The Impact of Gardens and Gardening on Seniors in British Columbia Health-Care Facilities: A Review of the Literature
The Impact of Gardens and Gardening on Seniors in
British Columbia Health-Care Facilities:
A Review of the Literature
Research Director: Paul Allison
Research Assistant: Claire Liberman
March 21st 2002
A project funded by the Royal Roads University Office of Research
The Impact of Gardens and Gardening on Seniors in
British Columbia Health-Care Facilities:
A Review of the Literature
Table of Contents
OVERVIEW ................................................................................................................................................... 3
GLOSSARY .................................................................................................................................................... 4
FOUNDATIONAL THEORY ON THE PLANT-PEOPLE RELATIONSHIP ...................................... 5
HISTORY OF HORTICULTURE AS THERAPY .................................................................................... 9
GARDENS AS AGENTS OF HEALING IN HEALTH CARE FACILITIES ...................................... 12
SPECIFIC IMPACTS ON SENIORS ........................................................................................................ 15
INTERNAL AND EXTERNAL BENEFITS TO HEALTH CARE FACILITIES................................ 16
EXAMPLES OF CURRENT ACTIVITY IN BRITISH COLUMBIA ................................................... 17
GAPS IN THE RESEARCH ....................................................................................................................... 20
REFERENCES ............................................................................................................................................. 24
A review of current literature seeks to inform the question: “What are the benefits of
gardens and gardening to seniors in health care facilities in British Columbia?”
Due to the lack of published work related specifically to British Columbia, this review
will outline the research that is available. While some of the research is quantitative, most
is research is qualitative and has taken place related to health care facilities in the United
States. Examples of current gardening activity in health-care facilities in British
Columbia are included as evidence of the theories set forth by published research.
Included in the review is a glossary of key terms, a history of the field of horticultural
therapy, significant theories underpinning the field of horticultural therapy, a detailed
overview of the psychological, physiological and social benefits derived from gardening
activities, perceptions on significant gaps in the research, statistics of numbers of seniors
in British Columbia and implications for future study.
The literature reviewed in this paper has no contradictory elements. All findings indicate
benefits of active and passive gardening activities to humans on every level, physical,
psychological, emotional and spiritual.
The findings have evolved greatly over the last 100 years. Early research concluded a
general knowledge that exposure to plant life is beneficial to humans and is enhanced
today by many specific findings from the last 35 years on the very specific ways that
humans benefit, particularly when in a health care environment. The decade of 19901999 has seen an explosion of research and publication on the benefits of therapeutic
gardening activities. The emergence in the 1990’s of The Journal of Therapeutic
Horticulture, published by the American Horticultural therapy Association has provided
a significant vehicle for publication of the research done in this field.
Seniors-for the purposes of this paper, seniors will be defined as persons age 65 and over.
Health Care Facilities-hospitals, long-term care facilities such as nursing homes and
Therapeutic Garden- “Any green outdoor space within a health care setting that is
designed for use…. A space to look out at, and a space for passive or quasi-passive
activities such as observing listening, strolling sitting, exploring and so on” (Barnes and
Horticulture- “The art and science of growing flowers, fruits, vegetables, trees and shrubs
resulting in the development of the minds and emotions of individuals, the enrichment
and health of communities and the integration of the ‘garden’ in the breadth of modern
civilization” (Relf, 1992).
Horticultural therapy- According to Relf (2001), horticultural therapy has four
1. A defined treatment procedure that focuses on horticulture or gardening
2. A client with a diagnosed problem who is in treatment for that problem
3. A treatment goal that can be measured and evaluated
4. A qualified professional to deliver the treatment
1 The definition of horticulture therapy has been significantly strengthened in recent years in an attempt to gain recognition and validation for the practice as a
significant therapeutic component of health care treatment. Most of the research referred to in this paper however, appears to be based on a less defined view of
horticulture therapy which would mean any and all interactions active or passive with plant materials and natural settings.
Foundational Theory on the Plant-People Relationship
Why is horticulture beneficial to humans? In the 1860’s, Frederick Law Olmstead,
considered the founder of landscape architecture, wrote extensively on his belief that
contact with nature was therapeutic to physiological and psychological health:
Nature employs the mind without fatigue and yet exercises it; tranquilizes it and
yet enlivens it, and thus, through the influence of the mind over body, gives the
effect of refreshing rest in reinvigoration to the whole system (Olmstead as cited
by Davis, 1998).
A traditional definition of horticulture has been “the science and art of growing fruits,
trees, vegetables and flowers or ornamental plants” (as cited by Relf, 1992). In 1992,
Diane Relf introduced a new and more holistic definition of horticulture:
Horticulture is the art and science of growing flowers, fruits, vegetables, trees and
shrubs resulting in the development of the minds and emotions of individuals, the
enrichment and health of communities and the integration of the ‘garden’ in the
breadth of modern civilization. By this definition of horticulture encompasses
PLANTS, including the multitude of products (food, medicine, O²) essential for
human survival; and PEOPLE, whose active and passive involvement with ‘the
garden’ brings about benefits to them as individuals and to the communities and
cultures they comprise” (Relf, 1992).
