August 2022

Gardening and horticulture therapy

With the worst of winter (hopefully) behind us, it’s time to think about gardening and all the benefits gardens and horticulture therapy can bring for people living with dementia.

Home gardens are an iconic part of Australian culture. And, since lock-down and other restrictions brought about by the pandemic, Australians are investing more time and money into their private gardens. For those living in apartments or with limited outdoor space, balcony and indoor gardening has become more popular, with indoor hydroponic kits, terrariums, herb gardens and “living walls”.

Gardening can bring a range of benefits for people living with dementia, including improved memory, attention, social interaction, reduced stress and increased feelings of calm and relaxation.

Physical benefits of gardening

Gardening is considered one of the main forms of exercise for older Australians. Gardening helps us practice a range of physical skills including walking, reaching, bending, pulling, digging, raking, pruning and more. It can improve endurance and strength as well as mobility, flexibility, and balance.

Other physical benefits of garden environments and gardening include:

• reduces stress and lowers blood pressure
• helps maintain circadian rhythms (the sleep/wake cycle)
• the natural absorption of vitamin D when the skin is exposed to sunlight, which is important for maintaining strong bones.

Therapeutic benefits of gardening

Gardening provides stimulation and interest in the outdoors. It is a meaningful activity that creates a sense of purpose, learning, discovery and fun.

Studies have found gardening has a wide range of benefits including:

• reduced feelings of agitation
• improved attention, memory and cognition
• gaining new skills/regain lost skills
• increased stimulation and interest in nature and the outdoors
• improved sense of responsibility/sense of accomplishment
• improved self-esteem and sense of wellbeing.

Gardening also lends itself to social interaction where people can meet, develop friendships and share their love of plants, the environment and being outdoors. Gardening as a family or in intergenerational settings provides opportunity for older adults to share skills and knowledge with children and young people.

Social gardening can provide a sense of belonging and acceptance for those who may otherwise feel socially isolated. Gardening groups and clubs can provide supportive environments that promote social inclusion of older people, people with disabilities, and people from culturally and linguistically diverse backgrounds. A great example of this is the DIGnity Supported Therapeutic Gardening Program that operates from two community gardens in southeast Tasmania.

For people with dementia, gardening can provide a form of social interaction without needing to engage in traditional forms of communication. You can encourage your local gardening group or club to become more socially inclusive and dementia friendly, by directing them to the Dementia Australia website: Dementia Friendly. 

Get involved in gardening!

Consider joining one of these garden-oriented group or clubs:

• Garden Clubs of Australia provides a range of services to its members (affiliated clubs) and currently has over 780 affiliated clubs representing more than 52,000 individuals. Their motto is: “Friendship Through Gardens.”
• Bushcare and Landcare volunteering – these groups are usually part of a local council or National Parks & Wildlife Service program. They are often provided with assistance in the way of qualified and experienced supervision, tools, training, etc.
• Community Gardens Australia are a networking organisation connecting community gardeners around Australia. They can help you connect with, or even establish your own, local community garden and provide advice about what plants you can grow including fruits, herbs and vegetables.

Therapeutic garden design

Therapeutic garden design focuses on increasing sensory stimulation for people with dementia living at home or in residential or assisted care facilities. Therapeutic gardens often include plants with a stimulating appearance, feel and smell. Plants and trees provide shade and seasonal variation, and a place for sitting, relaxing, socialising and, (of course!) gardening.

Some therapeutic gardens include raised planters where people with dementia can use their hands or simple safe tools for digging and other activities. Planting food, such as fruit, vegetables and herbs, increases the sensory experiences, provides meaningful activity and also promotes nutritional learning and healthy eating.

The Dementia Enabling Environments website provides a range of resources and garden design principles for home gardens and care facilities. Important principles include having visual cues so that garden users gain a sense of control and self-confidence. Also ensuring all potential safety issues are addressed in the garden planning process and removing physical and mental barriers to enhance garden accessibility. For more information, download the Dementia Australia document: “Gardens that Care: Planning Outdoor Environments for People with Dementia”.

Check out the Dementia Australia Dementia Friendly Garden in Port Macquarie via this video on YouTube.

More ways to enjoy gardens, plants and green space

• Go for a walk in a garden on your own, with your dog, or with a friend
• Create your own small pot garden or larger vegetable garden
• Decorate plastic or terracotta pots for planting
• Pick and arrange flowers to display about your house or gift to others
• Collect plant seeds and learn how to harvest and sow them
• Experience the joy and satisfaction of harvesting, cooking and eating produce from the garden
• Support a friend or neighbour by helping them maintain their garden
• Volunteer – for example, in a school or public garden.

