Cultivating Health Amongst Older People
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Cultivating Health Amongst Older People

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Cultivating Health Amongst Older People

Cultivating Health Amongst Older People

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    Cultivating Health Amongst Older People Cultivating Health Amongst Older People Document Transcript

    • Cultivating Health Cultivating Health A study of health andThe Cultivating Health Project was a joint study with the Institute for HealthResearch (IHR), Lancaster University, NHS Carlisle & District PCT (formerly mental well-beingNHS North Cumbria Health Authority), Age Concern, Carlisle and Carlisle City amongst older people inCouncil. The following people were involved: Northern EnglandProfessor Tony Gatrell IHR, Lancaster UniversityDr Christine Milligan, IHR, Lancaster UniversityDr Amanda Bingley, IHR, Lancaster UniversityDr Rebecca Wagstaff, Director, Eden Valley PCTMrs Jessica Riddle, End of Project Director, Age Concern, CarlisleMrs Elizabeth Allnutt, Allotments Officer, Carlisle City CouncilMrs Jane Barker Research Report Gardener/Club Organiser, IHR, LancasterUniversityThe project was funded by the former NHS Executive-Northern and Yorkshire as part of the Government ‘Healthy Ageing’ initiative. Institute for Health Research § Lancaster University O t b 2003 This Research Report is co-authored by Christine Milligan, Amanda Bingley, and Tony Gatrell.
    • Cultivating HealthThe Cultivating Health Project was a joint study between the Institute forHealth Research (IHR) at Lancaster University; Carlisle and district PCT(formerly North Cumbria Health Authority); Age Concern, Carlisle; and CarlisleCity Council.The project was funded by the former NHS Executive – Northern and YorkshireRegion as part of its Healthy Aging R&D Programme.The following people were involved in the project:Prof. A. Gatrell IHR Lancaster UniversityDr C.Milligan IHR Lancaster UniversityDr A. Bingley IHR Lancaster UniversityDr R. Wagstaff Director of Public Health, Eden Valley PCTMs J. Riddle Age Concern, CarlisleMs E. Allnutt Allotments Officer, Carlisle City CouncilMs J. Barker Gardener/Club Organiser, IHR Lancaster University This research report is co-authored by Christine Milligan, Amanda Bingley and Anthony Gatrell.Details and downloadable versions of reports can also be found on the IHR website:http://www.lancs.ac.uk/depts/ihr/research/mental/cultivatinghealth.htmFor further details about the study please contact:Dr Christine Milligan, Institute for Health Research, Lancaster University, Bailrigg, Lancaster,LA1 4YT. Tel: 01524 592127 e-mail: c.milligan@lancaster,ac,uk 2
    • AcknowledgementsWe would like to thank the following organisations and people who supported theproject: The NHS Executive (Northern and Yorkshire Region) for their generous funding NHS staff who supported us from Carlisle & District PCT (formerly North Cumbria Health Authority) Carlisle City Council Department of Leisure and Community Development who offered free use of Longsowerby and Lingmoor Way allotment sites during the study for the project gardening club Age Concern, Carlisle who provided support for the project social club The many people who offered their time as part of project club activities giving talks, demonstrations and hosting visits and outings. We would, particularly, like to thank all the people who volunteered to participate in this study and without whom the project would have been impossible. Their willingness and commitment has demonstrated that older people in Carlisle have a great deal to offer each other and the community. With adequate support they can create new opportunities for social and gardening activities that positively promote health and mental well-being. We hope that the ideas and experiences of those older people participating in this project will provide inspiration for continuing improvements in community health for older people both within Carlisle and beyond. § 3
    • ContentAcknowledgements 3Introduction 6Summary of key points 7Ideas and recommendations 8Section 1: Aims of the study 9Section2: Methods of collecting information 11Section 3: Setting up and running the groups 17Section 4: Dilemmas of recruitment and research design 19Section 5: Analysis of quantitative data 22Data analysis and results 24Concluding comments 27Section 6: Analysis of qualitative data 29Gardening activity 30Gardening in a Club 37Social Clubs 41Section 7: Discussion 46Section 8: Conclusion 55Section 9: Dissemination 57Bibliography 60 4
    • Tables and FiguresTable 1: Summary of Research Design 12Table 2: Distribution of respondents - 1st SF-36 22Table 3: Living circumstances by group 22Table 4: Housing tenure by group 23Table 5: Age distribution by group 23Table 6: Survey responses by group 23Table 7: Number of diary participants by group 24Table 8: Health comparison: 1st and 2nd survey responses 24Table 9: Change in health score at 5th week 26Table 10: Change in health score at final week 26Figure 1: Age range (%) – Carlisle over 65s population compared with CHP over 65s 13Figure 2: Age range in groups (%) 14Figure 3: Gender balance in groups compared with Carlisle over 65s population 14Figure 4: Numbers active in Clubs at start (blue) and finish of study (red) 21Figure 5: Comparison of family and adult history/ experience in gardening in three groups 31Figure 6: Comparison of age-related restriction to garden, expertise and interest in gardens in three groups 34Figure 7: Comparison of activities with members of the Social Club 42 5
    • IntroductionIn early 2002 ninety-three older people in Carlisle volunteered to take part inthe Cultivating Health Project (CHP), which ran from January to November2002. The project, funded by the NHS Executive (former Northern andYorkshire Region), was set up as part of the ‘Healthy Ageing’ R & D programme.The aim was to study the effects of different activities on the health andmental well-being of people over 65 years of age. In particular, the study wasdesigned to compare the relative health benefits of gardening versus socialactivity. We set up three groups, a gardening club, a social club and a referencegroup. People were invited to join one of these groups over the nine months ofthe study where they could take part in regular activities, or, for those in thereference group, continue to go about their everyday lives. Participants’ healthand well-being was assessed throughout by a combination of self-assessment andresearcher-led observation. The gardening and social clubs proved successfulinterventions and both have continued to run following the end of the study.In this report we present the main findings and key recommendations arisingfrom the study. In the first section we outline the aims of the project and themethodology used. We discuss recruitment issues, the setting up and everydayrunning of the project interventions. We also discuss, in detail, ideas andrecommendations for future initiatives that, we suggest, may help to promotehealth and well-being amongst older people in the community. In the secondsection we explore the quantitative and qualitative findings in relation to each ofthe two clubs set up as part of the project, referring also to the referencegroup. We conclude with a detailed discussion of several key issues thatemerged from the study.The Cultivating Health Project proved to be an enriching process for many ofthe people who took part as well as for us, as researchers. The study hasdeepened our understanding of the needs of older people and points to a numberof ways, very often simple and people-led, in which health and well-being can bemore effectively promoted and maintained in older age. § 6
    • Summary of Key PointsEvidence from this study suggests that gardening andsocial activities have profound and positive effects on aperson’s sense of worth and mental well-being. Theseeffects support older people to cope better with chronicor debilitating physical ill health.Social contact is a vital factor in enhancing the health andwell-being of older people, whatever activity they areinvolved in.There are positive benefits for the health and mental well-being of olderpeople if they garden ‘communally’ in a club with regular support.Gardening as an activity has a number of important qualities that help tosustain older people, not just by encouraging physical fitness, but also bymental stimulation.Social club activities were can be highly beneficial and sustaining to thehealth and mental well-being of older people. It is important that the organisation and choice of activities in clubs is entirely guided by the participants. This was key to the success of both the gardening and social clubs set up by this project, The ongoing support of a projectgardener/club organiser is essential in setting up and sustaining a successful,functioning club. § 7
    • Ideas and RecommendationsBoth the garden club and social club demonstrated that older people-ledgroups have definite benefits for the health and mental well-being of theirmembers. However, to be successful they require appropriate and adequatesupport and resources.The health benefits associated with sociable activities when meeting in clubsand societies, whether gardening or with otherwise, are far reaching. Even asingle weekly social meeting can add a new dimension to an older person’severyday routine. Developing older people-led activity groups is an importantway of reducing social isolation and improving mental well-being.There is potential for local clubs to run schemes, which aim to support peopleto continue to garden and thereby enjoy the benefits of their own gardensfor longer than is currently possible. People-led schemes of this kind couldadvise each other over designing appropriate adaptations, locating regularhelp, and offer sociable opportunities to exchange ideas and skills.To be successful, older people-led groups require the support of a communityofficer(s) to give initial guidance and ongoing support. This will provide thestructure around which a group can be recruited and developed. Our researchindicates that groups can become largely self-sustaining, requiring onlylimited (but regular) support, after the first year.Limited, ongoing support can help to maintain membership and recruitment ofa people-led group through outreach and other referrals, as well as acting asan independent group ‘mentor’ for supporting the organisation of the group’sactivities.Clubs of this kind can also accommodate disabled older people, but wouldrequire additional financial resources and support. § 8
    • Section 1: Aims of the StudyThe Cultivating Health Project was developed in response to a call from the‘Healthy Ageing’ R & D programme to look at more holistic ways of improving andmaintaining health in older people by appropriate support of their everydayactivities.The project was a two-year in-depth study, which included an intervention overnine months. The aim was to explore the extent to which different kinds ofgardening and social activities might help to promote the health and mental well-being of people over 65 years of age. In particular we focused on the benefitsof communal gardening on allotment sites, and social activity as part of a club.We were especially keen to study the benefits of gardening in comparison toother activities. Largely, this was because a number of previous studiessuggested that there were tangible and long-term positive effects to physicalhealth and well-being for people that garden regularly (see Galgali et al, 1998;Lemaitre et al, 1999; Galloway et al, 2000).However, very few of these studies looked, specifically, at an older age group interms of general health and mental well-being. There are virtually no otherstudies that we are aware of, which compare gardening with social activities. Yetolder people, with or without age-related and/or other health problems, areoften seen to rely on a great deal of social activity for their enjoyment and well-being, as well as very often being keen gardeners in their own and (less often),allotment gardens (Jerrome, 1990; Milligan et al, 2003). We, therefore, feltthat there was a need to better understand the ways in which these differentactivities promoted (or on occasion did not promote) health and mental well-being.It is essential that older people have an opportunity to voice their own ideas,opinions and thoughts about their experience of different activities. We,therefore, set out to offer as many openings as possible for this process duringthe nine months in which the intervention was conducted. We did this throughdiscussion in the groups, meeting with members of the research team in weeklyclubs, individual interviews, focus groups and asking our older participants tocomplete weekly diaries. Our aim was to discover more about how, when andwhere gardening, socialising and other activities fitted into the lives of olderpeople, as described by themselves. 9
    • We present this report in the hope that we may inspire future innovativecommunity-based initiatives with older people-led leisure and other activities forthose aged over 65.The study was based in Carlisle, north Cumbria, and targeted those electoralwards in the south of the city, that firstly, had been recognised as beingdeprived by the Health Action Zone (HAZ), and secondly, were located in areaswhere the population as a whole experienced a comparatively high level of socialand economic need. § 10
