The Garden Pathway – Ann’s Garden First Year Report, 2022

Social and Therapeutic Horticulture for People with Dementia at The Vale Hospital Dursley

Where joy can freely bloom

Over a year ago ‘Down to Earth Stroud’ and ’The Garden Pathway’ were delighted to receive funding from a number of organisations. The aim was to build and run a very special place. ‘Ann’s Garden’ is named after Ann, the wife of Down to Earth volunteer John, who died after living with Lewy Body dementia five years ago. Ann’s Garden is a bespoke, purpose-built garden designed to be cared for by people with dementia.

Housed in the grounds of The Vale Hospital, Dursley, Ann’s Garden was built from scratch in an area of unused scrubland. It now hosts Social and Therapeutic Horticulture courses for people with dementia. Once referred into the project each individual is assessed by an expert clinician in dementia and mental health. Their own unique programme of horticulture is designed to support their social, psychological, and emotional needs.

Courses have been specifically designed for and delivered to those who are experiencing social isolation or psychological difficulty. This includes low mood or anxiety as a result of their dementia diagnosis. Each individual is supported to care for Ann’s Garden through horticultural activities designed to meet their own unique needs.

After months of designing and developing the site for our client group the garden was completed with wheelchair friendly pathways, raised beds with build in seating, polytunnel, potting shed, and easy-grip specialist tools. The garden was opened with a grand party on the 18th May 2022 and we have since loved every moment of supporting our first course of gardeners who have brought life to the garden.

For those with a creative edge we have made bookmarks and collages from pressed flowers grown and cared for by our gardeners. We have shared stories and laughter, and made flower arrangements in vintage glass vases for gardeners to enjoy at home. We’ve made window boxes and planted bowls for gardeners to care for when they are not on the course. Our lavender crop was prepared to make into lavender bags for our gardeners to give to family and friends or enjoy in their own home.

For those more interested in the edible crops we have grown pumpkin, tomatoes, basil, squash, potatoes, sage, raspberries and strawberries. We all hugely enjoyed our bumper crop of cucumbers! Gardeners shared their produce amongst the group and we often had something delicious to take home for lunch, or enjoyed a plate of freshly picked raspberries with our regular coffee and cake breaks.

Evaluation and analysis of the first course

At the end of our first ten week long weekly course we sought qualitative feedback from our gardeners through semi-structed interviews. Measures of wellbeing were analysed pre and post the course through the Warwick – Edinburgh Mental Well-Being Scale (WEMWBS). The following results were obtained.

Demographics

Six gardeners attended the first course, three male and three female. The age range was 61 – 97 years. Dementia type varied, with three having a diagnosis of Alzheimer’s disease, two with Parkinson’s related dementia, and one with a diagnosis of Vascular dementia. All completed the full ten-week course other than one gardener who became ill during the course of the ten weeks and was admitted to hospital. This client unfortunately never became well enough to re-join the group. At the end of the ten weeks many gardeners and their carers expressed sadness that the course was coming to an end. As a result, a decision was taken to extend the course by a further month so gardeners could complete the growing season and harvest all their crops. All but one gardener chose to attend the extended sessions. At the end of October, regular weekly sessions were paused due to the weather turning colder but shorter ‘top up’ sessions were offered over the winter period which all remaining clients chose to attend.

Quantitative data

The WEMWBS questionnaire has not yet been administered in sufficient numbers for changes seen to represent statistical significance. However, the trend on all but one of the questionnaires was indicative of improvement in well-being scores after having attended The Garden Pathway course. The one questionnaire which was not suggestive of improvement showed no clear change over time, but this gardener scored relatively highly on initial assessment leaving little room for improvement to be seen on this set of scores. Initial results of the WEMWBS questionnaire therefore suggests that attending The Garden Pathway’s Social and Therapeutic Horticulture course leads to an improved sense of wellbeing for people diagnosed with a range of different dementia types and across an age range of 36 years.