Rediscovering libraries

Libraries provide a wealth of resources for all ages and can be particularly useful and engaging for older people including people living with dementia.

Accessing information, entertainment, technology and genealogy

Libraries are not just for books. In fact, libraries and librarians can help you to access a range of information and entertainment, and much of it for free. For example, you can access:

• Fiction (including large print) and non-fiction books
• Audio books and eBooks
• Music (CDs)
• Movies (Videos and DVDs)
• Computer, printing, scanning and photocopying services
• Magazines and newspapers
• Local studies and stories (including images and history)
• Outreach services including assisted borrowing or home delivery of your borrowed items.

Some libraries even employ a Family History Librarian and can assist you to research your family history. For example the National Library of Australia and the State Library of NSW have family history research resource. Check your state/territory or local library for their family history resources. Consider whether starting a project like this could be of interest to you. Doing this type of research is a great way to keep your brain active and make new connections.

Making social connections

Whilst information sharing is a primary role, public libraries are also important places for people to gather, relax and connect with one another and their community. Many local libraries act as venues or convene social groups for older people such as:

• sessions to support you use computers/mobile phones
• film appreciation groups
• craft groups
• book clubs
• or other educational programs.

Some libraries provide a book-club service with either online book club access or printed kits that can be borrowed for a set period.

Dementia specific library resources and services

Some libraries also have specific sessions and resources for people living with dementia, such as Newcastle Library’s Memory Room project with information sessions with an art therapist, and memory boxes available for loan. These memory boxes are each based on different topics with resources specifically designed to spark memories, stimulate conversation and provide entertainment.

Some libraries offer dementia collections with a range of materials like photobooks, puzzles, tools, and other objects designed to provide stimulation and keep the mind active. See for example, the Eastern Regional Libraries of Victoria which offer dementia care kits including a reminiscing kit (to prompt memories of the past); a sensory kit (items that can be held and handled to prompt the senses) and an activity kit (items that can be ‘played’ with such as games, etc). Ask your local librarian if they have dementia-specific sessions or resources.

Accessing Dementia Friendly places and spaces

More public libraries across Australia are becoming dementia friendly. They are working with people with lived experience of dementia, and their carers and supporters, and working to create awareness about dementia and reduce stigma within their local communities.

To become dementia friendly, the library staff undertake training and the library itself undergoes an environmental assessment is undertaken to ensure accessibility for people with dementia. If your local library hasn’t taken this step perhaps you could work with them to promote a more inclusive space for you and others in your community. To find out more visit: Dementia Friendly Australia.

Access Dementia Australia’s library and resources

Dementia Australia offer a national library service with access to a comprehensive collection of print and digital resources about dementia. The service supports people living with dementia, family carers and friends as well as people working in dementia care practice and allied health areas.

Dementia Australia's extensive collection includes books, articles, audio resources, ebooks and DVDs. Resources include information on dementia care, as well as items written by carers and people living with dementia, dementia in fiction, resources for children, clinical information, and practical information for caregiving and living well with dementia.

You can register online to become a Dementia Australia Library user, and:

• Browse their full library catalogue
• Access eBooks and Audiobooks with 24-hour access to resources

For more information, email library@dementia.org.au or call the National Dementia Helpline 1800 100 500.

Reading as therapy

Reading for pleasure has been shown to slow cognitive decline and enhance life satisfaction, relationships, coping skills and attitudes to, as well as engagement with, learning. Reading allows the imagination to flourish, reduces stress and enhances empathy by bringing about a greater understanding of ourselves and others.

Shared Reading Groups began in the United Kingdom in the early 2000s with an award-winning social enterprise known as “The Reader”.  Shared reading groups are quite different to book clubs. People come together in public places, like libraries and community centres, with a trained facilitator. Everyone takes turns to read poems or novels aloud to the group and discuss the characters and actions as they go. Participants report shared reading groups help them increase their confidence, reduce social isolation and improve their emotional wellbeing and empathy.

An evaluation report of literature-based interventions for people living with dementia in the UK found that shared reading produces a significant reduction in dementia symptoms and benefits the quality of life of both residents and staff carers.

Shared Reading is gradually taking off in Australia. For more information, visit Shared Reading NSW.