    • Section 2: Methods of Data CollectionIn the course of the project we gathered a vast amount of information withwhich to gain a better understanding of the relationship between health andmental well-being and the different kinds of gardening and social activitiesundertaken by older people. In this section we describe the methods used andthe kinds of data collected.After gaining approval from the Local Research Ethics Committee, we collectedtwo sorts of information. The first was quantifiable in the form of a HealthSurvey Questionnaire and the incorporation of standardised questions in theweekly diaries that gave longitudinal health data that related back to thequestionnaire.Here, we chose to use a well-known health profile, the Short Form 36 HealthSurvey (abbreviated to SF-36), as the instrument with which to collectquantifiable data from our three groups, both before and after the intervention.This was chosen because it is considered relatively straightforward, and nottime-consuming (no more than ten minutes) to complete (Jenkinson, 1996). TheSF-36 comprises a series of eight ‘domains’, covering: physical functioning; socialfunctioning; role limitations due to physical health; role limitations due toemotional health; mental health; energy/vitality; bodily pain; and general healthperceptions (Jenkinson et al, 1996). Within each of these domains a number ofspecific questions are asked, and then ‘scored’ for analysis.The results from these data were analysed numerically. Due to the numbers ofparticipants involved, however, the data were used largely to generatedescriptive statistics, although some statistical tests were performed on thelongitudinal data (see section 6).There is a wealth of applications using the SF-36 among older adults, typically inassessing the effects of clinical interventions (such as hip replacement) but alsoin needs assessment. Some authors (Mallinson, 1998; Hill et al, 1996) havecriticised the usefulness of the instrument among groups who are disabled orwho are hospital-based or who have serious illness, arguing in particular that itmasks patients’ views and proposing instead a more qualitative perspective.However, in a study of nearly 10,000 adults in Sheffield, Walters and colleagues(2001: 342) found that it is useful ‘as a self-completed instrument in community-based surveys of older people’. Their large sample permits them to reportmeans and medians, and standard deviations, for all domains, by age group andsex. Given that our population was also community-based we were confident that 11
    • the SF-36 would be a useful instrument, particularly, when complement by a richbody of qualitative material that we report on separately.The second source of information was qualitative and involved asking people totalk and write about their everyday lives. Here, we conducted focus groups andsemi-structured interviews with participants from each of the three groups. Inaddition, each participant was asked to complete a [standardised] diary givingdetails each week about a) their general health and well-being; b) events thatmay have affected their health and well-being; c) activities undertaken duringthe course of the week. The researcher also undertook regular observations ofthe club activities, recording the data both visually and in a research diary.Analysis of the qualitative data is reported in section 7.Table 1: Summary of Research Design:Method of Data Gardening Club Social Club Reference Group CollectionHealth Survey Completed at beginning & Completed at beginning & Completed at beginningQuestionnaire end of project end of project & end of projectDiscussion Convened: beginning & Convened: beginning & Convened: beginning &(Focus) end of project end of project end of projectGroupsSemi- 10 participants: 10 participants: 10 participants:structured beginning & end of project beginning & end of project beginning & end ofInterviews projectWeekly All willing participants All willing participants All willing participantsDiaries over 30 weeks over 30 weeks over 30 weeksObservation Regular visits over 30 Regular visits over 30 No weeks weeksVisual data Yes – photographic Yes – photographic No records of the sites and records of outings and gardening activitiesThe main themes and the complex of meanings and ideas that emerged fromthese qualitative data were then analysed using qualitative software (Atlas/ti)and interpreted thematically. In order to ensure the reliability of the data, theemergent themes were returned to the participants in the form of a projectsummary, and participants were encouraged to feed back their views on thesethemes.All participants gave informed (written) consent to the gathering and use ofboth the visual and spoken data and pseudonyms have been used throughout topreserve confidentiality.The SampleNinety-three people, over the age of 65, were recruited to the project with thehelp of General Practitioners. This was mainly by invitation to 1,800 people in 12
    • south Carlisle, but also through the distribution of general publicity about thestudy in health centres, libraries and community organisations. The recruitmentwas conducted with the help of GPs to ensure that people were reasonably fitand able to take part. The only exclusion criteria were that potentialparticipants were aged over 65 not mentally confused and had some physicalmobility (to the extent that they were able to walk at least one hundred yardswithout support). The decision to exclude on the basis of lack of physicalmobility was purely a financial one; in that the project did not have sufficientresources to put in place the hardcore pathways and raised beds that would havebeen necessary to facilitate disabled access.We invited our recruits to join one of three groups set up as part of theproject, either the gardening group, the social group or the reference group.Each person had the option to join the group of their preference. We aimed tohave roughly equal numbers in each group, though seven recruits withdrewbefore the start of the club meetings and a further seven withdrew during thefirst three months of the project. By the end of June 2002 the numbers ofactive members in each of the three groups had stabilised. All those whosubsequently withdrew or stopped attending club meetings and activities did sobecause they were unable to take any active part in the study (due either totheir own, or partner’s ill-health).In general, the age distribution of participants follows the trend evident inCarlisle as a whole. However, as Figure 1 (below) illustrates, the project didrecruit a rather higher proportion of 65-74 year olds and a slightly lowerproportion of those aged 85 and over than the Carlisle average. This was notunexpected given the tendency for increased age-related health problems andthe pattern in the general population. Figure 1: Age range (%) - Carlisle over 65s population compared with CHP over 65s 40 % in Age Group 30 Carlisle 20 CHP 10 0 65-69 70-74 75-79 80-84 85-89 >90 Age Group (years) 13
    • The age range between the three groups varied significantly (see Figure 2,below). These variations appeared to be directly related to the amount and kindof activities people anticipated would be involved in joining a particular group andwhether they felt physically able to take part. Gardening was perceived as themost physically strenuous and appealed to few people over 80 years of age(although, interestingly, gardening appealed to a higher percentage of people inthe 75-79 age group). There was a more even balance in age range within groupswhere less active input was required (as in the case of the reference group) andwhich did not appear to intervene in an individual’s everyday, regular pursuits.For instance, more people over 80 years of age felt able to take part in whatthey perceived to be the two less physically demanding groups. Figure 2: Age range in groups (%) 60 50 40 Gardeners 30 Social % 20 Reference 10 0 65-69 70-74 75-79 >80 Age (yrs)There were, however, some marked differences in the gender balance betweenthe three groups (see Figure 3) and against that of the population aged over 65in Carlisle as a whole. Very few men elected to either join or were prepared toattend the social club. Figure 3: Gender balance in Groups compared with over 65s population in Carlisle (%) 100 86 80 58 55 52 % Men 60 48 45 42 % Women % 40 17 20 0 Garden Social Ref Grp Carlisle Group / over 65 population 14
    • Conversely more women were prepared to join and regularly attended thegardening club than had been anticipated. The balance of men and women in thereference group was roughly in accordance with the general population, possiblybecause, unlike the other two groups, this did not require any change in theireveryday activities. Clearly, the reference group presented the least challengeto each individual’s gender perception and consequent choice of activity. Thereappeared to be a number of other reasons for the gender differences betweenthe three that emerged as the project progressed. These are considered inmore detail in the Discussion section.MethodAt the start of the project all ninety-three volunteers completed a HealthSurvey Questionnaire; this was repeated again at the end of the project. Theaim, here, was to enable us to numerically assess and compare participants’general health and well-being at the start and end of the nine month study.Over the course of the project a total of sixty-six people from the group alsotook part in in-depth discussions. Following an initial pilot discussion (focus)group we convened three separate focus groups, each with around eight to ninepeople from each of the three groups. The focus groups were repeated at theend of the intervention. We also conducted semi-structured interviews withthirty people selected equally from each of the three groups at both thebeginning and end of the intervention.In the first round of interviews and focus group discussions we asked peopleabout their general pattern of health and well-being and the kinds of activitiesthey participated in over the course of an average week as well as things thataffected their everyday lives and health. People spoke about how their healthand well-being was affected by their living situations, their neighbourhood,family situations and events and also the effects of local and national events.In the second assessment we were concerned to examine the extent to whichparticipants’ general pattern of health and well-being had (or had not) changedover the period of the study. We were also interested in people’s experience ofbeing involved in activities, whether in the reference group or as part of thegarden or social club. People spoke about the extent to which the club and othersimilar activities affected their own sense of their health and mental well-being.We also explored, in more depth, the kinds of everyday activities people liked toparticipate in and how different activities and events in the average weekappeared to affect their lives. 15
    • Throughout the nine months of the data collection all participants were asked tocomplete and return a weekly diary. The first section of the diary involved anumerical score of self-assessed general health and mental well-being thatrelated directly to questions on the SF-36. The second section was anopportunity for people about each week’s activities both outside the project (forthose in the reference group) and within the project if they were part of thegarden or social club. Participants could write as much or a little as they wished.Participants from all groups also wrote about events in their everyday lives andcould include ideas, thoughts and feelings in connection to anything they wroteabout in the diary. This gave us (and the diarists) a rich and detailed picture ofpeople’s everyday lives and events over a sustained period of time.In addition to the above methods of data collection, we also undertook regularobservations of both the social and gardening club activities. Over the course ofthe project, the researcher spent one day per fortnight observing and recordinggardening activities on the allotments and one day per fortnight observing andrecording the social club activities. These observations were supplemented byregular visual photographic data and written and oral reports gathered from theproject gardener/club organiser. § 16
    • Section 3: Setting up and running the groups.The Gardening ClubThe gardening club started out with twenty-nine participants. The club was giventwo City Council allotment sites in Carlisle to use throughout the course of theproject, one site in Longsowerby and the other in Harraby. People were given achoice about which site to garden, though most chose the site nearest to theirhome. The sites were prepared for use by the City Council under the supervisionof the allotments officer. The club was organised and supported by agardener/club organiser, who was employed by the project, and who broughtinvaluable experience to the project of working with groups and gardens overmany years. The gardener/club organiser was ‘on duty’ on both sites at specifiedtimes during the week in order to offer advice and encouragement to peoplewithin the group and to help arbitrate in minor disputes until it began to cohere.Project funds provided for all the gardening equipment including seeds, tools,specialist tools for the less able-bodied, bedding plants, compost, a garden shedand most importantly a polytunnel for each of the two sites along with somechairs and tables. We believed (accurately, as it turned out) that the northernclimate would be erratic, generally wet and often cold. In order to encouragepeople to leave their homes to attend the site, we would have to provide shelterand somewhere to sit, rest and socialise. We also had to ensure that the sitewas accessible and manageable for the less able-bodied participants. With thisin mind, the polytunnels proved essential for sheltering both the club membersas well as nurturing the seedlings, growing tomatoes and the more delicateflowers in hanging baskets.The gardeners could meet on their allotment site either on a weekly basis or asoften or as little as they wanted (or were able) to. The gardener/club organiseralso arranged a monthly meeting in Carlisle Old Town Hall Assembly Rooms fortalks and discussions. On two occasions an outing to a local open garden wasarranged in place of the indoor session.The Social ClubTwenty-nine people initially joined the social club. A regular weekly venue wasarranged in the Old Town Hall Assembly Room. This site is conveniently locatedin the centre of Carlisle and has good disabled access, both of which acted tofacilitate and greatly encourage attendance. The club was organised by theproject gardener/club organiser, who set up an initial programme of events,talks and activities suggested by club members and with which everyone in theclub agreed. 17
