Scales of Psychological Well-Being, the General Activities of Daily Living Scale (GADL), and the Social Well-Being Questionnaire by Jacqueline Radzyk were used to measure cognitive, psychological, physical, and social well-being, respectively. The statistical tools used were frequency, percentage analysis, mean, standard deviation, correlation coefficient, paired t-test, MANOVA, Chi-square, Z-test for proportion, regression analysis, and related samples Wilcoxon signed rank test. In the first phase of the study, a protocol for GHT was developed with a specific list of horticultural therapeutic activities potentially suitable for each observation under the selected 4 dimensions of wellbeing, namely cognitive, psychological, physical, and social well-being of the inmates of the care home. The protocol was developed after the judges' rating and in consultation with the experts of the department of physical health and rehabilitation at Government Medical College Thiruvananthapuram and experts from various psychology departments of government colleges in Kerala. The relevancy index of each GHT activity was calculated, and a high relevancy index of activities indicated high content validity. Thus, GHT activities that had a relevancy index of more than 85 percent were selected for protocol development. In addition, those activities suggested by the judges were also included in the protocol. A total of 72 activities under four components were developed as a protocol. The Metabolic Equivalents (MET) score of each activity, which describes the intensity of each of the developed therapeutic activities of the protocol, was also included in the protocol. The activities were finalised in such a way that each of the sub-dimensions contained all three MET categories, namely low, medium, and high. In the second phase, a developed protocol was implemented among the inmates of the care home to assess the effectiveness of GHT on their cognitive, psychological, physical, and social well-being for 15 minutes per participant three times a week for sixteen weeks. Observations were taken before and after the intervention. The inmates were divided into six groups of ten each for easy implementation of the GHT. The results revealed that 46.67 percent of inmates were in the age category of 60–65 years, 65% were female, and the majority (81.67%) of them belonged to the Hindu religion. About 23.33 percent of the inmates had primary and higher secondary educational status, respectively; 51.67 percent were daily labourers; and the majority (88.33%) depended on care homes, i.e., didn’t have any financial support. The majority (86.67%) were widowed, 35% had a single child, and 85% belonged to nuclear families. About 46.67 percent of them joined care homes in less than one year, 61.67 percent had no visitors, and 70 percent of them consumed medicines continuously. The results of the paired t test indicated a significant difference between the cognitive components of inmates in care homes before and after the implementation of GHT. The cognitive components of behaviour were further divided into five components: attention, registration, recalling, orientation, and language. The result of the paired t test of these five subdimensions revealed a significant difference between the pre- and post-scores of the attention component. However, cognitive components such as registration, recalling, orientation, and language did not show any significant changes. Results also showed an association between gender, BP, and MMSE scores, with men having higher BP. There was also an association between gender, MMSE scores, and the presence of diabetes, indicating that more men had diabetes and lower MMSE scores. The results of gender-related variations in MMSE scores and Body Mass Index (BMI) categories showed no significant associations. College Thiruvananthapuram and experts from various psychology departments of government colleges in Kerala. The relevancy index of each GHT activity was calculated, and a high relevancy index of activities indicated high content validity. Thus, GHT activities that had a relevancy index of more than 85 percent were selected for protocol development. In addition, those activities suggested by the judges were also included in the protocol. A total of 72 activities under four components were developed as a protocol. The Metabolic Equivalents (MET) score of each activity, which describes the intensity of each of the developed therapeutic activities of the protocol, was also included in the protocol. The activities were finalised in such a way that each of the sub-dimensions contained all three MET categories, namely low, medium, and high. In the second phase, a developed protocol was implemented among the inmates of the care home to assess the effectiveness of GHT on their cognitive, psychological, physical, and social well-being for 15 minutes per participant three times a week for sixteen weeks. Observations were taken before and after the intervention. The inmates were divided into six groups of ten each for easy implementation of the GHT. Engaging in Geriatric Horticultural Therapy (GHT) offers multifaceted benefits. Activities like plant care and observation of leaves and flowers can enhance individuals' cognitive behaviour. Tending the garden, taking brisk walks, and nurturing plants can have a positive impact on psychological well-being. Participating in GHT activities like walking with roommates, sharing gardening experiences, and teamwork can contribute to improved social well-being. Horticultural therapy is a comprehensive approach that significantly improves the well-being and learning experiences of students. It fosters better concentration, academic performance, and environmental awareness. Additionally, GHT can help alleviate the financial and health-related burdens of stress associated with urbanisation, benefiting individuals and communities by enhancing overall wellbeing, promoting togetherness, reducing stress, and improving mental and physical health.