Diabetes and dementia

Diabetes is the fastest growing chronic condition in Australia. Over 1 million Australians have Type 2 diabetes, and up to 1 in 5 people with the disease are yet to be diagnosed.

Research has shown that having diabetes increases your risk of developing dementia. The risk of developing dementia in the general population is around 10%, for people with diabetes this risk increases to around 20%.

People most at risk of developing Type 2 diabetes include:

• people with a family history of diabetes
• people aged 55+ (risk increases with age)
• people aged 45 + and overweight and/or high blood pressure
• people over 35 from an Aboriginal or Torres Strait Islander background; or from Pacific Island, Indian subcontinent or Chinese cultural background
• women who have given birth to a child over 4.5 kgs (9 lbs) or had gestational diabetes or Polycystic Ovarian Syndrome.

While there is currently no cure, Type 2 diabetes can be well managed through lifestyle modifications and medication.

Reducing the risk of diabetes and dementia

To reduce your risk of developing Type 2 diabetes and dementia:

• Regularly check your blood sugar levels and follow treatment advice if diabetes or other problems are found.
• Engage in regular physical exercise
• Keep your cholesterol levels and blood pressure in the target range.
• Maintain a healthy body weight by eating a well-balanced and healthy diet of foods low in saturated fat (avoid fatty, salty and sugary foods) and regular exercise
• Reduce alcohol consumption
• Stop smoking
• Keep mentally and socially active to reduce the risk of developing dementia.

Annual health assessments 40-49 years and 75+ years

People aged 45 to 49 years who are at risk of developing a chronic disease such as Type 2 diabetes and all people over 75 years can have comprehensive health assessments with their GP and practice nurse. These assessments are funded by Medicare and incur no out-of-pocket expenses.

Health assessments help determine your personal risk of diabetes and/or dementia. Depending on the outcome of these assessments, your GP can then put together a Chronic Disease Management plan. These plans provide up to five subsidised allied health visits every year. This can include visits to podiatrists, physiotherapists, occupational therapists, dieticians, exercise physiologists and more. Your GP will coordinate and liaise with your allied health practitioner to ensure you get the support you need to better manage or lessen the impact of unwanted symptoms.

Alcohol and dementia

Alcohol is the most widely used drug in Australia. People drink alcohol for a range of reasons and in different social and cultural contexts. But heavy and frequent alcohol consumption can cause many chronic health conditions. Drinking a lot of alcohol (i.e. more than 7 drinks a week for women, or more than 14 drinks a week for men) also increases your risk of getting dementia.

As you age, it is important to talk with your GP about your alcohol consumption in case of adverse reactions alcohol may have with your medications. Alcohol may also increase your risk of accidents, falls or fractures. Heavy drinking may speed up deterioration in people living with dementia.

Alcohol-related dementia

Anyone who engages in heavy or binge drinking regularly, over a long time, can develop alcohol-related dementia. It is most common in men over 45 years but can affect men and women of any age. Alcohol related dementia is caused by nutritional problems which often accompany long-term heavy drinking or binge drinking. Key parts of the brain may suffer damage through vitamin deficiencies, particularly thiamine deficiency (Vitamin B1).

What are the symptoms?

The symptoms of alcohol-related dementia are like other forms of dementia. They can vary from person-to-person but generally include:

• Impaired ability to learn things
• Personality changes
• Problems with memory
• Difficulty with problem solving, particularly for tasks which require planning, organising, common sense judgement and social skills
• Problems with balance
• Becoming more socially isolated and withdrawn.

Is moderate alcohol consumption safe for the brain?

It is not possible to say how drinking within recommended guidelines affects the brain. However, adopting a healthy lifestyle throughout your life can help reduce the risk of dementia and other long-term health issues. This includes drinking in moderation but also other factors such as not smoking, engaging in physical exercise and eating a healthy, balanced diet. For more information, read these articles on our website:

• 4.2 Exercise to boost your physical health
• 4.3 Eat and drink well

If alcohol-related dementia is diagnosed early, symptoms may be improved or reversed if the person stops drinking alcohol and starts replacing thiamine (vitamin B1).

If you’re worried about a friend or family member who is experiencing memory problems, confusion and/or personality changes, encourage them to visit their GP. If they don’t have a GP, help them  find one by searching on Health Direct. Delays in help-seeking can compound issues, delay potential early treatment and therapy, and increase individual and family distress.