    • Project funds covered all costs incurred in running the club and Age Concern’sinvolvement in the project enabled the venue to be booked at a reduced cost.The project also covered the costs of: all equipment and materials required forarts and crafts; engaging speakers; and arranging outings to local (and moredistant) places of interest. From the outset, club members were encouraged totake ownership of the club – to have a say in the kinds of activities that theywanted to take part in; to make suggestions; and to become involved in theweekly running of the club. This was welcomed by participants who insisted thatthey wanted to avoid the ‘games’ style of activities commonly offered in manyother local clubs around the city.The Reference GroupThe reference group, with twenty-seven members, was designed to provide abaseline for the study in terms of understanding the kinds of activities thatolder people engaged in, generally, on a weekly basis. We were interested inunderstanding the level of participation in activities as well as the ways in whichill health or disability impinged upon an individual’s ability to become involved indifferent activities. We were keen to ascertain how much and what kinds ofeveryday activities seemed to generally promote health and mental well-being ina group of older people in the city. This information, we hoped would enable us tocompare the ways that the project clubs affected people’s everyday health andmental well-being in comparison to that of people who may or may not be involvedin similar activities in the area.Though reference group participants completed the Health SurveyQuestionnaire (HSQ), and participated in the focus group and interview process,the main means of data collection was via the weekly diaries. A core of twenty-one reference group members became regular (and mostly) very keen diarists. § 18
    • Section 4: Dilemmas of recruitment and research designWe learned a number of significant lessons in undertaking this research that wesuggest could support others involved in designing future projects of this kind.With this in mind, we have attempted to be frank about the dilemmas that wefaced and how we resolved them.The original research design was based on a mixed methodology with an emphasison quantitative data collection using a well-known quality of life questionnaire,the SF-36 (Walters et al, 2001), together with interviews and focus groups. Inorder to ensure the study was sufficiently powerful, it required the recruitmentof up to 300 participants. Recruitment was intended to be via a randomstratified sample drawn from GP lists. Within a few weeks of initiatingrecruitment, however, it became clear that the take up rate would besubstantially lower than we had anticipated. We can point to three contributoryreasons for this low take up rate: 1) Unforeseen delays occurred in gaining access to the sample. GPs are busy people and giving up time to identify exclusions for a research project is necessarily low on their agenda. Consequently, the turnaround time for the return of these lists was considerably longer than anticipated. As a result, the main recruitment drive fell around the Christmas period. Recruitment in winter time is likely to be more difficult especially as the project involved (amongst other activities) outdoor gardening; 2) Despite clear assurances that we were setting up accessible gardening that did not require any heavy digging, the perceived strenuous nature of the allotment gardening activity appeared to be putting some people off joining the study; 3) The initial publicity was not as effective as we had anticipated.In a bid to increase recruitment, we made conscious efforts to improvepublicity. This was achieved through the wider dissemination of leaflets locallythrough GP surgeries, community groups and other community facilities. We alsoliased with two of the main Community Nurse teams in the area; and raised theproject profile by ensuring appeals and articles were published in localnewspapers. A short slot was also broadcast on both the local radio andtelevision. Border TV also interviewed some of the project team on theallotment sites. We also increased the extent to which we emphasised thesupport that would be offered in the two clubs, especially that gardeningactivities would be tailored for people of all abilities and skills and extended therecruitment deadlines later into the spring. 19
    • Even with this change in strategy it became clear that recruitment would notreach those levels anticipated in the original research design. Followingdiscussion amongst the research team we took the decision to modify theresearch strategy to one that would give us greater depth of data using asmaller number of participants. The focus on the use of quantitative methodswas thus reduced, with a concomitant increase in the qualitative element of thestudy. This shift allowed us to work with smaller numbers of participants, using avariety of ‘in-depth’ methods (semi-structured interviews, discussion groups,written weekly diaries, regular participant observation, visual data and regularparticipant feedback), as outlined above.The shift from a quantitative to a qualitative approach also meant that it was nolonger necessary to use a stratified random sampling technique. Given thesignificantly different sampling strategies used in qualitative research design,we were able to employ snowballing techniques to increase our sample size.Clearly, a theoretical or a purposive approach would have strengthened thesampling strategy, but despite this, as Figures 1 to 3 have illustrated, our sampleof ninety three older people represented a good range of men and womenbetween the ages of 65 years to 91 years.The, largely, ethnographic study that emerged as a result of the change inresearch design proved to be a highly effective way of covering the issuesexplored. The changes also meant that, once identified, we could also addresssome of the limitations found in using the SF-36 Health Survey Questionnaire(Mallinson, 2002). It became clear that participants frequently found the tickingof boxes to answer questions to be a difficult exercise. At times they foundquestions and possible responses either irrelevant, inaccurate, or lacking inmeaning. In addition, it became clear that participants’ responses were eitherhighly subjective or relative (for example, one elderly participant consistentlymarked his health down as being ‘excellent’ despite evidence from the qualitativedata that revealed he had serious heart problems).Because the researcher and the gardener/club organiser were in regular contactwith participants, the project team was able to explore quite accurately whatwas actually happening in the lives of people within the groups. Participants,themselves, had far greater opportunity to share their thoughts and ideas withthe research team and to talk about their feelings and reasons for enjoying oravoiding different activities. In contrast to the questionnaire, the ethnographicapproach appeared to be a mutually enjoyable and instructive experience forthose who remained actively involved in the project. § 20
    • Dilemmas of drop outAny longitudinal study of older people is likely to suffer high rates of attritiongiven that there are inevitably increased age-related health and mobilityproblems in any group over 65 years of age. Relatively high rates of attritionwere not, therefore, unexpected in this study. Over a nine months period, nearlyone third of our original participants dropped out (see Figure 4 below). Figure 4: Numbers active in Club at start (blue) and finish of study (red) 40 29 29 27 Participants 30 22 21 16 20 10 0 Gardeners Social Reference Club/GroupIf someone left the group the remaining active members, understandably, oftenfelt disappointed. However, there were always clear reasons, ranging fromunexpected commitments, serious or incapacitating health problems (unrelatedto the project activities), to illness or bereavement in the family. By July 2002,midway through the project, the numbers stabilised and remained at the levelsillustrated above. There were sixteen active members of the gardening club,around twenty-two members regularly attending the social club and twenty-oneregular diarists in the reference group. However, there were several clubmembers who, though ‘non-active’, were still considered part of the project.These participants were unable, for a variety of reasons, to either attend any,or only occasional, social club meetings or gardening club site activities. Forexample, two or three of this ‘non-active’ group were occasionally able to attenda club outing, or in the case of the gardening club, one of the monthly talks orevents. This group continued to complete diaries and their contribution wasinvaluable. § 21
    • In the following sections we discuss the main research findings Section 5: Analysis of quantitative dataIn this section we report on the collection and analysis of the quantitativesurvey data collected from our respondents. This took two forms; first, datacollected using the SF-36 and, second, data from the weekly diaries.DiariesEach group was asked to fill in a weekly diary between 15th March and 2ndNovember (31 weeks) responding to four general health and well-being questions,together with a comment whether any particular event had affected their livesin each week. The response to this last question is to help interpretation of thescores for the general health and well-being questions.Sample characteristicsWe recruited 93 participants to the study, although 8 withdrew before thestudy commenced. For the first SF-36 survey the distribution of respondentswas as follows: Table 2: Distribution of respondents –1st SF-36 Group Number (%) Gardeners 29 (33.7) Social 29 (33.7) Reference 27 (31.4)Slightly more men (n=16) than women (n=13) were in the gardening group and thereverse was true for the reference group (12 men, 15 women). However, veryfew men were in the social group (n=4), compared with women (n=25). Notsurprisingly, as table 3 indicates, the living circumstances of the three groupsreflected this, with those in the social group tending to live alone compared withthe two other groups (percentages in parenthesis): Table 3: Living circumstances by group Group Living alone Living with spouse Living with other family member Gardeners 10 (35) 16 (55) 3 (10) Social 15 (54) 10 (36) 3 (11) Reference 11 (41) 14 (52) 2 (7) 22
    • In terms of housing tenure (see table 4), again the gardening and referencegroups were broadly similar, but the social group had more participants living inprivate rented or sheltered accommodation: Table 4: Housing tenure by group Group Own home Local Private Sheltered Authority/Housing rented housing Association Gardeners 22 (82) 3 (11) 0 2 (7) Social 19 (66) 5 (17) 3 (10) 2 (7) Reference 23 (85) 3 (11) 1 (4) 0The age distribution was broadly similar across the social and reference group;however, the gardening group tended to have a greater proportion of youngerpeople. While five members of the social and reference groups were in their 80sonly one of the gardeners was: Table 5: Age distribution by group Group 65-69 70-74 75-79 Over 80 years years years years Gardeners 15 (52) 7 (24) 6 (210 1 (3) Social 10 (35) 10 (35) 4 (14) 5 (17) Reference 10 (37) 8 (30) 4 (15) 5 (19)While there were data for 85 study participants at the time of the first SF-36survey, as table 6 indicates, this dropped to only 68 at the time of the secondsurvey. Moreover, while there was little drop-out among the social group theresponses from gardeners had dropped by a third and the reference groupresponses were also fewer, as the table below indicates: Table 6: Survey responses by group Group Number in first Number in second survey (%) survey (%) Gardeners 29 (33.7) 20 (29.4) Social 29 (33.7) 27 (39.7) Reference 27 (31.4) 21 (30.9)We obtained diary data from a total of 62 individuals. The gardening clubattendance records show that seven participants never worked on theallotments, while a further four were there a maximum of four times. Wefocused on the remaining 18 individuals who worked on the allotments at least 5 23
