Skip to main content
American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2008 Feb-Mar;23(1):31–45. doi: 10.1177/1533317507309799

Does a Wander Garden Influence Inappropriate Behaviors in Dementia Residents?

Mark B Detweiler 1, Pamela F Murphy 2, Laura C Myers 3, Kye Y Kim 4
PMCID: PMC10846086  PMID: 18276956

Abstract

Background: The effect on resident behaviors of adding a wander garden to an existing dementia facility was investigated. Methods: 34 male residents were observed for 12 months before and after opening the garden. Behaviors were assessed using the Cohen-Mansfield Agitation Inventory Short Form (CMAI), incident reports, as needed medications (pro re nata [PRN]), and surveys of staff and residents' family members as indices of affect. Results: Final CMAI scores and total PRNs employed were lower than baseline values with a trend for residents who used the garden more often to have less agitated behavior. Verbal inappropriate behaviors did not change significantly whereas physical incidents increased. Staff and family members felt that the wander garden decreased inappropriate behaviors and improved mood and quality of life of the dementia residents. Conclusions: Study design characteristics and garden management may have affected behaviors both positively and negatively. Additional studies are needed to explore the benefits of wander gardens for dementia residents.

Keywords: dementia, agitation, inappropriate behaviors, medications, wander garden

Full Text

The Full Text of this article is available as a PDF (243.2 KB).

Contributor Information

Mark B. Detweiler, Psychiatry Service, Veterans Affairs Medical Center, Salem, Department of Neuropsychiatry, Behavioral Science, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia, Mark.Detweiler1@med.va.gov .

Pamela F. Murphy, Virginia Polytechnic Institute and State University, Blacksburg, Virginia.

Laura C. Myers, Catawba Hospital, Catawba; Virginia.

Kye Y. Kim, Psychiatry Service, Veterans Affairs Medical Center, Salem, Department of Neuropsychiatry, Behavioral Science, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia.