Qualitative Evaluation

At the end of the course gardeners were asked their views on attending a course at The Garden Pathway through the use of a semi-structured interview. Gardeners were asked how they felt about attending the course, what they liked most about the course, what they liked least about the course, if there was anything they would change about the course, and if they had any further comments. Of all feedback obtained from the gardeners only one dislike / change was suggested by the gardener who chose not to attend the extended sessions. This gardener, whilst enjoying the space and environment, did not feel the purpose of their attendance on the course had been clearly explained. All other gardeners provided only positive feedback which was analysed into the following themes:

  • Reducing social isolation

The first theme emerging from gardener feedback was that the group offered meaningful companionship and a reduction in social isolation. The conversations and social content were regularly commented upon as one of the best things about the group and a source of pleasure and joy for gardeners.

“It’s so wonderful, I’ve had a wonderful time.

I haven’t been out all week, but I feel happy now”

  • Re-discovering old skills or developing new skills with improvement in self-esteem

Gardeners described enjoying the chance to use skills that they may not, due to illness, mood difficulty, or lack of opportunity, have employed for some time with an improved sense of self-esteem as a result. Others talked about the pleasure of learning new skills or taking part in gardening activities with which they may not have otherwise engaged.

“Before coming here I didn’t really like gardening but I love this (with hands covered in compost after taking the lead on a bulb planting exercise) and I miss it when I’m not here.”

  • Opportunity to reminisce / re-live happy memories

At the Garden Pathway gardeners were always given the opportunity to tell their own story and recount memories that were important to them. Feedback suggested that the multisensory medium of the gardening activity often triggered memories and supported this positive reminiscence approach.

“I don’t like cucumbers in the home and pick them out of salad but these taste like something I haven’t tasted in years. These are the cucumbers like my father grew with me.”

  • Improved mood

Gardeners reported that their mood lifted not only while they attended the session but that their attendance supported an improved mood even in between the weekly sessions. One gardener commented how they kept the lavender bag made at The Garden Pathway by their bed and the smell every evening helped them to relax, remember the happy time they had had, and even sleep better.

“before coming here today I felt really (sighed and slumped body indicating a low feeling) but I feel so much better now, I feel happy now” being one comment and

“I feel happy and energized” being another.

Family / carer feedback

Whilst family members / carers weren’t formally asked to provide feedback many comments were received which also serve as useful evidence as to the effectiveness and impact of the group.

  • Family members comments included areas linked to giving their loved one back a purpose they had previously been lacking.

 

thank you for inspiring (name of gardener) and giving him a purpose back again”

  • Other feedback related to improved mood even in those who had had previously been significantly depressed and withdrawn from other activities.

 

It (the session) was wonderful – it was the most animated I have ever seen him”

  • Multiple comments were made by carers that The Garden Pathway course had been the only thing that their client / loved one had engaged in and several referrers or family members have asked if the individual can continue at the garden when we re-start courses in the Spring.

    “thank you for facilitating such a therapeutic space (name of client) has again told me how much she has benefited from attending your group” being one comment and

    “It’s so important what you’re doing as it’s so nurturing for people to still be able to till the soil and be in touch with plants” another.

 

Next Steps

We now have multiple gardeners who would like to continue attending The Garden Pathway in the Spring and more new gardeners who are on our waiting list and keen to commence sessions with us. To maintain sessions for another year we are now seeking additional funding to continue providing Social and Therapeutic Horticulture for people with dementia for another year.

Breakdown of costs sought:

£500 plants, compost, containers, craft equipment

£3,360 staff cost

£250 maintenance / improvement to the site

We have also been asked if we can offer outreach sessions to individuals who find it difficult to get to the garden. This is not a service we have been able to provide in our first year. If we were to add this option into the offering we would require a further £1,680 to cover staff cost and travel to our outreach clients.

We are therefore seeking funding of

£4,110 to maintain our weekly sessions at Ann’s Garden for the next year or

£5,790 to maintain our weekly sessions and offer an outreach service for clients who have difficulty getting to the garden.

Ann’s Garden is a pioneering project in dementia care and part of the ‘new solution’ to mental health as recommended by the National Institute for Clinical Excellence. We have been excited to join with our client gardeners to grow together, cultivate wellbeing and create a space where people living with dementia can connect with nature, exercise choice and control, experience success, and develop friendships. We would like to thank our funders for making this possible and for your support going forward.

Website: www.thegardenpathway.org

Twitter: @GardenPathway