    • times, but note that while many attended on five consecutive weeks, otherscame sporadically and, therefore, any health benefits may not be comparable.Two people in the social club never attended club meetings, but wrote diaries(for 26 and 18 weeks respectively); a further four attended the club on no morethan four occasions. We focused on the remaining 23 individuals who attendedthe club at least 5 times. The reference group (apart from two individuals whodropped out from the study) have fairly complete diary records with somemissing data. The diary data is therefore summarised in table 7 below: Table 7: Number of diary participants by group Group Number completing diaries (%) Gardeners 18 (29.0) Social 23 (37.1) Reference 21 (33.9)Diary entries were not completed for some weeks because of holidays. Therewere a maximum of 28 weeks of diary entries for the reference group (29/3,3/5,20/7 missing), and a maximum of 30 weeks of diary entries for the socialand gardening clubs (20/7 and 29/3 missing respectively). There is considerablemissing diary data. In addition to the diary entries information is available aboutclub attendance. Many people completed diaries without attending their clubs;the diary data for these weeks therefore does not relate to club participation.Data analysis and resultsSF-36A preliminary comparison of responses to the question that asked about healthnow, compared with a year ago, suggested evidence that the gardening group feltbetter about their health, compared with other groups (see table 8). Forexample, while in the first survey 14 per cent of the gardeners felt that theirhealth was better than 12 months ago, this proportion had increased to 25 percent by the time of the second survey; of course, this suggestion is subject tothe caveat of the samples being very small. Table 8: Health comparison: 1st and 2nd survey responses. First survey Second survey Group worse same better worse same better Gardeners 6 (21) 18 4 (14) 3 (15) 12 (60) 5 (25) (65) Social 7 (25) 17 (61) 4 (14) 4 (15) 19 (70) 4 (15) Reference 5 (19) 17 5 (18) 6 (29) 11 (52) 4 (19) (63) 24
    • However, we also conducted some more rigorous statistical analysis of the datain order to determine what influence, if any, group membership (gardening,social, reference) had on changes in health status during the study period. Themethod used was analysis of covariance (ANCOVA: see Field, 2000). This is aform of linear modelling in which variation in a response variable (here, one ofthe changes in the nine ‘domains’ of the SF-36) is ‘explained’ in terms of groupmembership, while controlling for the possible confounding effects of othervariables. For example, if we detect between-group differences in changedhealth status, this could be because the groups differ in terms of agedistribution, or living arrangements. We therefore entered into the model thefollowing four variables, before entering group type: age (65-69 years; 70-74years; over 75 years); sex (female; male); living arrangement (alone; not alone);tenure (owning home; not owning home). We then conducted nine separateANCOVA analyses, where the dependent variables were, in turn, changes inhealth status on the SF-36 domains.In six of the domains changes in health status could not be accounted for by anyexplanatory variables. These domains were: physical function; role limitation dueto physical problems; role limitation due to emotional problems; socialfunctioning; energy/vitality; and change in health. There were no significantdifferences between the three groups, nor were age, sex, tenure or livingarrangements associated with changed health status.For the pain domain there was evidence that those aged 65-69 years weresignificantly more likely to have had improved health (p = .020). For mentalhealth there was weak evidence that those aged 70-74 years had significantlyimproved health (p = .074) and also that the social group had also registeredimproved health status (p = .061). Last, considering general health perceptionthere is a suggestion that membership of the social group brought significantimprovements along this dimension (p = .015), while adjusting for other factors(owning one’s own home was weakly significant: p = .060).Diary dataAs explained above, the diary entries must be used together with allotment orsocial club attendance records. As each individual enters the study with adifferent level of health and well-being, we looked for changes in health andwell-being scores (sum of scores for the four questions) between the beginningof the study for each person (some people entered the study late) and laterweeks. 25
    • Each individual’s entry score was taken to be the score for the first week oftheir diary entry. This is to be compared with the scores a few weeks later (seetable 7):a) on the fifth week of diary entry (at least four weeks later) for the referencegroup, the fifth week of allotment attendance (at least four weeks – in one case19 weeks later) for the gardening group and the fifth week of club attendancefor the social club group (at least four weeks later) andb) on the last week of diary entry for the reference group, the last week ofallotment attendance (or as soon as possible after) for the gardening group andlast week of club attendance for the social club group (or as soon as possibleafter) (see table 8).Rarely, there was a missing value for a question. Then the average of theprevious and next week’s score for that question was used, or for the first andlast week, a score was imputed from the pattern of scores for that question, e.g.consistent value over several weeks.Of the 62 individuals included (with data at week 5), there were 20 in the socialclub and 14 in the gardening club who continued with both club activities andwith diary entries so as to produce useful data beyond the fifth week. Thequantity of useful data was therefore limited. Table 9: Change in health score at fifth week change in Q2 score week 5 Standard Mean Error of Mean Minimum Maximum Valid N 1 reference .38 .62 -4.00 11.00 N=21 2 social .48 .63 -7.00 5.00 N=23 3 gardening -.67 .61 -5.00 4.00 N=18 Table 10: Change in health score at the final week change in Q2 score final week Standard Mean Error of Mean Minimum Maximum Valid N 1 reference .33 .64 -4.00 11.00 N=21 2 social .70 .62 -6.00 6.00 N=20 3 gardening -.36 .71 -5.00 5.00 N=14The mean change in health score for each of the social club and gardening clubwas compared with that of the reference group, using t-tests for the equality ofmeans and analysis of variance. There is no evidence of a difference in the mean 26
    • change in health scores between groups either after five club attendances(p≥0.24) or at the end of the study (p>0.48). However, as in the analysis of SF-36 data this does not control for other explanatory variables. We, therefore,tested the group effect using normal regression analysis, with change in healthscore as the response variable and controlling for change in Q3 score (healthqualifier coded as 0 for serious illness or grief to 5 for a very happy event) andfor measures of involvement in the project.Analysing data after the fifth week of club attendance suggests that aftercontrol for the change in the health qualifier (entered either as a continuous orcategorical explanatory variable) there was no evidence for a group effect(p≥0.3). Analysing data after the last week of club attendance was as follows. Inaddition to the change in health qualifier, two measures of involvement in theproject were used: a) the number of social club or allotment attendances, or the number of diary entries for the reference group, expressed as a percentage of the maximum possible for each group b) the number of social club attendances plus diary entries for the social group, the number of allotment and club meeting attendances plus diary entries for the garden group and the number of diary entries for the reference group, expressed as a percentage of the maximum possible for each group.After control for the change in the health qualifier (entered either as acontinuous or categorical explanatory variable) and a measure of involvement,there was no evidence for a group effect (p≥0.4). Last, as an exercise, four non-attendants from the social and gardening clubs were added to the referencegroup. The mean change in health score for the reference group was thennegative, showing the effect of just a few more observations on this smallsample. The overall conclusions are unchanged.Concluding commentsFrom the analyses we have conducted we draw the following main conclusion.There is no quantitative evidence that belonging to the gardening group broughtsignificant health improvements across a range of health ‘domains’. There wasweak evidence that membership of the social group conferred benefits in termsof improved mental health, and stronger evidence that it led to improved generalhealth. From the diary data there was no evidence of a ‘group membership’effect on health and well-being. 27
    • We need to interpret these findings with some caution, for several reasons.First, the sample sizes are modest, certainly in comparison with other publishedstudies using the SF-36 (Jenkinson et al, 1996). Second, our study has sufferedfrom considerable drop-out, not least among the very group (gardeners) in whichwe were interested. We were restricted to only 20 gardening respondents in thesecond survey and in analysing change from the baseline could never increase oursample size beyond that number. A consequence of this is that randommodifications in how the questionnaire was filled in (or how the diaries werecompleted) could affect the results quite markedly.There is very little quantitative evidence of a ‘group’ effect and nothing toindicate that our small sample of gardeners were statistically more likely thanthe other groups to register an improvement to their health. § 28
    • Section 7: Cultivating health: analysis of qualitative dataThe previous sections have illustrated some of the difficulties we encounteredin attempting to analyse the quantitative data and the limited utility of thesefindings given our small sample size. While we were unable to demonstrate fromthese quantitative data that participating in social or gardening activityproduced any statistically significant changes in the health and well-being ofolder people, the qualitative data gave us some rich and detailed insights intotheir experiences during the course of the nine month intervention. We havesummarized these findings for both of the two main activity groups, beforedrawing together the implications of these findings in Section 8.As indicated previously, the qualitative data was analysed thematically, we havetherefore chosen to present the main findings under heading that represent thekey themes emerging from the data. § 29
    • Gardening activity “I love my garden, like. I come away/I stand back and look as I close the gate and say ‘I achieved something today’, you know? I love it, aye.” (Archie, 70 yrs) Gardening is a very popular leisure activity amongst the older people in Carlisle. The Carlisle City Forum survey, undertaken in 2003, found that three quartersof the respondents aged over 65 to 75 gardened regularly and over half therespondents aged over 75 were regular gardeners (Wilde, 2003). The vastmajority of them gardened in their own homes, and almost all had gardenedthroughout their adult life. However, very few of those in the 65-75 age groupgardened on allotments. Those older people who responded to the survey notedthat their main reasons for gardening were enjoyment, exercise and generalinterest.Inevitably the nature of the Cultivating Health Project appealed to those peoplewith a particular interest in gardening and in common with the older populationas a whole in Carlisle, the majority of those who took part in the project(whichever club/group they were in) had a garden. Garden sizes varied, butalmost all well-tended.The past history of gardening and garden ownership between members of thethree groups was varied (see Figure 5). About a quarter of all participants (inthe gardening and social clubs) to a third (in the reference group) had beenbrought up with gardening, either in the family garden or on an allotment plot: ahistory described by one of the gardening club members as ‘gardening in theblood’. Where gardening had been a prominent activity for members of theirfamily or themselves as children, participants were more likely to have beengarden owners in adult life, and vice versa.Of those people who were able and willing to join the gardening club, and thustake part in allotment gardening, more had experience with their own allotmentsas adults. In contrast no-one with gardens in either the social club or referencegroup had been involved with allotment gardening as adults and only some people 30
    • Figure 5: Comparison of family and adult history/experience of gardening inthree groups Garden/Allotment History - Garden Club participants 30 25 Number of participants 20 15 10 5 0 Own garden No garden Allotment now Allotment in Family past gardened Garden History - Social Club 20 18 Number of participants 16 14 12 10 8 6 4 2 0 Own garden No garden Allotment Garden in past Family gardened Garden history - Reference Group 25 Number of participants 20 15 10 5 0 Own garden No garden Allotment Allotment in Family now past gardened 31
    • had childhood memories of fathers, uncles, or in one or two cases mothers, whohad gardened allotments.This pattern would suggest that childhood experience in gardens tends toencourage more confidence and interest in later life.However, we found that not everyone enjoyed gardening in spite of his or herchildhood experiences and that a love of gardening appeared to be more of aninnate enjoyment. One participant noted that despite having two sisters (withexactly the same upbringing), she was the only one who had developed a lifelonglove of gardening. Very often people described either themselves, or others, ashaving a ‘natural gift’ for gardening.Most of those participating in the project had enough garden space in whichthey could at least keep some tubs and hanging baskets. There were a surprisingnumber of very enterprising gardeners who, despite only having a tiny backyard,grew carrots, potatoes, fruit bushes and, in one case, even a cherry tree usingold buckets and variety of containers.Although many participants described enjoying their garden, for others, keepingthe garden tidy and looking good had become a burden as their age-relatedhealth problems many gardening tasks exhausting or impossible.People had found various ways of overcoming these problems. About a quarter ofour participants, for example, had paved or grassed over existing garden areas.This was viewed as a positive action in the face of increasing limitations as it eased the chore of tidying. Other adaptations ranged from gardening almost entirely in easily managed pots and tubs or putting down ‘shillies’ (shingle or gravel) with pots or tubs set within the areas. Planting that did not require annual replacement (such as small trees, shrubs etc.) was also popular.Only two of those participating in the project had paved or grassed over areasbecause they actively disliked or had absolutely no interest in gardening.Some participants had found help in maintaining their own gardens, but only twowere able to pay for this service. More often relatives or neighbours helped tokeep the grass cut and the garden weeded and tidy. 32