The impact of horticulture on human health and well-being has been studied in depth for
the last 35 years. There are foundational theories from other fields that underpin the
research done in horticultural therapy. Numerous disciplines are acknowledged by
horticultural therapy scholars as underpinning contributors to their own research--environmental psychology, landscape architecture, social ecology, anthropology,
sociology, geography, communications and forestry (Relf, 1992). There are three
fundamental theories that underpin subsequent research about how and why plants
positively impact humans:
Overload and Arousal Theory
Environmental psychologists Parsons and Ulrich developed a theory called
“Overload and Arousal” in which they assert that the bombardment of noise and
movement, with visual complexity overwhelm the senses and can lead to damaging levels
of psychological and physiological excitement. Their research concludes that plants are
“less complex and have patterns that reduce arousal” (Parsons and Ulrich as cited by
Relf, 1992, 1998).
This theory maintains that human response to plants is related to early-learned
experiences. For example, people who grow up in the plains of western Texas seem to
prefer flat landscapes. Ulrich maintains “modern western cultures condition people to
like nature and plants and to have negative feelings about cities” (Ulrich as cited by Relf,
1992). This theory however, does not consider that often, people from vastly different
cultures, geographies and historic periods have had similar positive responses to nature.
This theory maintains that human response to plants is a “result of evolution” and that
people respond positively to things such as water, stone and other scenes that resemble
the conditions present during the periods of early human survival and development.
(Orians, Balling and Falk, Kaplan and Kaplan and Ulrich as cited by Relf 1992).
Significant quantitative and qualitative studies have been conducted which conclude that
contact with plants leads to increased positive feelings, and reduced fear and anger
(Ulrich as cited by Relf, 1992). A quantitative study in 1986 documented several
physiological changes related to recovery from stress that included lower blood pressure
and reduced muscle tension. This study concluded that after viewing a natural scene,
recovery of stress was indicated within 4 to 6 minutes. (Ulrich and Simon as cited by Relf
There are several studies specifically focused on the impact of passively viewing a nature
scene from a window. Heerwagen & Orians and Kaplan report in separate studies that
when nature is viewed from an office window, there are reports of less job stress and
higher job satisfaction (Heerwagen and Orians and Kaplan et. al as cited by Relf, 1992).
In a study of gall bladder patients in 1984, viewing a nature science from a window led to
shorter post-operative stays and the use of fewer potent pain drugs than by those whose
only view was of a wall (Ulrich as cited by Relf, 1992). In a study of inmates who had a
view of farmland and forest, there were reports of fewer sick calls than among those with
a view of a prison yard (Moore as cited by Relf, 1992). A similar study showed less stress
symptoms such as headaches among inmates who had a view of a natural setting. (West
as cited by Relf, 1992).
Much of the literature of the late 1980’s and 1990’s refers to the concept of “restoration”
as the key benefit of plants and natural settings to humans Ulrich states that “restoration
is required from stress which is caused in anticipation of a challenge of threat to wellbeing” (Ulrich as cited by Betrabet, 1996). Rachel and Steven Kaplan define restoration
as the “recovery of voluntary attention, in other words, concentration” (Kaplans as cited
by Betrabet, 1996). Betrabet refers to the 1978 study of Cohen and the 1970 study of
Milgram when noting “the antecedent condition which leads to a need for restoration is
mental fatigue, where a capacity for voluntary attention is depleted.” (Betrabet, 1996).
In 1989, environmental psychologists Rachel and Steven Kaplan (as cited by Betrabet,
1996) broke down the process of restoration into four successive stages each resulting in
deepening levels of restoration based on cognitive processes:
1. Clearing the head; the removal of cognitive leftovers
2. Recovery of directed attention
3. Achieving of cognitive quiet fostered by soft fascination
4. Reflection on one’s actions goals, priorities and possibilities
According to Betrabet, each stage requires “more time in a high quality restorative
setting” (1996). Betrabet defines a restorative environment as “a setting that fosters
restorative experiences and consists of interesting elements that engage and fascinate,
drawing forth without taxing the individual’s capacities and creates an ambiance and
conditions to reflect. (Betrabet, 1996). He further defines this environment as one that
provides access to positive distractions, enables a sense of control with respect to
surroundings and provides access to social contact. Rachel and Stephen Kaplan further
define restorative environments as natural settings effective for rest and relaxation that do
not have to be dramatic and can be viewed passively to which even short exposure can be
helpful. They further assert that restorative benefits can be received without intention.
Examples of the restorative settings include opportunities for quiet fascination,
wandering in small areas, separation from distraction, and nature views from windows.
(Kaplans and Ryan, 1998).
Diane Relf, in the conclusion of her article, Human Issues In Horticulture gives and
excellent overview of the impact of horticulture on humans:
The role of plants in the evolution of civilization reaches far beyond food, fiber
and medicine…Plants and gardens have been havens for reflection by
philosophers, as teachers for those who learn by example and examination and as
sources of inspiration and symbols of virtue/vice by artists and poets. Plants and
nature are woven into the unconscious minds of humans and serve as a source of
spiritual renewal (Relf, 1992, p.10).