References

  1. McMinn BG , Hinton L. Confined to barracks: the effects of indoor confinement on aggressive behavior among inpatients of an acute psychogeriatric unit. Am J Alzheimers Dis Other Demen. 2000. ;15:36-41. [Google Scholar]
  2. Marlowe RA Effects of environment on elderly state hospital relocates. Paper presented at: The 44th Annual Meeting of the Pacific Sociological Association; 1973; Scottsdale, AZ. [Google Scholar]
  3. Lieberman MA Relocation research and social policy. Gerontologist. 1974:14:494-500. [PubMed] [Google Scholar]
  4. Epstein M., Hansen V., Hazen T. Therapeutic gardens: plant centered activities meet sensory, physical and psychosocial needs. Oreg J Aging. 1991. ;9:8-14. [Google Scholar]
  5. Namazi KH, Johnson BDN. Pertinent autonomy for residents with dementias: Modification of the physical environment to enhance independence. Am J Alzheimers Dis Other Demen. 1992;7:16-21. [Google Scholar]
  6. MalkinJ. Hospital Interior Architecture. New York, NY: Van Nostrand, Reinhold; 1992:13-37. [Google Scholar]
  7. Tariot PN, Ryan JM, Porsteinsson AP, Loy R., Schneider LS Pharmacologic therapy for behavioral symptoms of Alzheimer's disease . Clin Geriatr Med. 2001;17:359-376. [DOI] [PubMed] [Google Scholar]
  8. Cohen-Mansfield J., Marx MS, Rosenthal AS A description of agitation in a nursing home . J Gerontol. 1989;44: M77-M84. [DOI] [PubMed] [Google Scholar]
  9. National Center for Health Statistics. The National Home Survey; Series 13, #97. Hyattsville, MD: DDHS, USPHS, #89-1758; 1989. [Google Scholar]
  10. Patel V., Hope RA A rating scale for aggressive behavior in the elderly—the RAGE. Psychol Med. 1992;22:211-221. [DOI] [PubMed] [Google Scholar]
  11. Cohen-Mansfield J. Nonpharmacologic interventions for inappropriate behaviors in dementia. Am J Geriatr Psychiatry. 2001;9:361-381. [PubMed] [Google Scholar]
  12. Kaplan R., Kaplan S. The Experience of Nature: A Psychological Perspective. Ann Arbor, MI: Ulrich's; 1996. [Google Scholar]
  13. Ulrich RS, Parsons R. Influence of passive experiences with plants on individual well being and health. In Relf D, ed. The Role of Horticulture in Human Well-being and Social Development . Portland, OR: Timber Press; 1992. :93-105. [Google Scholar]
  14. Kuo FE, Sullivan WC Environment and crime in the inner city: does vegetation reduce crime ? Environ Behav. 2001;33:343-367. [Google Scholar]
  15. Laben JK Wandering: a current problem, nursing's responsibility for effective management . J Nurs Law. 1997; 4:65-71. [Google Scholar]
  16. Ellis DJ Gardens for Alzheimer's patients. Am Horticulturist . 1995;74:6. [Google Scholar]
  17. Weisman GD, Cohen U., Ray K., Day K. Architectural planning and design for dementia care units. In: Coons DH, ed. Specialized Dementia Care Units. Baltimore, MD: Johns Hopkins University Press; 1991:93-98. [Google Scholar]
  18. Mather JA, Nemecek D., Oliver K. The effect of a walled garden on behavior of individuals with Alzheimer's . Am J Alzheimers Dis Other Demen. 1997;12:252-257. [Google Scholar]
  19. Cohen-Mansfield J., Werner P., Watson V., Pasis S. Agitation among elderly persons at adult day-care centers: the experiences of relatives and staff members. Int Psychogeriatr. 1995;7:447-458. [DOI] [PubMed] [Google Scholar]
  20. Cohen-Mansfield J. Assessment of agitation. Int Psychogeriatr. 1996;8:233-245. [DOI] [PubMed] [Google Scholar]
  21. Cohen-Mansfield J., Billig N. Agitated behaviors in the elderly: a conceptual review. J Am Geriatr Soc. 1986. ; 34:711-721. [DOI] [PubMed] [Google Scholar]
  22. Meyers LS, Guarino A., Gamst G. Applied Multivariate Research: Design and Interpretation. Thousand Oaks, CA: SAGE Publications; 2005:20. [Google Scholar]
  23. Ott RL, Longnecker M. An Introduction to Statistical Methods and Data Analysis. 5th ed. Pacific Grove, CA: Duxbury; ; 2001. [Google Scholar]
  24. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum; ; 1988. [Google Scholar]
  25. Segal S., Moyles E. Management style and institutional dependency in sheltered care. Soc Psychiatry. 1979;14: 159-165. [PMC free article] [PubMed] [Google Scholar]
  26. Ernst RL, Hay JW The US economic and social costs of Alzheimer's disease revisited . Am J Public Health. 1994; 84:1261-1264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Fillit H., Hill J. Economics of dementia and pharmacoeconomics of dementia therapy. Am J Geriatr Pharmacother. 2005;3:39-49. [DOI] [PubMed] [Google Scholar]
  28. Doody RS Current treatments for Alzheimer's disease: cholinesterase inhibitors . J Clin Psychiatry. 2003:64 (suppl 9):11-17. [PubMed] [Google Scholar]
  29. Sunderland T. Treatment of the elderly suffering from psychosis and dementia. J Clin Psychiatry. 1996;57 (suppl 9):53-56. [PubMed] [Google Scholar]
  30. Sunderland T. Treatment of the elderly suffering from dementia . J Clin Psychiatry Monogr. 1995;15:31-33. [PubMed] [Google Scholar]
  31. Aldridge J., Sempik J. Social and therapeutic horticulture: evidence and messages form research . Centre for Child and Family Research; 2002, Evidence Issue 6. http://www.growingtogether.org.uk . [Google Scholar]
  32. Ulrich RS View through a window may influence recovery from surgery. Science. 1984;224:420-421. [DOI] [PubMed] [Google Scholar]
  33. Coulter AH Healing gardens: when nature is therapy. Altern Complement Ther. 1999;5:64-73. [Google Scholar]
  34. Kaplan R., Bardwell LV, Ford HA, Kaplan S. The corporate back-40: employee benefits of wildlife enhancement efforts on corporate land. Hum Dimens Wildl. 1996;1:1-13. [Google Scholar]
  35. Colenda CC, Hamer RM Antecedents and interventions for aggressive behavior of patients at a geropsychiatric state hospital. Hosp Community Psychiatry . 1991;42: 287-292. [DOI] [PubMed] [Google Scholar]
  36. Robertson A. , Gilloran A., McGlew T., McKee K. Nurses' job satisfaction and the quality of care received in psychogeriatric wards. Int J Psychiatry. 1995;10:575-584. [Google Scholar]
  37. Rosen J., Burgio L., Kollar M., et al. The Pittsburgh Agitation Scale: a user-friendly instrument for rating agitation in dementia patients. Am J Geriatr Psychiatry . 1994;2:52-59. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Alzheimer's Disease and Other Dementias are provided here courtesy of SAGE Publications

RESOURCES