    • Several people had been keen gardeners in the past, but age-related disabilitiesand changing circumstances had forced them to move to apartments orsheltered housing which had either no garden or small, communal gardens whichwere managed by the city council or housing association. One or two people inthis situation noted that, if they wanted, they could still have a hanging basketor share some small area that was gardened for residents.Those without gardens often had a long-held interest in gardening generally, andmost enjoyed visiting garden centres or open gardens, an activity that was alsopopular with garden owners (see Figure 6). Many people without gardens felt,that to some extent, this made up for the loss of their garden or the fact theyonly had a small yard or shared resident garden.Gardening, for those who do enjoy it, has certain particular qualities thatare distinct from other activities.There is a strong sensory pleasure associated with being in a garden. Manypeople said that they enjoyed just sitting or gardening amongst the colours,scents and different types of flowers. Others described a sense of wonder inthe process of nature: the ‘magic’ of seeds germinating, plants growing andripening. “the magic of planting something and seeing that it grows, you know, is still a source of wonder.” (Hugh, 70 yrs)Some gained particular enjoyment from the task of nurturing young seedlingsand plants, which they likened to the kind of tending involved in caring for achild. While tending young plants always has an edge of uncertainty, thoseparticipants who gardened, especially the more experienced, were veryphilosophical about the likelihood of certain plants failing in some years, and sawsuch events as a challenge to be overcome. As one man said: ‘there’s a challengeevery day - you learn summat every day’ (Archie, 70 yrs). For many people the challenge was to successfully grow fresh vegetables that could then be eaten. This added to the overall sense of ‘achievement’, ‘satisfaction’ and ‘wonder’ reported by the majority of those that gardened. 33
    • Figure 6: Comparison of age-related restriction to garden, expertiseand interest in gardens in three groups Ability and interest in garden - Gardening Club 10 9 Number of participants 8 7 6 5 4 3 2 1 0 Does minimum Has help Garden Unable to do Keen/able Like it/less adapted able Ability and interest in garden -- Social Club 6 Number of participants 5 4 3 2 1 0 Does Has help Garden Unable to do Keen/able Like it/less minimum adapted able Ability and interest in garden - Reference Group 12 10 8 6 4 2 0 Does Has help Garden Unable to do Keen/able Like it/less minimum adapted able 34
    • People described gardening as ‘creative’: it provided mental as well asphysical stimulation.Gardening is often assumed to be largely about physical activity. This view wasre-iterated, mostly, by those who were either unable to garden due to physicaldisability or who had little gardening experience. However, the moreexperienced gardeners in our study noted that gardening is creative in manyways, both physically and mentally, in that people have to plan and think aboutthe design, learn about the needs of different plants and glean new ideas fromother gardeners.Others had very little gardening knowledge, but as one woman commented, thishad made the gardening club more interesting for her as ‘you are learning all thetime’ (Amy, 72 yrs).This mental stimulation was an aspect of gardening that some participants feltwas often overlooked; yet it is an important feature of the activity. Oneindividual noted that gardening encouraged him to go and look up information andgather gardening books, where previously he had very little call to acquireknowledge through books. “It’s a bit of a challenge the garden like, in any sense, and as I say I’m still learning. I’ve got a lot of books on gardening.” (Stuart, 66 yrs)Another described how he enjoyed lying in bed at night thinking out hisgardening plans and designs for the season and attempting to work out how tosolve problems in the garden.Gardening is perceived to provide a ‘therapeutic space, which enhances orimproves mental well-being.Gardening and gardens can offer many opportunities for engendering positivefeelings of well-being, for example through the sense of achievement insuccessfully nurturing and tending plants, to the pleasure of being surroundedby the colours, scents and variety of flowers and shrubs (Milligan et al,forthcoming). Gardening activity differs from many other popular activities inthat it can also provide solitary space and time, which is beneficial to theindividual rather than leaving them feeling lonely or isolated. 35
    • As described by ‘Barbara’, below, not only can gardening be less stressful thanforcing oneself to socialise and do things that perhaps may not be enjoyed, butthe garden, itself, can also provide a setting in which it is possible for anindividual to sort out difficult feelings on their own: “I was a bit of wary wondering what the Social Club was going to involve you in, if you were sitting, you know, ’four walls to a group of people’ that you maybe didn’t gel with and doing things that you weren’t very happy with. Where in the garden you can just dig your way out of your misery.’ (Barbara, 67 yrs)While the positive and therapeutic aspect of gardening is well-documented instudies, largely arising from research in ‘horticultural therapy’ (see Wells, 1997;Sempik et al., 2003), there is also a negative aspect to gardening that has, toour knowledge, not been addressed in other studies to date, and which we foundto be especially prevalent in this older age group.Participants noted, that at some point, due to reduced physical health andenergy, a garden or allotment plot can become too difficult to manage andconsequently becomes uncared for and overgrown. Its presence, then, can be asource of worry, anxiety and depression - a constant reminder of the individual’sincreasing disability and loss of strength. This aspect of gardening activity maybe particularly relevant to those older people who are not associated with anyparticular ‘therapeutic’ or ‘community’ gardening project and who thus remainunsupported in their gardening activities.As we discuss in the following section ‘communal gardening’ can go some way tomitigating this perceived burden. These findings are examined in more detail inthe Discussion Section. § 36
    • Gardening in a Club Sharing tasks is a vital and very supportive way of gardening. Communal gardening activity on an allotment site offers the opportunity to share the responsibility for the upkeep and maintenance of the garden plot with others. This can reduce the burden of a garden site, which has becometoo large for one individual to manage, and increase the enjoyment gained fromthe gardening activity.In our project, gardening in a club appeared to counteract this problem verywell, particularly for those participants who had been forced to abandon theirgardening activity after a period of illness, or because they felt generally lessenergetic and able to manage an allotment site or their own garden. Even thosegardening club participants who were still able to manage their own plots orgardens found ‘communal gardening’ on allotment sites to be better thangardening alone.For six participants who had never before considered an allotment, being in theclub opened up a ‘new dimension’ to gardening: “.. because there was quite a bit of enthusiasm, people were quite keen to learn and, you know, put effort into it. And it did, it went well, and when they saw things growing of course/ I mean some of them hadn’t gardened before, you know. And when they saw things growing/ took more interest in it. It was good.” (Ben, 65 yrs)A key reason for the success of the club approach to gardening was theopportunity it offered to share tasks in a sociable environment and, as ‘Barbara’says below, as part of a ‘communal effort’: “[It’s] ..a communal effort. So when you’re digging out or weeding and that, instead of having a tired/well you know it’s weary when you’re doing a section on your own, you don’t seem to get anywhere. We do it in little groups and you have a bit [of a] laugh and talk and stop and get a chair out..” (Barbara, 67 yrs) 37
    • Group support offered people an opportunity to garden as much or as little asthey were able to without feeling guilty or pressured. Those who were frail orunwell were particularly appreciative of this. Despite feeling unwell, some groupmembers would come to the allotment site simply to sit down, watch theactivities and enjoy the company. Though the gardening activity still continued,other members of the group would express their concern and care for theindividual, facilitating their ability to still feel included as part of the group.This was viewed as an extremely supportive function of the club, combining thetherapeutic benefits of both social contact and gardening. As ‘Ben’ commented: “There was a lot of people who weren’t really physically fit enough to do the work. So then it was just a matter of helping them, so everybody just ended up piling into the plot, and that seemed to work. It was communal, everyone helped each other.” (Ben, 65 yrs)Group support offered the potential for everyone could go away from agardening session with a sense of achievement. Communal gardening can, thus,fulfil several different functions: from the therapeutic effects of gardeningactivity; to the beneficial effects of social contact between the members of thegroup. The social space and opportunity for social contact provided by thegardening club was an aspect of the activity that was seen to be of equalimportance to the gardening, itself: “.. when I come home, and I’m thankful I’ve been and happy I’ve been, you know. ‘Cos like you say, you’ve got that feel good, you’ve been in the fresh air, you’ve been talking to people and discussing the gardening and this, that and other. .. It’s gave you that pleasure to know that you’ve been and enjoyed it.. You feel so different.” (Alice, 66 yrs) As ‘Alma’ explains below, whether able to do the heavy digging or only able to be involved in less strenuous activities such as potting up or planting seeds, participants could still enjoy the social interaction. 38
    • “I don’t know what else I can do except set seeds in the polytunnel and do little jobs, sit around or maybe have a chat with them. ..We are all a lively group, you know, we are/really, have some fun, you know laugh and that. So I quite enjoy that.” (Alma, 80 yrs)In addition to the weekly gardening on the allotment sites, all the club membersfrom both the Lingmoor Way and Longsowerby allotment sites met every monthin a central indoor venue. The meeting would involve both a talk on gardeninggiven by an invited ‘expert’ speaker and a general get together. On two occasionsmembers went on visits to local ‘open gardens’. On one further occasion therewas a demonstration of the use of coppice products in the garden.These outings and talks were very successful and universally enjoyed, mainlybecause the events encouraged discussion and ideas on gardening. The eventsalso provided an opportunity for those who were unable do the gardening as aresult of ill health to participate in some club activities, so gaining a degree ofsocial benefit from sharing their enjoyment of gardens and gardening.The sharing of gardening knowledge and ideas is an important element of‘communal gardening’.People noted that they found the club a safe, sociable place in which to learnnew techniques or to pass on their skills to others. As noted above, this wasfound to been an especially compelling aspect of gardening: “the thing I like about it is we all seem to have gelled you know, the people that go there.. There’s different characters, we’ve all sort of gelled, and talk to each other a lot, and ask, you know, not be frightened to ask anybody something, you know. Shouldn’t be ashamed to ask anybody anything if you are not sure.” (Ben, 65 yrs)For some, the opportunity to grow vegetables was an aspect of gardeningactivity that they had not experienced before. Participants not only gainedknowledge and a sense of achievement, but also benefited from harvesting freshproduce to eat. 39
    • Oh I’ve done a bit of digging .. and a bit of weeding and a little bit of planting. I did potatoes and lettuce and things like that. I put potatoes in early on. Well I’d never done that before. Aye it’s very rewarding I think like. .. it’s nice when you’ve grown them and you’ve eaten them. You know it’s lovely. (Amy, 72 yrs)For many participants, sharing and gaining knowledge promoted a sense of worth,re-affirming their place as a valued and experienced member of the community.Our observations indicated this was not only an important element in the‘communal approach’ to gardening, but also in the running and dynamics of thesocial club and in other group activities undertaken by members of thereference group. We discuss this in more detail in the following section.Towards the end of the active fieldwork, participants were encouraged todiscuss how they might go about continuing the club by themselves. The aim wasto demonstrate how a gardening club, of this kind, might become self-sustainingor at least manage with limited support. At the time of writing (October 2003) asmall group are still successfully maintaining allotment plots at Longsowerby.This was the larger of the two sites with a greater core of able-bodiedmembers. However, our findings indicate that for a club to work, successfully,for its less able members, older people need to be offered regular and sustainedsupport. This need not be the intensive levels of support offered during thefirst year of the project, but should be offered on a regular weekly basis. Therecommendation is discussed in more detail in the later section. § 40