History of Horticulture as Therapy
For centuries, the healing benefits of plants and gardening to humans have been observed
and documented. (Kamp, 1996, Olmstead as cited by Kamp, 1996, Relf, 1998, Davis,
1998). The use of plant material in clinical settings began in the late 1700’s in the United
States, England and Spain. In the 1800’s horticultural therapy began to be used in the
treatment of mental illness. In 1798, Dr. Benjamin Rush identified the therapeutic effects
on mentally ill patients of field labour in a farm setting (Davis, 1998, Lewis, 1996). In
1806 hospitals in Spain began to use horticultural activities and favorable results from
studies led to building institutions for the mentally ill in rural settings (Davis, 1998).
In 1817, a turning point came in the use of horticultural and horticultural activities in a
health care setting when the first psychiatric facility in the United States opened in
Philadelphia in a park-like setting. The Friends Asylum for Persons Deprived of their
Reason was designed to include walking paths, open grassy meadows and included the
cultivation of fruits and vegetables Greenhouse activities were added in 1879 (Davis,
1998. Lewis, 1996). The more passive horticultural activities such as viewing and
walking were employed as therapy for the first time and are considered a turning point in
the passive use of horticulture as therapy. “A passive form of therapy was a new and
innovative use of horticulture as a treatment tool” (Strauss, 1987).
In the 1900’s horticultural therapy was used for the first time for disabled patients in
long-term care (Davis, 1998). After World War II, HT moved “beyond diversionary
status and became an important part of therapy and rehabilitation programs (Lewis as
cited by Davis, 1998). Reduced hospital stays were observed in veterans returning from
the war when thousands of garden club volunteers employed HT methods (McDonald as
cited by Davis, 1998).
In 1936, the Association of Occupational Therapists in England officially recognized
horticulture as a specific treatment for “physical and psychological disorders” (McDonald
as cited by Davis, 1998). In 1942, Milwaukee Downer College offered the first course in
horticulture within an occupational therapy program.
A capstone event for the use of horticultural therapy for the elderly came in 1951 (Davis,
1998 and Lewis, 1996) when Alice Burlingame started a horticulture program in the
geriatric ward of the Michigan State Hospital. This program “validated the use of
horticulture with another population besides the disabled---older adults” (Davis, 1998).
The first horticultural therapy program initiated through a public garden came in 1953
when the Arnold Arboretum at Harvard University began a program for veterans at a
nearby hospital. In 1968, Rhea MCCandliss at the Menniger Clinic documented the
evidence of horticultural therapy programs. (Lewis, 1996, and Davis, 1998) Of the 500
hospitals that she surveyed, she found that most either had programs or had interest in an
ht program, but identified that a lack of trained professionals was a barrier (Davis, 1998.
In the last thirty years research has been done on the impact of the “gardening”
experience on numerous populations including the disabled, the elderly, children,
tenement dwellers. Many extensive case studies have been developed as well. (Allison,
et. al, 1997, Marcus and Barnes, 1995, Beckwith and Lister, 1996. Gerlach-Spriggs, et.
Gardens as Agents of Healing in Health Care Facilities
In the last ten years, the documented use of gardens and horticultural activity has become
more prevalent in hospitals and long-term care facilities. Terms such as healing garden,
restorative garden, therapeutic garden and evolutive gardens are used throughout the
literature in reference to gardens in health care facilities. (Eckerling, 1996, La Breque and
Tremblay, 1996, Allison et. al, 1997, Kamp, 1996, Marcus and Barnes, 1995). Mara
Eckerling defines a healing garden as a “garden in a healing setting designed to make
people feel better” (Eckerling, 1996).
Studies are appearing which indicate that access to nature is highly valued by patients and
staff in all health care facilities such as hospices, care facilities for those with
Alzheimer’s, long-term skilled nursing care facilities and facilities for the mentally ill.
(Allison, et. al, 1997). “Helping patients heal through contact with nature helps provide
balance in the high-tech fast paced hospital setting of this new managed care era” (Hazen,
1997). According to Claire Cooper Marcus, “The Healing Garden Movement is
intimately linked with and overall paradigm shift in society as we move from a
mechanistic and technological world view to one that is more holistic embracing spirit as
well as science”(Allison, et. al, 1997).
