The effect of horticultural therapy on older adults in pension institutions: a systematic review

As fertility and mortality levels decrease, the number of older adults is on a continuous growth trend. The total number of older adults worldwide has reportedly exceeded 700 million, and countries with 10 million older adults have increased to 13, in the following order: China, India, United States, Japan, Russian Federation, Brazil, Indonesia, Germany, France, Italy, United Kingdom, Thailand, and Mexico.1,2 The World Health Organization predicts that by 2050, the world's older adults will reach a high rate of 16% (1 in 6 people will be aged 65 years or older) and the issue of aging cannot be ignored.3 When the burden of care exceeds family resources or leads to inadequate living for family members, institutional pension becomes another reliable option for people.4

Pension institutions are long-term care facilities that provide comprehensive services for older adults such as old-age security, life care, rehabilitation care, health management, and recreational activities. The service subject is older adults.4,5 It was found that for different groups of older adults (e.g., healthy, disabled, economically disadvantaged, etc.), pension institutions can provide various choices of senior care, including retirement communities, social welfare homes, continuing care retirement communities, senior apartments, nursing homes, and care homes, to meet the demand for different services for the older adults.5 For example, services for older adults with disabilities can be provided by pension institutions with both 24 h care and day care options, depending on the care needs of the family and the older adult. The purpose of a pension institution is to provide a safe environment and continuity of care for older adults with senior living needs.6 However, for many older adults, moving into a pension institution can be a difficult decision. Pension institution admission implies a change in the living environment and social isolation, which may lead to maladjustment, reduced socialization, and increased negative emotions (e.g., feelings of loneliness, abandonment, etc.) that can significantly undermine the health and well-being of older adults.7, 8, 9 For older adults who lack mobility and suffer from serious medical conditions, pension institution can be traumatic and often results in serious health outcomes for older adults, such as increased anxiety, emotional distress, and confusion, which may lead to further decline in functioning.10,11

Nowadays, institutional pension is an unstoppable trend, how to mitigate the negative effects of institutions and enhance or improve the health and well-being of older adults is a challenging issue, and we should actively explore the effects of various therapies or interventions on older adults. Horticultural therapy (HT) is an emerging therapeutic approach. There is no uniform definition. The American Horticultural Therapy Association defines HT as guided gardening activities within an established therapeutic, rehabilitative, or occupational program.12 The Chinese Division of Horticultural Therapy defines it as horticultural therapy is a method of maintaining and restoring people's bodies and functions and improving their quality of life through plants, their growing environment, and various activities related to plants.13 Although the definitions vary slightly from country to country, the main idea is to regulate the physical and mental health of people through horticulture. Therefore, all horticultural activities that use plants and horticultural practices to serve the physical, mental, and spiritual aspects are referred to as horticultural therapy in this article.

As a form of "active" contact and interaction between human and natural elements, HT can improve quality of life, negative emotions (anxiety, depression, etc.), well-being, social interaction, etc. HT is particularly suitable for pension institutions because it can be adapted to all populations and meet the needs of people with different health conditions. At the same time, it can have an economic effect and does not add additional burden to pension institutions. Nowadays, HT has been reported to support the health of older people. A recent systematic review was searched until June 2021 and included only one piece of relevant literature from 2020 (no literature from 2021), and the inclusion was limited to older adults only, without categorizing further types of older adults.14 In contrast, older adults in pension institutions are different from general older adults in that they are in a relatively closed environment and differ from general older adults in terms of physical and mental health. Since several randomized controlled trials on the benefits of HT in older adults in pension institutions have been published in the last 2 years, there is a need to update the evidence to assess the benefits of HT in older adults. Therefore, this systematic review aims to identify and evaluate the impact of horticultural therapy on older adults in pension institutions.

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