A Systematic Review of Horticultural Therapy’s Influence on Chinese Older Adults’ Psychosocial Wellbeing

Effectiveness of Horticultural Therapy in Older Adults without Dementia: A Systematic Review and Meta-Analysis

OBJECTIVES

Horticultural therapy (HT) has garnered growing interest because of its psychological and physical benefits. Previous reviews have demonstrated its therapeutic effects in older adults with cognitive impairment or mental illnesses. However, its impact on older adults without dementia has not been synthesized. This systematic review studied the effects of HT on the physical and psychosocial functions of older adults without dementia.

DESIGN

Systematic review and meta-analysis.

SETTINGS AND PARTICIPANTS

Older adults without dementia ≥60 years of age.

METHODS

Randomized controlled trials and quasi-experimental studies were systematically searched in 7 databases. The Cochrane Risk of Bias Tool version 2 and the Risk of Bias in Non-randomized Studies of Interventions tool were used to assess study quality. A random-effects meta-analysis with Hedges' g was conducted to estimate the effect size, and Cochran's Q test and I2 were used to evaluate heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation approach was applied to determine the overall quality of evidence.

RESULTS

Twenty-seven studies, including 11 randomized controlled trials and 16 quasi-experimental studies comprising 1629 older adults from 11 countries, were included. HT tended to improve psychosocial outcomes in older adults, particularly in terms of self-efficacy (g = 0.52; 95% CI, 0.26-0.79) and self-esteem (g = 0.52; 95% CI, 0.26-0.79). In terms of physical benefits, HT appeared to have a greater impact on aerobic endurance, with a large effect size (g = 0.84; 95% CI, 0.54-1.15), compared to agility, which showed a smaller effect size (g = 0.45; 95% CI, -0.90 to -0.01).

CONCLUSIONS AND IMPLICATIONS

This review demonstrated that HT could provide psychosocial and physical benefits to older adults without dementia. These benefits include slight improvements in self-efficacy, self-esteem, aerobic endurance, and agility. However, the certainty of this evidence is very low due to the quasi-experimental design and potential bias in outcome measurements. Further research with well-designed clinical trials is necessary to confirm its effectiveness.

Efficacy of Horticultural Therapy on Positive, Negative, and Affective Symptoms in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: Positive symptoms, negative symptoms, and emotional disturbances are core features of schizophrenia. Although horticultural therapy (HT) has shown promise as an adjunctive treatment, evidence supporting its effectiveness remains limited. This systematic review and meta-analysis aimed to assess the impact of HT on total symptoms, positive symptoms, negative symptoms, and emotional disturbances in individuals with schizophrenia. Methods: We conducted a search for randomized controlled trials (RCTs) published up to March 2024 across multiple databases, including PubMed, Embase, Cochrane Library, CINAHL, CEPS, CNKI, Wanfang, and Yiigle. A random-effects model was employed to calculate the standardized mean difference (SMD). Results: A total of 35 studies enrolling 2899 participants were included. Our results indicated that, in the short term (≦3 months), HT has moderate to large effect sizes on total symptoms (SMD = 0.690, 95% CI 0.463 to 0.916), positive symptoms (SMD = 0.695, 95% CI 0.038 to 1.351), negative symptoms (SMD = 0.681, 95% CI 0.395 to 0.967), depression (SMD = 0.646, 95% CI 0.334 to 0.959), and anxiety (SMD = 0.627, 95% CI 0.364 to 0.890), with more pronounced benefits for anxiety symptoms in patients with a shorter duration of illness. In the long term (>3 months), HT shows large effect sizes for total symptoms (SMD = 1.393, 95% CI 0.858 to 1.928), negative symptoms (SMD = 1.389, 95% CI 0.935 to 1.842), anxiety (SMD = 1.541, 95% CI 1.042 to 2.040), and moderate to large effect sizes for positive symptoms (SMD = 0.667, 95% CI 0.077 to 1.258) and depression (SMD = 0.707, 95% CI 0.198 to 1.217). Additionally, longer weekly treatment durations are associated with better outcomes for total symptoms and negative symptoms. Schizophrenia patients with more severe initial symptoms may be potential responders to HT. Conclusions: These findings support the efficacy of HT in improving symptoms and emotional well-being in schizophrenia patients. Further trials with more rigorous designs are warranted to confirm these benefits.

The impact of gardening on well-being, mental health, and quality of life: an umbrella review and meta-analysis

BACKGROUND

Gardening and horticultural therapy (HT) has been widely recognised as a multicomponent approach that has affected a broad range of health and well-being outcomes. The aim of this umbrella review and meta-analysis was to compare the findings of previous reviews on the impact of multiple gardening interventions and gardening attributes on different well-being constructs.

METHODS

Electronic databases including PubMed, Web of Science, Science Direct, the Cochrane Library, and Google Scholar were searched from inception to December 2022. Interventional and observational reviews were eligible for inclusion in this umbrella review. Outcome measures included mental well-being, health status and quality of life. The key exposure variables were gardening and horticultural therapy. Narrative synthesis was used to evaluate the overall impact of gardening and HT on study outcomes. For a subsample of studies with available quantitative data, a random effect meta-analysis was conducted.

RESULTS

This umbrella review included 40 studies (10 interventional studies, 2 observational studies, and 28 mixed interventional and observational studies). The reviewed studies reported an overall positive impact of gardening activities on several measures of mental well-being, quality of life, and health status. Meta-analysis showed a significant and positive effect of gardening and HT activities on well-being (effect size (ES) 0.55, 95% confidence interval (CI) 0.23, 0.87, p < 0.001).

CONCLUSIONS

Evidence from observational and interventional studies supports a positive role for gardening and HT activities on well-being and general health. Interventional studies with horticultural-based therapies were effective in improving well-being and quality of life both in the general population and vulnerable subgroups. The high degree of heterogeneity in the included studies cautions against any direct clinical implications of the study findings.

Effects of horticultural therapy on health in the elderly: A review and meta-analysis

Aim

Given the current aging population, the demand on medical facilities, facilities for elderly care, and even their high prevalence, it is crucial to investigate the advantages of older people. The purpose of our study was to systematically review the existing literature on the health effects of horticultural therapy as a treatment option for the elderly.

Subject and methods

Article searches were conducted through five databases: Web of science, Science Direct, PubMed, EBSCO, and Google Scholar, according to the standard method of systematic evaluation and meta-analysis. Thirty-two published articles were included, and 27 relevant variables were meta-analyzed to assess the benefits of horticultural therapy in terms of physical and psychological functioning in the elderly.

Results

Results show that horticultural therapy may be helpful in helping seniors lose weight -0.195 (95% CI -0.507,0.117), reduce their waist circumference -0.327 (95% CI -0.637, -0.017), lower their stress -0.339 (95% CI -0.610, -0.069) and cortisol -0.902 (95% CI -0.728, -0.002) levels, improve their physical flexibility 0.302 (95% CI 0.036, 0.569), social interaction 0.370, (95% CI 0.115, 0.624), and daily vegetables and fruit consumption 0.688 (95% CI: 0.287, 1.089).

Conclusion

Horticultural therapy may be a useful tool for enhancing the physical, mental and social aspects of the elderly. However, there is substantial heterogeneity and wide variation in the quality of the included studies. Further high-quality studies, rigorous controls and adjustments for significant confounding variables, and larger populations are needed in the future to further our understanding of the link between horticultural therapy and elder health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01938-w.