The benefits of gardens to those in health care facilities are well documented and
consistent. (Allison, et. al, 1997, Eckerling, 1996, Haas, et. al. 1998, Labreque and
Tremblay, 1996, Kavenaugh, 1998, Lewis, 1996, McGuire, 1997, Thomas, 1996, Kamp,
1996, Gray, 1999, Haller, 1998, Beckwith, 1996, Hazen, 1997, Marcus and Barnes,
1995). Benefits are received to the individual patient and often to the facility staff and
families whether the involvement with the garden is active or passive. Studies show that
the experience of being in a health care facility is a stressful one accompanied by sets of
difficult emotions such as depression, loneliness, anxiety, fright, sadness, restriction of
personal choices and a sense of isolation (Eckerling, 1996, Labreque and Tremblay,
1996, Kamp, 1996, Beckwith and Glister, 1996, Allison et. al, 1997). Seniors in nursing
homes often face an additional set of issues as identified by McGuire: withdrawal, refusal
to leave room, impaired mobility, limited endurance, and restlessness (McGuire, 1997).
The specific benefits of gardens and/or gardening activities to those in health care
facilities are myriad. Relf divides the benefits into four categories, intellectual, social,
emotional and physical (Relf, 1994). Specific findings are documented in case studies.
One example is the work of Suzanne Gray, in her 1999 study, Therapeutic Garden
Design for Older Adults including those with Dementia and Physical Frailties which
concluded that benefits include personal enjoyment, experiencing a relaxed environment,
and opportunity to experience the familiar. She found that therapeutic gardens
“Ultimately contribute to quality of life” (Gray 1999). In a quantitative case study of four
hospitals in northern California, Marni Barnes found that 94% percent of patients
indicated that they were more relaxed and invigorated while in or viewing the garden.
(Allison, et. al, 1997) A case study done within the Legacy Health Care system in
Portland, Oregon of two long-term care facilities found that patients (whose average age
was 71) showed increased mobility from both passive activities such as sitting in a room
overlooking a garden or active involvement such as going out into a garden (Hazen,
1997). This study also showed that a “positive facility culture” was created from the
presence of gardens. (Hazen 1990).
Many scholars (Haller, 1998, Gray, 1999, Alison, et. al, 1997, Beckwith and Glister,
1996, Hazen, 1997, Kavenaugh, 1998, Lewis, 1996 McGuire, 1997, Thomas, 1996,
Eckerling, 1996 and Relf, 1994) conclude the benefits of exposure to nature in a health
care facility as:
1. An increase in general physical and mental well being
2. Opportunity to have mental and physical exercise
3. Social interaction
4. Building of confidence and self-esteem
5. Connection to past experiences
6. Positive mood shifts
7. A sense of comfort, safety and of being soothed
8. Less time spent in rooms and hallways
9. A respite from hospital sounds and smells
10. Distraction from a focus on illness and treatments
Diane Relf, a well-known and prolific horticultural therapy scholar, developed her own
list of therapeutic benefits in 1994. Her list included many of the same benefits as
mentioned above, yet ads three significant benefits not previously addressed
1. Aroused sense of curiosity
2. Opportunities to relieve aggressive drives in a socially acceptable manner
3. Promoted interest and enthusiasm for the future
Some studies conclude specific benefits to patients with dementia and Alzheimer’s.
According to Haas et. al, “gardening slows the effects of dementia and provides sensory
stimulation and mild exercise through the creative use of safe garden spaces, appropriate
plant materials and simple tasks.” (Hass, et. al, 1998). According to Beckwith and
Glister, “people with Alzheimer’s have anxiety associated with a progressive cognitive
demise and gradual dissolution of memory”. For these patients the garden provides “ a
connection to the continuum to life” (Beckwith and Glister, 1996). According to the
Canadian Horticultural therapy Association, “a study of B.C. residences for Alzheimer's
patients showed that, at the residences with gardens, the rate of violent incidents declined
by 19% over two years. At the non-garden residences, the violent incidents increased by
680% (CHTA, 2001).
Much of the current literature is focused specifically on the impact of therapeutic gardens
on patients with Alzheimer’s or dementia or more generally on the therapeutic benefits of
gardens to patients of all ages. Marni Barns acknowledges the need for more specific
study to be done on the effects of gardening on specific populations by culture, gender,
age and type of illness. (Allison, et. al, 1997)
Specific Impacts on Seniors
There are, however, some specific pieces of literature related to the impact of
horticultural therapy and garden availability on seniors in health care facilities. According
to Hazen, (1997) horticultural therapy activities for seniors in long-term care can assist
Increasing functional skills to pre-hospital level
Helping patients cope with aging
Helping patients deal with loss and grief
Providing seniors the opportunity to engage in essential life review
Helping senior patients reassess skills and develop transferable skills
Increasing strength and endurance and personal care
Increasing the desire to return home
Providing an opportunity for social interaction
A similar study published in 1997 by McGuire of four long-term care facilities notes
many of the same benefits as Hazen’s study and adds:
1. Opportunity for failure free activity
2. Opportunity for reality orientation,
3. Validation and re-motivation and improved attention span
McGuire (1997) notes that nurses, physical therapists and occupational therapists noted
specific benefits of the availability of the garden and gardening activities they noticed:
Increase in smiles
Less time spent in rooms and hallways
Increased neuromuscular function
Stimulation of body and mind
Removal of focus from self
Increased balance, strength and endurance
In a 1994 quantitative study called Assessing the Benefits of a Therapeutic Horticulture
Program for Seniors in Immediate Care, Milstein and Mooney used three standardized
psychological measurements to determine the impact of horticulture therapy on
institutionalized seniors (Milstein and Mooney, 1994). Their findings reflect a highly
positive impact of exposure to horticultural therapy activities. In a September 4, 2001
email correspondence from study author, Patrick Mooney, professor of landscape
architecture at University of British Columbia contained the author’s observation that
“one of the findings was that the most deteriorated benefited the most” (Mooney, 2001).