    • Social ClubsThe Social Club added a new dimension to the lives of many of those whoregularly took part.Although the club was only convened once a week, many participants reportedthat attending it had made a significant change in their weekly life. It was anevent to look forward to, one which was especially enjoyable for those who livedalone, felt isolated or restricted in their activities. “Makes another afternoon out, if you’re on your own, you know, you enjoy an afternoon out.” (Connie, 71 yrs) For others the club provided an opportunity to meet with other people, where previously they had felt increasingly anxious about going out as a result of age-related disabilities or frail health. “..as somebody who’s sort of housebound because of physical disability, getting out, at first I couldn’t stop talking. Now I just talk as much as everybody else does, and I thoroughly enjoyed it, and the company [and] the speakers because it’s something different to think about. I’ve thoroughly enjoyed it.” (Angela, 68 yrs)For some, the contact and opportunity to share each other’s stories andexperiences was particularly valued as it helped them to see their own lives in adifferent perspective: “Well, I find that’s the best bit about it. It does get you out. You meet other people and you make friends. Instead of sitting at home feeling sorry for yourself or depressed it gets you out and about. And you realise that other people have illnesses and things, you know and that.” (Esther, 68 yrs) 41
    • The social club opened up the opportunity to make new social contacts.Participants particularly appreciated being able to start afresh in a club whereeveryone was on an equal footing in a new venture. This aspect of the club wasinteresting given the findings of Jerrome’s (1989) earlier study, in which the‘ritual’ of attending an established club with regular, well-practised activitieswas found to be of prime importance. In contrast, in our study, althougheighteen (out of the total of twenty-nine) participants in our social group wereregular attendees of other clubs or activities, many had previously (and in somecases studiously) avoided some of the more traditional clubs.Participants maintained that they often found people in well-established clubs tobe ‘set in their ways’ and that the activities on offer were often ‘boring’ androutine. Some, further, noted that when they had attempted to join a well-established club they had experienced unfriendliness, even hostility, from thelong-term members, who appeared to find a newcomer rather threatening to thestatus quo.Figure 7 illustrates the extent of social club participants’ involvement inadditional activities such as clubs, societies, or adult education. Fig.7 Comparison of Social Club members outside activities 13 14 12 10 Numbers involved 10 8 6 4 4 3 4 1 1 2 0 Social Class Society Sport Games Church MU/WI Club Club Club/Society etcWe found sporting activities to be the most common additional activity thatpeople participated in on a regular basis. Indoor (and outdoor) bowling, keep fitand gym, swimming and golf were particularly popular. Only one third of oursocial club members attended other clubs. In the main, (with the exception ofsporting activities) this group was involved in far fewer outside clubs orsocieties than those who participated in the gardening club or reference group. 42
    • This finding reflects the more isolated nature of the lives of the majority ofsocial club members.The social club was, therefore, felt by some participants to have provided anunusual and welcome opportunity to join a club where previously they mightnever have considered such a move.For those put off by what they perceived to be the negative aspects of existingsocial clubs, the project offered an opportunity to create a club with adifferent agenda. Club members had a wide choice and say in the kinds ofactivities they would like to participate in. Some also felt that this provided anopportunity to develop a different and more inclusive ethos within the club.Without exception, participants asked for arts and crafts, talks, andoutings rather than games.These activities, particularly the local outings, proved very popular. Only fourmembers already attended clubs where they could take part in arts, music, adulteducation, or cookery (two of which were organised by Age Concern). The othermembers had either been unaware of possible educational activities or societies,or felt unable to get out to a music or art class or club.Within the social club, several arts and crafts sessions were organised rangingfrom silk painting, card making to pot decoration. The arts and crafts sessionswere greatly enjoyed. Some participants noted that they would never haveimagined being able to do any arts and crafts before, and were surprised howmuch fun and pleasure they gained from taking part. As ‘Meryl’ commented: “I’ve thoroughly enjoyed it. Oh, it’s really tickled me pink. Like last week sitting painting plant pots. I thought if anybody, any of my colleagues, knew and they could see me now they wouldn’t believe it. And yet you get something out of things you never think of doing, you know the painting and that sort of thing. It never entered my head I would paint, ‘cos I’m not a person for my hands. But I’ve enjoyed doing different things.” (Meryl, 71 yrs)Some participants noted that they had consciously avoided the traditional‘games style’ of club. They had no interest in playing Scrabble, board games orcards. Within the project social club, everyone, it seemed, was looking for somedifferent or new ideas. 43
    • Organised outings were felt by social club participants to be very important. Inmany cases it was an opportunity to get out and about, with company, in a waythat was otherwise no longer possible: “I like getting out to Tullie House very much, I enjoy that. You see any change of scene is a joy to me now, and going somewhere different. Going to the llama farm, we had a bit of a laugh on the bus going. I enjoyed seeing the animals. I haven’t seen them before. I’ve enjoyed the activities and the lectures.”While local activities in the immediate vicinity, or the city centre, were popularthe outings further afield were less well-attended in spite of significantinterest, initially, in the suggestion. The longer trips were, mostly, attended bythe more able members of the group. This suggests that, for less-able members,the reality of longer excursions may be too arduous, hence they opted to stayhome.At the regular venue people enjoyed the way the sessions were structured, withthe planned activity at the start of the session followed by some social timewith refreshments. This facilitated the opportunity for participants to chattogether, encouraging a ‘social atmosphere’: “this club’s different from the other Clubs that I go to because the other Clubs are more competitive and this is you know a social atmosphere.” (Monica, 73 yrs)Participants felt the emphasis placed on developing the ‘social atmosphere’meant that the club was very relaxed. As one person said: “There’s no stressattached to this club.” (Esther, 68 yrs). This highlights the general feeling amongstparticipants that because the club was a new venture, they had a sense ofempowerment and common ownership.It is worth noting that the preferred activities of this group were markedlysecular with only three people professing to be strong churchgoers involved intheir local church activities. This, contrasts sharply with the findings ofJerrome’s study (see above) in which she had found that older people’s clubsoften retained a strongly religious ethos that determined the structure andrunning of a club. 44
    • An important function of the social club was to provide a focus ofconversation for people to share with family or friends. “It’s a shared experience, you know. You chat about it the next week and I’ve been able to share it with friends and family, that sort of thing.” (‘Meryl’, 72 yrs)Being involved in activities outside the home was seen by participants asempowering, enabling them to renew their sense of selves as valued, valid andactive member of the community as well as gaining a sense of well-being fromtaking part in their chosen activities.The key to the success of the social club proved to be the way memberschose to organise it.As a people-led venture decisions about the organisation and activities withinthe club were made by consensus (supported by the organiser). The cluborganiser ensured all participants had an opportunity to discuss their choice ofactivities with both her and each other. As a consequence, all participants wereable to have an equal say in the running of the club.Towards the end of the Project members were encouraged to discuss continuingthe Club by themselves. At the time of writing the Club’s success has beenmaintained by a continuing, strong group commitment and limited but ongoingsupport from Age Concern. § 45
    • Section 7: DiscussionHealth: physical fitness and mental stimulationThe health benefits of different activities for older people often tends to focusaround promoting or improving physical health and fitness. In terms ofgardening, for instance, this is reflected in previous studies that emphasisephysical activity as the major health factor in gardening (see for exampleCaspersen et al., 1991; Cowper et al., 1991; Crespo et al., 1996; Galgali et al.,1998). Mental health and well-being in relation to gardening activity for olderpeople has been less well-documented (for exceptions see Houseman, 1986;Armstrong, 2000). Importantly, as noted in the gardening section of this report,mental stimulation was considered by many of our participants to be a keyelement of gardening activity.In this study we were primarily concerned to explore the benefits to mentalhealth and well-being of different activities, although we did note those changesin physical health and fitness that participants observed in their self-assessment both during and at the end of the project. It is interesting to notethat, for those older people participating in the project, the physical benefitsarising from an activity were of less concern than whether or not they ‘feltbetter in themselves’. The exception to this general view focused around thoseactivities specifically designed to improve physical fitness, such as yoga, keep-fit classes, ‘prescription fitness’ gym sessions, walking, cycling and so on.Whilst a varying degree of age-related illness and disability is inevitable withincreasing age, participants demonstrated a variety of strategies that theyemployed to maintain their physical and mental abilities for as long as possible.These included keeping themselves ‘disciplined’ by making a positive effort to goout to do things whenever and wherever possible and keeping their minds activewith topics that interested them. This might include either joining a club,society, or an adult education class, keeping physically active, gardening, andmaking a positive effort to ignore their chronological age. As Ted (69) andNatalie (69) commented respectively, ‘my age is no excuse’ ; ‘I don’t want to besaying ooh I’m seventy and I can’t do this.’Most significantly, participants noted that they made a positive choice to avoidwatching much television. This activity was considered by most of theparticipants as a ‘death knell’, particularly daytime television. As Archie (70) putit, ‘In fact you get worse as you/sitting watching television is/you’redeteriorating all the time’. Conversely, crossword puzzles were seen as aparticularly useful means of keeping the mind active. For some participants this 46
    • kind of mental activity was viewed as a preventative measure against illnessessuch as Alzheimer’s or other memory loss problems.The intensity with which some people engaged in activities suggested they weredistracting themselves from concerns about possible, and in some casesincreasingly real, age-related disability. Mental impairment was by far the mosttroubling aspect of ageing for our participants and finding sufficient mentalstimulation in their activities was a priority for many. These strategies could(and some felt should) be used to minimise age-related physical restrictions togetting out of the home, thus maximising older people’s enjoyment of everydaylife.Several participants noted that the highly creative and mentally stimulatingqualities of gardening are also to found in other skilled activities. This wasparticularly true of those activities that require manual dexterity andcreativity, such as upholstery, flower arranging, art, DIY or woodwork. In part,as suggested by the quote below, there is great value in any activity that ismentally stimulating and which provides a sense of achievement: “I get the same feeling with the DIY work I do as well. Yeah, I agree entirely with everything said there, maybe, about the gardening. Brilliant. You know the achievement. Ah, I just think being active is mentally stimulating really.”(Ronald, 67 yrs)Health and gardeningParticipants noted that although, on occasion, they found that gardening helpedtheir fitness and stamina, its key benefit was in improving their sense of mentalwell-being. These positive aspects to gardening activity occurred despite, insome cases considerable, age-related health problems and disabilities thatplaced limits on their ability to bend or kneel, or to undertake any gardeningthat demanded physical exertion. In particular, people gained pleasure in beingable to get out and feel occupied, even if this was limited to a little ‘potteringabout’: You get out in the garden and it keeps you going, summat to occupy. Whether you can bodily or physically do it or not it’s ‘get out there and get summat done’. That’s what I say! (Archie, 70yrs) 47
