Most people love a garden, however small the plot of land involved. Even a few square feet of paving slabs with a few pots planted with colourful and scented flowers can be pleasant to sit out in. No matter how small the space available, or how limited an individual or organisation's financial resources, a lot can be achieved with one or two keen participants, and the results can be enjoyed by those that give care and those that receive it alike.
Having access to an enjoyable outdoor space can meet many needs for people with dementia, and also those that care for them. A carefully though out garden design can be part of a treatment plan for people with Alzheimer's who are very restless or agitated and who like or need to walk around lot. A well planned area can provide exercise and therefore give an opportunity to relieve tension, frustration and aggression, provide personal space for reflection and privacy, give an area to accommodate a different social environment and provide additional stimulation with colours, smells and sounds of wildlife.
A "memory garden" needs additional planning but can be regarded as a therapeutic activity and can actually stimulate sensory sensations of persons with dementia. As we go through our lives we experience places and people which memories may be triggered by a certain sequence of images or smells. Everyone can enjoy a memory sensory garden, but the garden can be created and planned with features that will make them especially appealing to older adults and those living with Alzheimer's or dementia. Include your service users with dementia in the planning and designing of the garden - what scents or areas trigger good memories for them? The smell of mint, roses, lavender or even wet leaves can be particularly good triggers, as can a seating area or dry plot of grass to lay on, or patches of lawn daisies grown deliberately to make daisy chains. Obviously someone who's idea of a good garden has historically included two tonnes of hardcore and a clean sweep of tarmac over anything green may have less to contribute than a patient who has dug and planted several acres keenly over the past forty years, but persevere if you think that your patient really wants to participate. Many people with dementia will have built up a lot of knowledge and experience about gardening. They can contribute in varying ways, from active involvement in digging and planting to smelling their favourite flowers, or picking herbs or vegetables and discussing what you might cook with them for this week's meals.
There is evidence to suggest that as mental capacity changes in people with dementia, some patients will function more on a sensory level rather than an intellectual level. Patients will have the opportunity to hear and experience sounds and smells of any garden through plants, water features, birds and the activities of people using or working in the garden space. Patients who are chair bound could be transferred by wheelchair to experience the garden, and patients who are nursed in bed where open windows can give access to the sights and smells of the garden can also enjoy it.
You may have the time and money available to plan a Dementia Garden specifically designed around the needs of your service users. Consider a figure-of-eight looped path, or similar, simple returning-path system through the flower beds or planted area - you can plan a garden that allows access outside but always leads the wandering person back to their house or building. Consider observation and visibility in your plans so that carers can keep everyone in their line of sight - boundaries such as fences and hedges will need to be kept in good repair. A well thought out dementia garden should cater for the able bodied as well as those who have problems with mobility.
Safety issues are central to good garden design for people with Alzheimer's or dementia. Your design should include safe level pathways with a minimum of steps and obstacles, and some constructions or shelters that will give protection from the sun and the wind throughout the four seasons of the year. Protection from the sun is very important as certain medications can make the skin more prone to sunburn. Avoid dark, shadowy areas, as people with Alzheimer's or other types of dementia can mistake shadows for negative events and become distressed.
Consider your planting carefully - plants should not be poisonous or toxic and you should consider that some plants such as honeysuckle can harm people if they eat the berries or other parts of the plant, and others can cause skin rashes and irritation. Fill the garden with colourful and scented flowers to encourage bees and butterflies, and place herbs, lavender and other plants close to the paths so that when brushed they will release their fragrance.
A memory sensory garden was one of the winners of our Bright Ideas Grant - their idea was "Provision of a memory and sensory garden suitable for use all year round to benefit the 53 service users at The Old Rectory." This scheme won a grant to help the community at The Old Rectory take their garden forward, but if you read their updates via the link below you will see that they have also employed a number of other innovative ways to bring in free labour, plants and other resources. The creation of their garden and the associated fundraising for it has been a real factor in helping bring together residents, families and staff at The Old Rectory, and their team is made up of permanent residents and those on respite care placement as well as participation from their families. Many of the service users have mental and physical disabilities so a safe enclosed garden is important, this project promotes their dignity allowing them to create friendships, maintain their identity and allow them to work alongside care staff and activity coordinators in the garden if they so wish, as well as creating the opportunity to enable service users to reminisce and relax. The benefits of this scheme have been considered substantial from a holistic viewpoint.