Internal and External Benefits to Health Care Facilities
In an unpublished paper called The Value of Gardens, (Allison, 2001) Royal Roads
University craftsman gardener Paul Allison overviews some of the practical benefits of
presence of gardens and horticultural therapy activities to the actual health care facilities.
Among the external benefits to the facility he lists:
Positive public relations
Added recruitment tool for new for patients and staff
Attraction for new volunteers
Attraction for new sources of funding,
Meeting point between facility and community
Decreased isolation from community
Among the internal benefits to the facility he lists:
Enhancement of facility mission
Easement of family fear,
Generation of income,
Increased moral and pride in workplace,
Lessened hierarchical status barriers within the facility, and community
Added space for recreational and social activities. (Allison, 2001).
Examples of current activity in British Columbia
In the process of this review a number of hospitals and nursing home facilities in British
Columbia were contacted and asked if they would provide details of any horticultural
therapy and or gardening activities at their facilities. This was not a formal study. Not all
health care facilities were contacted and not all those who were contacted responded.
Also, several people who work as horticultural therapists in BC were contacted but few
responded. The information gathered and presented here only serves as examples of
current activity in BC.
Yucalta Lodge, Campbell River BC
Marvin Holmgren of the Yucalta Lodge shared the following information in an email
correspondence with the reviewer in September 5, 2001.
We are in the process of making final preparations to move into a new
facility in October. The new Yucalta Lodge will have 3 courtyards and 1
stroll along the side of a memory care cottage. Horticulture programs have
always been an important component of our lifestyle activity program but
will take on a greater role in the new facility - we will have more outdoor
areas to work with. All the outdoor areas will be planted and have raised
planters etc. for use with Residents.
(I) wanted to make one point in regards to the impact of gardens
etc. on seniors: horticulture programs have played a key role in allowing
Residents the ability to continue or participate in familiar, past lifestyle
activities. Horticultural/gardening programs are of a home-like nature (in
keeping to our philosophy), allow independent activity but also work well
in group settings, are enjoyable, are rewarding and show positive results
over time that enhance or maintain self-concept, provide opportunities for
various levels of participation, can be combined with school groups for
intergenerational programs etc. At Yucalta we have observed positive
outcomes where very successful independent projects and intergenerational
programs have occurred. Although our horticulture programs generally
involve less Residents at a time and overall, the observable/measurable
positive outcomes are much more evident that most other programs.
Inglewood Care Centre, West Vancouver, BC
Wilma Acthison, Activity Coordinator at Inglewood Care Centre, shared the following
information in an email correspondence with the reviewer on August 27, 2001:
It is delightful that you have contacted me on this subject, as it is so dear to my
heart. I have recently submitted a proposal to the owner of our facility with regard
to a dementia care garden. Much time has been spent with a local garden architect
to come up with a garden that is secure, aesthetic as well as therapeutic. We think
we have been successful. Our owner has agreed to fund half of it and we are
currently looking for other funding resources. We expect to break ground in May
and complete it in 6 weeks. After that we'd like to do a research project on its
benefits. We are currently doing some gardening with the help of the West Van
Garden Club and it’s been quite beneficial.
Simon Fraser Health Region, BC
Elaine Field of the Simon Fraser Health Region, in an email correspondence with the
We have a lovely "therapeutic garden" in front of our acute care
facility. Our patients and families love going out in it for walks and we
hold other activities there such as picnics and group sessions.
Northern Interior Regional Health Board. Prince George Area, BC
In an email correspondence with the reviewer, Tim Rowe, Director of Community and
Senior Services for the Northern Interior Regional Health Board in Prince George, BC.
indicated the presence of therapeutic garden developments at Rainbow and Parkside,
immediate care facilities for seniors.
Banfield Pavilion at Vancouver General Hospital
In a 1996 article, Shelagh Smith describes therapeutic gardens and horticultural therapy
activities at the Banfield Pavilion, an extended care facility at Vancouver General
Hospital. The garden is located on the second floor rooftop and provides a “sanctuary for
residents, their visitors and staff, with trellises defining private ‘rooms’ and dozens of
containers spilling over with plants. It provides a natural space removed from the
institutional setting” (Smith, 1996).
Victoria, British Columbia
In Victoria, BC, there are therapeutic gardens and horticultural therapy activities in health
care facilities such as The Lodge at Broadmead, The Oak/Bay Kiwanis Pavilion and The
Priory (conversation with Allison, September, 2001). The gardens at The Lodge at
Broadmead are extensively described in Marcus and Barnes 1999 book “Healing
Gardens”. Features of these gardens include, wandering paths with handrails, landmarks
for location awareness, a place for bird feeding, and a courtyard garden that provides
active and passive activity opportunities. (Marcus and Barnes, 1999, pp. 439, 441, 450).