    • The health benefits of gardening were, thus, felt by many participants to be adirect result of being out in the fresh air, and in contact with ‘nature’ via theearth and the plants.For our participants, the on-going ‘challenge’ of gardening and the need to ‘lookand plan ahead’ were key factors in helping to maintain mental well-being. “The great joy of gardening is .. it’s always making you look ahead isn’t it? You know, although you’re regretting the end of the Summer .. you are planting bulbs and looking forward to the snowdrops that you planted last year and so on, coming through.”In addition to the pleasure and anticipation of planning and designing the gardenand the new tasks to be undertaken each season, gardening offered thepotential to learn new ideas and refine existing skills. Participants maintainedthat the mental stimulation engendered by their gardening activities enabledthem to cope more effectively with their existing physical health problems, aswell as making them feel less prone to low moods or depression. As ‘Barbara’commented: “Oh everybody should garden! Because it’s so healthy. It’s so calming. It’s, you know it’s just/you forget the world somehow.” ( Barbara, 67 yrs)Gardening provided the space for participants to distance themselves from thewider world for a little while and people found they could forget some of theirworries and troubles, including anxieties about physical health or actual physicaldiscomfort. ‘Avril’, in particular, felt that without the communal gardening tolook forward to, and the pleasure of being able to still get out in her own garden,her increasing physical disabilities would have been much harder to deal with: “Oh its been great! I think if I hadn’t had that [gardening] to look forward to I’d have been much more depressed and weary than I’ve been. It’s been my main activity since I’ve had to give things up through being limited.” (Avril, 73 yrs)One of the key aspects of the gardening activity was that it offered people theopportunity to garden communally on an allotment site. The ‘communal gardening’proved to be a significant factor in maintaining mental health and well-being, 48
    • combining the enjoyment of the gardening activity with the substantial healthbenefits of social contact.Health and social activitySocial contact is critical to maintaining and promoting health and mental well-being. The majority of people recruited onto the project, with a few exceptions,described having very active lives with regular social contact either with theirfamily, friends or as part of a club or society. This social contact was cruciallyimportant for everyone involved, regardless of the different activities theyengaged in. The most successful activities were those that offered good socialopportunities.Even when illness and disability prevented people’s active involvement in socialactivities, participants noted that they felt better for having some socialcontact either by going to a club, society meeting or other activity and justbeing in the company of other people. Generally, people’s enthusiasm for activityoccurred regardless of their age (active people aged over 80 years were as busyas those in the 65-69 yrs age group). If people were unable to be physicallyactive then, as often as possible, they did some mental activity.In the initial interviews participants commented on the extent to which anactive or fulfilling social life helped to maintain their health and mental well-being. This was viewed as particularly important in helping to prevent lonelinessand isolation. For some, families, especially grandchildren (and greatgrandchildren) provided the major social contact in the week. For others, thiswas met through strong and enriching friendship networks that had beenmaintained or developed over many years.Many people gained supportive and sustaining social contact by attending clubs,societies, church activities or taking part in voluntary work in schools, hospitals,charities or community projects. A few of our participants were still in part-time paid work, which also provided them with social contact.However, in spite of a multitude of activities undertaken every week, asignificant number of people noted that they had to make a conscious effort togo out and get involved in some form of activity in order to ward off feelings ofisolation and loneliness.We also found a close relationship between physical health problems and anoverall decline in well-being. This might arise either as a result of loneliness orfollowing some personal upset or family event, often after bereavement. At 49
    • these times participants found that if they made a conscious effort to maintainsome social contact with other people, this would also help to reduce or ease theill-effects on their general health.Strategies to maintain social contact were particularly important where anindividual had lost a partner, lived alone, where they lived at some distance fromtheir family, or were estranged. Social isolation was also more likely where aperson suffered illness or disabilities that made it difficult to get out.Overcoming these problems could be particularly difficult where transport wasscarce and/or it meant waiting, alone, in streets that were perceived to bedangerous, and during winter months when dark, cold nights discouraged peoplefrom going out of the house.Keeping active and feeling valuedOlder people’s need to feel valued in society is highly vulnerable to ageism andageist attitudes (Bytheway, 1995). Sharing knowledge in a group or club wassupportive to different individuals in often quite subtle ways, boosting theirself-confidence and sense of self-worth. Some participants had only recentlyretired and one or two still undertook some part-time paid work. Although someparticipants clearly relished retirement, finding it gave them the freedom andopportunity to undertake voluntary work, or to pursue [sometimes new] hobbiesand activities, for others the transition had been difficult. These individualstalked quite frankly about how hard the transition to retirement had been forthem. This was especially relevant to those aged between 65 –70 years of age,where the experience, itself, was still vivid as were the strategies adopted toovercome the problems of this transition. As ‘Robert’ (68) commented: When you retire, I don’t know if any of the rest have told you, it’s a bit of a shock to the system. It’s like driving a car and crashing it and writing it off. And when you get out of that car your mind tells you it’s not all - you’re alright, the car’s bent.‘Robert’ sought to overcome the ‘shock’ of retirement by involving himself in asignificant amount of activities, some of which involved physical activity andothers that he found mentally stimulating. He belonged to a regular, formallyorganised, social club and an informal ‘coffee club’ consisting of friends (allretired men) that ‘put the world to rights’ every week. He was also a keenmember of the golf club and he and his wife socialised regularly with groups offriends. This range of activities presents a typical picture of range and extentof activities undertaken by a significant number of those participating in theproject. 50
    • As ‘Robert’ noted, however, numbers in the informal club had fallen recently as‘the obituary columns have thrust their knife into it’. As ‘Sarah’ furthercommented: “I don’t have as many friends, as you get older they seem to fall by the wayside … They’ve all died, that’s me, I’ve none left”. (Sarah, 89)The increased likelihood of ill-health and mortality amongst older people canthus result in a significant shrinking of those social networks that older peoplehave formerly drawn on for support. Furthermore, the loss or long-term illnessof a partner can result in older people having to re-think their identity withintheir existing social networks. The provision of social spaces in which olderpeople can meet and share experiences while participating in mutually enjoyableactivities, can, we suggest, facilitate the re-forging of new social identitieswithin new social networks.Strategies to determinedly pursue social and other activity following retirementwere also viewed as important by some participants as it gave them a sense ofvalue and worth. Older people can often find themselves combating the feelingof being of less worth to the community. Their knowledge and experience is nolonger valued or called upon by younger, fitter, working members of thecommunity. Yet many older people have gained significant knowledge andexpertise in the course of their lives. An important aspect of the activitiesengaged in within this project was that they offered a forum for the skills andexpertise of these older people to be acknowledged and shared amongst theirpeers. This was particularly true of the gardening activities, but was also evidentin other skilled activities in which our participants engaged, such as DIY, crafts,volunteer teaching and organisational skills. As ‘Roger’ commented: I often think retired people, they’ve all done something throughout their working life, whatever, and they’ve all been experts in their field. It doesn’t matter what it is. They’ve all done their - they’ve an awful lot to offer, you know, plumbers, joiners, electricians. All these people, all this knowledge and it’s just gonna disappear when they go. You know, if there was some means where they could pass this on, I don’t mean to people my age, but to younger people. “ (Roger, 72 yrs)There were several people who were very active in the community working asvolunteers in schools or in church-led and secular social and sport projects withyounger people. These sorts of activities provided the kind of outlet for sharingskills that ‘Roger’ alludes to. Equally, for those who participated in the clubs set 51
    • up by the project, there was a clear sense of value in sharing knowledge amongsttheir peers. People noted that they found the social club settings and communalgardening especially helpful in this respect.Health and issues of genderGender issues emerged throughout the project, not least because, as notedearlier, there were some wide (though predictable) differences in the balance ofmen and women in the three groups.Although, we often found that gender stereotypes were affirmed, there weremany occasions when gender issues confounded both our own perceptions, andsurprised those of our participants. These issues were seen to be an importantfactor for participants in terms of their willingness to either engage with theproject in the first place or, once part of the project, the choice of activities inwhich they were prepared to engage.Both women and men agreed that a social club where there was little structureleaving much opportunity to talk together was going to reflect what theyperceived of as the needs of women. In general, participants considered thatwomen were happy to ‘chat’ together over a cup of tea during the daytime in aninformal, homely setting, whilst men preferred to ‘go down to the pub for adrink’, or to a structured, often highly organised and usually well-established,male-dominated club.Predictably, then, the most blatant stereotypes were apparent in the social club.This was considered by two or three of the men to be ‘just another women’schat club’. While, originally the allocation of participants to the club wasintended to reflect a relatively mixed gender balance, drop out and new [early]recruitment meant that, once club numbers stabilized, it was dominated bywomen (twenty-three women to six men). Of the six men that did join the club,only three were still regularly attending by the end of the project.Two men withdrew following the first social club meeting - one commenting that,for him, ‘it was just another WI meeting’ (Bruno, 75 yrs). Another simply found it‘boring’ (Huw, 79 yrs). Three of the male participants said they would havepreferred something more structured, with some structured purpose.Exceptions to this view were found in two of the men who liked the company ofwomen, were happy to take part in the less formal meetings and enjoyed thevariety of talks and crafts. One of the men who continued to attend commentedthat, in his view, he was untypical of most men in that he was a ‘loner’ andpositively disliked the sort of stereotyped clubs dominated by men and alcohol. 52