Gaps in the Research
There are gaps in 4 significant areas:
1. Research related to seniors
2. Lack of statistics
3. Lack of published research based in British Columbia and Canada.
4. A lack of published work on the benefits of horticultural activities to health care
1. Research related to Seniors
As reflected in this review, some research does exist on the impact of gardening activities
on seniors in health care facilities. However, much of the published work related to
horticultural therapy is focused on disabled patients or patients with dementia or
Alzheimer’s disease and the implications of horticultural therapy for those particular
conditions. As the life span of seniors increases, and more and more well seniors go into
long-term care or into health care facilities for short-term care, there is an opportunity for
more research in this area.
2. Lack of Statistics
During the course of this review, the Canadian Horticultural Therapy Association
(CHTA) was contacted for statistics on the numbers of health care facilities in Canada
and BC that have therapeutic gardens and or horticultural therapy activities. The BC
Chapter of the CHTA was contacted as well. An email response from the national office
of the CHTA indicated that there are no statistics available for Canada as a whole or for
individual provinces. Due to the volunteer nature of the CHTA and their small budget,
they are unable to finance this type of research. No response was received from the BC
Chapter of the CHTA. Therefore, no statistics exist of any kind on the numbers of
healthcare facilities using horticultural therapy or even gardening activities in health care
facilities in Canada.
3. Lack of Published research based in British Columbia and Canada
In order to contextualize the lack of published work related to horticultural therapy
activity in BC it is important to note that this is a gap all across Canada. A great majority
of the published research and case studies related to therapeutic gardening or horticultural
therapy is based in the United States. The lack of published articles; websites and
research based in or connected to horticultural therapy in BC is notable, as well.
Although there appears to be a significant number of horticultural therapy programs and
therapeutic gardens in health care facilities in BC, there is very little written about these
programs. One exception is the research of Patrick Mooney, professor of landscape
architecture at UBC who did a quantitative study on the effects of horticulture on seniors
in immediate care facilities. He based his 1994 study at four health care facilities in the
The BC Chapter of the Canadian Horticultural Therapy Association has a quarterly
newsletter which features in each issue profile of a horticultural therapy program. This
serves only as a very broad program overview. The newsletter is not a platform for
4. Research on Benefits to Health Care Facilities
As noted earlier in the review, there is a great deal of work published work on the benefit
of horticultural activities to patients. However, there is gap on the internal and external
benefits to the healthcare facilities themselves. The unpublished work of Paul Allison
(2001) is the exception in this field of study. Ulrich and Parsons outline the need for
further research in this area:
Unfortunately, intuitive arguments in favor of plants usually make little
impression on financially pressed local or state governments or on developers
concerned with the bottom line. Politicians, faced with urgent problems such as
homelessness or drugs, may dismiss plants as unwarranted luxuries. The lack of
research on plant benefits has tended to reduce spending for plants in other
important settings such as workplaces, health-care facilities and outdoor areas of
apartment complexes (1992).
Conclusion: Implications for Future Study based in Victoria
Victoria, British Columbia is known all over the world as a place friendly to senior
citizens. As of the 1996 Census, (Statistics Canada, 1996) there were a total of 27, 380
people living in Victoria age 65-74. There were 27, 015 people living in Victoria age 75
and over. This makes a total of 54, 395 living in Victoria over the age of 65. Victoria
shows an average age of 39.5 years old compared to the overall population of BC whose
average age are 36.3. According to the Greater Victoria Chamber of Commerce
Many people spend their retirement years in the Victoria area: retirees make up
about 20 percent of the population, nearly double the national average. Victoria
has excellent health care resources. Countless groups, clubs, organizations and
government agencies assist seniors and/or provide cultural and recreational
programs (GVCC, 2001).
Several conclusions may be drawn from the review of the literature and the discovery of
significant gaps that would have significant implications for the Botanical Gardens at
Royal Roads University in Victoria.
1) There is a need for a Canadian national center for research related to the human
and institutional benefits of horticultural activities. Based on the information provided
by the Directory of Canadian Horticultural Research Organizations and Professionals on
the Agriculture and Agri-Food Canada website, there are many universities and agencies
across Canada which conduct horticultural research, but they are all focused on crop and
plant issues related to agriculture and food production. There is no Canadian university or
institution that currently has a research focus on the people-plant relationship in the
health care arena. A national center could fill the gaps in research activity and at the
same time; provide a much-needed national support to the work of the Canadian
Horticultural Therapy Association. A center of this type could serve as a provincial
support to horticultural therapy activities in BC.
Victoria is a well-known retirement destination. The numbers of seniors are predicted to
rise. There will be an increasing number of seniors in health care facilities and retirement
homes in the Victoria area. This could provide significant opportunity for activity related
to a national center.