    • Gender issues, however, were more complex in the gardening group. The gardenoffered a much freer space for women and men to share tasks that they hadpreviously associated with the opposite gender, and thus helped to create asocial space based on a greater equality and respect than is often found intraditional settings. We would argue that this in part was due to the fact thatboth in the UK and in many other cultures around the world, women havetraditionally occupied a niche in the garden (Wells, 1997; Buckingham Hatfield,2000).Although, within this niche, women are seen to have specific roles in nurturing(food production), healing (the growing of herbs) and aesthetics (tendingflowers), they have, nevertheless, maintained a respected place in the garden ingeneral. Conversely, men are often regarded as having more technical knowledgein gardening activity (e.g. agricultural food production) or specific expertise (e.g.as horticultural specialists). On allotment site where the gardening activity wasshared, however, both men and women discovered much common ground. Whilstone woman initially referred to the men as the ‘diggers’ (Alice, 66 yrs), she,along with other participants, later noted that, in fact, men and women sharedall the tasks. The major factor determining the tasks each person undertook,was their physical ability.Major changes occurring in people’s lives, such as bereavement, retirement,illness or family difficulties also focused attention on some of the gendered andageist attitudes experienced by older people. Most evidently, men were able tomaintain their status in a crisis by avoiding making any significant adjustment totheir lives. In cases of bereavement or illness, for example, men were morelikely than women to be supported by a female friend or relative, thus enablingthem to continue their lifestyle with only limited change.In contrast, women were more likely to find themselves having to adjust togreater changes in their lives. This occurred not solely as a consequence of theirincreased likelihood of being bereaved, but because they were more frequentlycalled upon to support’ other family members in crisis. This support wasfrequently demanded of them regardless of their own disabilities.Women who were left alone often found themselves having to forge a new lifefor themselves through engaging in new forms of social or physical activity ifthey wanted to avoid suffering from extreme isolation. This reflects theincreased willingness of older women to participate in the project, particularlythe social club, seeing it as an opportunity for a supportive social network. 53
    • The reference group had a relatively even balance of men and women, but interms of willingness to join the project, gender issues were not seen as a factor,since the status quo of either male or female would not be challenged. § 54
    • Section 8: ConclusionTwo major conclusions arise from this study. The first specifically concerns thebenefits of gardening communally and/or alone; the second concerns healthbenefits associated with social activities in clubs or other settings.Gardening offers a valuable tool for maintaining older people’s health and mentalwell-being, and in some cases supporting fitness and stamina. However, there is aneed for sensitivity and flexibility in the approach taken. Communal gardeningwill not appeal to, or suit, everyone; hence gardening interventions for olderpeople need to be tailored to individual needs and, in particular, communalprojects need to be adequately and skilfully supported.Other communal projects report similar findings. Though not an evaluatedproject, the Marsh Age Link (Community Project) in Lancaster, NW England, alsofound that the presence of a skilled support worker on a site dedicated tocommunal gardening was crucial in encouraging older people to get involved in thegardening activities. Within this framework the worker was able to offerindividual, but often, unobtrusive support for each person who showed interest(Drew, 2003). This kind of approach is supported by evidence from otherprojects around the country that have been supported by the horticulturaltherapy charity, Thrive (see Sempik et al., 2003).Our findings also indicate that gardening activities can be encouraged if theallotment site or domestic garden is adapted to accommodate people with avariety of abilities and needs. The allotment site needs to be close to people’shomes and specialist tools are helpful for those people with more limitedphysical ability.In the course of the study we provided some support for some people within thegardening group to tend a plant in their homes. While only a few individuals tookup this option, a large number of participants, across all groups, spoke about theways in which they had adapted their gardens to enable them to keep gardeningas long as possible. This leads us to suggest that the health benefits ofgardening might be best promoted by a combination of schemes, from allotmentsites with supportive clubs to the introduction of ‘flexible supported gardeningschemes’ where people can garden in their own homes with support. There is alsoa case for the provision of small domestic plots in sheltered housing withgardens (Milligan et al., in press). 55
    • Finally, we conclude that there is a need for the development of social spaceswithin which older people, particularly those who feel socially isolated, can meetand share experiences. Social contact was unanimously and overwhelmingly foundto be the crucial factor in maintaining the health and well-being of older people.Whether as a club, a society, through voluntary work, or an informal meeting offriends or family, the development of spaces in which older people can makethese social contacts is of prime importance. They can facilitate not only the re-forging of new social identities within new social networks, but they can also actto cushion the effects of stress and anxiety.During the course of our study, it became clear that the garden and social clubsacted as sites within which older people were able to develop friendships,express caring and discuss issues around family life, struggle and copingmechanisms in their daily lives. Activity within such clubs can bring a range ofbenefits, e.g. the opportunity for self-expression; a context for working out newsocial identities; a sense of security; supportive networks; and a chance toconfront some of the ambiguities and losses of ageing. The importance of theseclubs, we would argue, is that they can open up spaces for some older peoplethat offer greater opportunities for their emotional expression that thoseexisting in their everyday lives. § 56
    • Section 9: DisseminationThe project team have made a considerable effort to ensure that the findingsfrom this project have been disseminated both orally and in written format to arange of different audiences as detailed below. Papers have been delivered atregional, national and international conferences and presentations have beengiven in less formal seminars. Professor Gatrell has also been an advisor to aproject supported by the Community Fund (joint Thrive and LougboroughUniversity) on assessing the evidence base for horticultural therapy.Published journal articles on issues arising from this study are detailed below.We have also produced a summary report aimed at older people – particularlythose who participated in the project - alongside this more detailed report forvoluntary/community organisations and other groups who may be interested inthe project and who may wish to develop similar clubs or gardening schemes.Both of these reports are available electronically as Word and .pdf documentson our Cultivating Health website at: http://www.lancs.ac.uk/users/ihr/research/mental/cultivatinghealth.htmA limited number of hard copies will be made available to those interested in thefindings of the research. Please contact Dr Christine Milligan (for contactaddress see page 2 of this report).Our overall aim has been to disseminate the findings of this study to a widevariety of audiences including academics, health and social care professionals,the voluntary and community sector as well as older people themselves.Current and Submitted Publications:Allnutt, E. (2003) ‘Cultivating Health’, Allotment and Leisure Gardener, TheJournal of the National Society of Allotment and Leisure Gardeners, Issue 1 p.6.Allnutt, E (2003) ‘Cultivating Health’ Carlisle Focus Issue 7 p.6.Milligan, C., Gatrell, A. and Bingley, A. (in press) ‘Cultivating health: therapeuticlandscapes and older people in northern England’, Social Science and Medicine,(corrected proofs online). 57
    • Milligan, C., Bingley, A. and Gatrell, A. (submitted) ‘Healing and Feeling: the placeof emotions in later life’, in Davidson, J., Bondi, L. and Smith, M. (eds) EmotionalGeographies, Blackwell Pubs, London.Planned and Forthcoming publications:Bingley, A., Milligan, C. and Gatrell, A. (forthcoming) ‘In the garden and beyond:observations on gender and ageing’, Gender, Place and Culture.Gatrell, A. and Wagstaff, R. (planned) ‘Cultivating Health and well-being amongstolder people in Northern England’, Health Services Journal.Gatrell, A., Milligan, C., and Bingley, A. (planned) ‘The Plot Thickens:methodological issues in cultivating health amongst older people in NorthernEngland’, Aging and Society.Milligan, C., Bingley, A. and Gatrell, A. (planned) ‘Diaries and dilemmas: exploringhealth and activity amongst older people through narrative approaches’,International Journal of Qualitative Health Research.Reports:Bingley, A., Milligan, C., Gatrell, A., Allnutt, E., and Wagstaff, E. (2003)Cultivating Health: a study of the health and well-being of older people inCarlisle, end of project summary, June 2003. Institute for Health Research,Lancaster University.Milligan, C., Bingley, A. and Gatrell, A., (2003) Cultivating Health: a study ofhealth and mental well-being amongst older people in Northern England, FinalResearch Report, October 2003. Institute for Health Research, LancasterUniversity.Conference Papers and Presentations:2001 IHR Seminar, Lancaster University: ‘Cultivating Health’ - A. Gatrell.2002 University of Liverpool Seminar – Department of Primary Care: ‘CultivatingHealth’ – A. Gatrell. 58
    • 2002 North Cumbria NHS: International Older Person’s Awareness Day: HealthyLiving Conference: ‘Cultivating Health amongst Older People in Northern England’- C. Milligan, A. Bingley & J. Barker.2002 Emotional Geographies Conference, Lancaster University: Digging andDreaming: therapeutic landscapes and older people in Northern England,Lancaster - C. Milligan and A. Bingley.2002 IHR Seminar, Lancaster University: ‘Digging and Dreaming: therapeuticlandscapes and older people in Carlisle’: C. Milligan and A. Bingley.2002 North Cumbria Healthcare Research and Development Conference,Westlakes: ‘Cultivating Health and Well-Being among Older People in NorthernEngland’ – A. Bingley2003 International Medical Geography Symposium, Manchester: ‘The plotthickens’: methodological dilemmas in cultivating health amongst older people inNorthern England - C. Milligan.2003 Association of American Geographers, New Orleans, USA: CultivatingHealth: therapeutic landscapes and older people in Northern England - C.Milligan.2003 GRAIN, Reading: Growing Together Seminar - C. Milligan.2003 Institute of British Geographers Annual Conference (RGS-IBG): ‘In thegarden and beyond: observations on gender and ageing’ - A. Bingley. § 59
    • BibliographyArmstrong, D. (2000) ‘A survey of community gardens in upstate New York:implications for health promotion and community development. Health and Place,6:4 pp. 319-327Buckingham-Hatfield, S. (2000) Gender and Environment (Routledge: London &New York)Bytheway, B. (1995) Ageism (Open University Press: Buckingham & Philadelphia)Caspersen, C.J. et al. (1991) ‘The prevalence of selected physical activities andtheir relation with coronary heart-disease risk-factors in elderly men – TheZuphen Study, 1985’ American Journal of Epidemiology 133:11 pp. 1078-1092Cowper, P.A. et al. (1991) ‘The impact of supervised exercise on thepsychological well-being and health status of older veterans’ Journal of AppliedGerontology 10:4 pp.469-485Crespo, C.J. et al. (1996) ‘Leisure-time physical activity among US adults –Results from the third national health and nutrition survey’ Archives of InternalMedicine 156:1 pp.93-98Drew, J. (2003) pers. comm.re: Marsh Age Link Community Project August 27th2003.Field, A. (2000) Discovering Statistics using SPSS for Windows, Sage, London.Galgali, G. Norton, R. Campbell, A.J. (1998) ‘Physical activity in NewZealanders aged 60 years and older’ New Zealand Medical Journal 111 (1063) pp.115-117 (April 10)Jenkinson, C., Layte, R., Wright, L. and Coulter, A. (1996) The UK SF-36:An Analysis and Interpretation Manual, Health Services Research Unit,Department of Public Health and Primary Care, University of Oxford.Hill, S., Harries, U. and Popay, J. (1996) Is the short form 36 (SF-36)suitable for routine health outcomes assessment in health care for older people?Evidence from preliminary work in community based health services in England,Journal of Epidemiology and Community Health, 50, 94-8.Houseman, D. (1986) ‘Developing the Links Between Horticultural Therapy andAging’ Journal of Therapeutic Horticulture’ 1, pp.9-14Jerrome, D. (1989) ‘Virtue and vicissitude: The role of old people’s clubs’. In M.Jefferys Growing Old in the Twentieth Century’ (Routledge: London & New York)pp.151-165Mallinson, S. (1998) The Short-Form 36 and older people: some problemsencountered when using postal administration, Journal of Epidemiology andCommunity Health, 52, 324-8.Milligan, C., Bingley, A. F., Gatrell, A. C. (2003) ‘Cultivating health’:therapeutic landscapes and older people in northern England Social Science &Medicine (in press) 60
    • Pretty, J., Griffin, M., Sellens, M., Pretty, C. (2003) Green exercise:complementary roles of nature, exercise and diet – physical and emotional well-being and impications for public health policy CES Occasional Paper March 2003:University of EssexSempik, J., Aldridge, J., Becker, S. (2003) Social and therapeutichorticulture: evidence and messages from research (Thrive in association withthe Centre for Child and Family Research: Loughborough University MediaServices)Walters, S.J., Munro, J.F. and Brazier, J.E. (2001) Using the SF-36 witholder adults: a cross-sectional community-based survey, Age and Ageing, 30,337-43.Wells, S. (1997) (ed.) Horticultural therapy and the older adult population(Haworth Press: New York & London)Wilde, L. (2003) Carlisle Citizens Panel Eleventh Questionnaire (Carlisle CityCouncil: Carlisle) 61