Royal Roads University has a renowned botanical garden and landscape that could be
potentially developed for a national centre. Another potential for RRU could be in
establishing the first Bachelor of Science Degree in Horticultural Therapy in Canada
Currently only one degree of this type exists in the world. (Kansas State University).
Because of the combination of these factors, Royal Roads University is in a unique
position to pursue further funding, not only for research but also for capital development.
Agriculture and Agri-Food Canada Website. (2001). Directory of Canadian Horticultural
Research Organizations and Professionals. Accessed: October 3, 2001. URL:
Allison, P. (2001). The Value of Gardens. Unpublished paper.
Allison, P., Barnes, M., Burnett, J., Crisp, B., Delaney, T., Kamp, D., Kavenaugh, J.,
LeFrank, D., Marcus,C., & Ulrich,R. (1997). The Anatomy of a Healing Garden IN The
Journal of Health Care Design Volume X: The 10th Symposium on Health Care Design
held November 20-23, 1997 Martinez California
Atchison, W. (2001). Inglewood Care Centre, West Vancouver, BC. Unpublished email
correspondence with Claire Liberman, August 27, 2001.
Balling, J.D. & J.H. Falk, (1982). Development of visual preference for natural
environments. Environ. & Behavior 14(1):5-28.
Beckwith, M. & Glister, S. (1996). The Paradise Garden: A Model for Designing for
Those with Dementia and Alzheimer’s Disease IN The Journal of Therapeutic
Horticulture Volume VIII American Horticultural Therapy Association.
Betrabet, Gowri. (1996). The Garden as a Restorative Environment: A Theoretical
Perspective. IN The Journal of Therapeutic Horticulture Volume VIII American
Horticultural Therapy Association.
Canadian Horticultural Therapy Association. ( 2001). Did You Know? Accessed,
September 5, 2001 URL: http://www.chta.ca/facts.htm
Davis, S. (1998). The Development of the Profession of Horticultural therapy”. IN
Horticulture as Therapy: Principles and Practice. Simpson, S.P. & Strauss,M., editors.
New York, London: Haworth Press.
Eckerling, M. (1996). Guidelines for Designing Healing Gardens. IN The Journal of
Therapeutic Horticulture Volume VIII The American Horticultural Therapy Association.
Field, E. (2001). Simon Fraser Health Region, BC. Unpublished email correspondence
with Claire Liberman, September 6, 2001.
Gerlach-Spriggs, N., Kaufman, R. E. & Warner, S.B. (1998). Restorative Gardens: The
Healing Landscape New Haven: Yale University Press.
Gray, S. (1999). Therapeutic Garden Design in Residential Care for Older Adults
Including those with Dementia and Physical Frailties .IN The Journal of Therapeutic
Horticulture Volume X: The American Horticultural Therapy Association.
Greater Victoria Chamber of Commerce Website (2001). About Victoria: Retiring Here.
Accessed October 3, 2001 URL: http://www.gvcc.org/retiring.html
Haas, K., Simpson S., Stevenson, N. (1998). Older Persons and Horticultural therapy
Practice. IN Horticulture as Therapy Principles and Practice eds. Simpson, S.P. and
Strauss, M.C. Haworth Press NY London.
Haller, R. (1998). Vocational, Social and Therapeutic Programs IN Horticulture as
Therapy Principles and Practice eds. Simpson, S.P. and Strauss, M.C. Haworth Press
Hazen, T. (1997). Horticultural therapy in The Skilled Nursing Facility .IN Horticultural
therapy and the Older Adult Population ed. Wells, S. Binghamton, NY, Haworth Press.
Heerwagen, J.H. & G. Orians. (1986). Adaptations to windowlessness: A study of the use
of visual decor in windowed and windowless offices. Environment and Behavior
Holmgren, M. (2001). Yucalta Lodge, Campbell River, BC. Unpublished email
correspondence with Claire Liberman, September 5, 2001.
Kamp, D. (1996). Design Considerations for Development of a Therapeutic Garden. IN
The Journal of Therapeutic Horticulture Volume VIII The American Horticultural
Kaplan, S. (1992). The restorative environment: nature and human experience. In: D.
Relf (ed.). The role of horticulture inhuman well-being and social development: A
national symposium. Timber Press, Portland, Ore.
Kaplan, S. & R. Kaplan. (1982). Cognition and environment. Praeger, New York, NY.
Kaplan, S., J.F. Talbot, & R. Kaplan. (1988). Coping with daily hassles: The impact of
nearby nature on the work environment. Project Report. USDA Forest Service, North
Central Forest Experiment Station, Urban Forestry Unit Cooperative Agreement 23-8508.
Kaplan, R. & Kaplan S. (1989). The Experience of Nature: A Psychological Perspective.
Cambridge University Press, Cambridge, Mass.
Kaplan R., Kaplan S. & Ryan, R. L. (1998). With People in Mind: Design and
Management in Everyday Nature. Island Press Washington, DC.
Kavenaugh, Jean (1998) Outdoor Space and Adaptive Gardening: Design Techniques
and Tools. IN Horticulture as Therapy Principles and Practice eds. Simpson, S.P. and
Strauss, M.C. Haworth Press NY London.
LaBreque, C and Tremblay, L (1996). The Evolutive Prosthetic Garden: A New Concept
for Elderly Living in Nursing Homes IN The Journal of Therapeutic Horticulture Volume
VIII The American Horticultural Therapy Association.
Lewis, C. (1996). Green Nature/Human Nature. Chicago, University of Illinois at
Lewis, C. (1976). Address to 4th Annual Meeting of National Council for Therapy and
Rehabilitation Through Horticulture. September 6, 1976. Philadelphia, PA.
McDonald, J. (1995). A Comparative Study of the Horticultural Therapy Professions in
the UK and USA. Master’s Thesis, University of Reading, England.
Milgram, S. (1970). The experience of living in cities IN Science Vol 167 p 1461-1468.
McGuire, D. (1997). Horticultural therapy in a Geriatric Long-Term Care Facility. IN
Horticultural Therapy in the Older Adult Population ed. Wells, S. Binghamton, NY,
Malaspina University-College (2001) Human Services Calendar Website 2001-2003.
Marcus, C., & Barnes. M. (1999). Introduction to Healing Gardens: Therapeutic Benefits
and Design Recommendations. eds. Marcus, C. & Barnes, M. John Wiley and Sons.
Marcus, C., & Barnes, M. (1995). Gardens in Health Care Facilities: Uses, Therapeutic
Benefits and Design Recommendations The Center for Health Care Design: Martinez
Mooney, P. (2001) Unpublished email correspondence with Claire Liberman. September
Mooney, P. and Milstein, S. (1994). Assessing the Benefits of a Therapeutic Horticulture
Program for Seniors in Intermediate Care. IN The Healing Dimensions of People-Plant
Relations. Eds. Francis M., Lindsey, P., & Rice, J.S. Blacksburg, VA: Office of
Moore, E.O. (1982). A prison environment's effect on health care service demands. IN
Journal of Environmental Systems 11(1):17-34.
Orians, G.H. (1986). An ecological and evolutionary approach to landscape aesthetics.
In: E.C. Penning-Rowsell and D. Lowenthal (eds.). Landscape meanings and values.
Allan & Unwyn, London, Boston.
Relf, D. and Dorn, S. (2001). Horticulture: Meeting the Needs of Special Populations.
Accessed, September 5, 2001 URL: http://www.hort.vt.edu/human/HortTher1. html
Relf, D. (2001). Defining Horticultural therapy. Accessed: September 9, 2001. URL:
Relf, D. (1994). Horticulture: A Therapeutic Tool. Originally Published in J. Rehab.
39(1): 27-29. Portions originally presented at the Japan Greenery Research and
Development Center Workshop, Tokyo, Japan and Professional Development in
Horticultural therapy, Heartful Park International Symposium ’94, Osaka, Japan.
Accessed: September 5, 2001. URL: http://hort.vt.edu/human/HortTher1.html
Relf, D. (1992). Human Issues in Horticulture. HortTechnology April/June 1992 2:2
Accessed: September 12, 2001. URL: http://www.hort.vt.edu/HUMAN/hihart.htm.
Rowe, T. (2001). Northern Interior Regional Health Board, BC. Unpublished email
correspondence with Claire Liberman, August 27, 2001.
Smith, Shelagh (1996). Program Profile: Banfield Pavilion IN British Columbia Chapter
of the Canadian Horticultural Therapy Association Newsletter, Winter Edition, 1996 P.2
Statistics Canada. (1996). Statistical Profile of Victoria, British Columbia
Accessed: September 5, 2001 URL:
Strauss, M. (1987). Horticulture as Therapy at Friends’ Hospital. Pamphlet.
Thomas, W. (1996). Life Worth Living: How Someone You Love Can Still Enjoy Life in a
Nursing Home. Acton, MD: Vanderwyck and Burnham.
Ulrich, R.S. (1983). Aesthetic and affective response to natural environment. In: I.
Altman and J.F. Wohlwill (Eds.). Behavior and the Natural Environment 6(85-127).
Plenum, New York, NY.
Ulrich, R.S. (1979). Visual landscapes and psychological well-being. Landscape
Ulrich, R.S. and R. Parson. (1992). Influences of passive experiences with plants on
individual well-being and health. In: D. Relf (ed.). The Role of Horticulture in Human
Well-Being and Social Development: A National Symposium. Timber Press, Portland,
Ulrich, R.S. and R.F. Simons. (1986). Recovery from stress during exposure to everyday
outdoor environments. In: J. Wineman, R. Barnes, and C. Zimring (eds.). The costs of not
knowing: Proceedings of the Seventeenth Annual Conference of the Environmental
Design Research Association. Environmental Design Research Association, Washington,
West, M.J. (1985). Landscape views and stress response in the prison environment.
Unpublished Master's Thesis. Department of Landscape Architecture, University of
Washington, Seattle, WA.