Healing Gardens and Cognitive Behavioral Units in the Management of Alzheimer's Disease Patients: The Nancy Experience

Abstract

The French Alzheimer Plan 2008-2012 anticipates the implementation of new Units specialized in cognitive rehabilitation and psycho-behavioral therapy of Alzheimer's disease (AD) patients. Conceived for AD and other dementia patients of all ages, their objectives are to propose a cognitive rehabilitation program, to prevent or treat psycho-behavioral crises, and to provide support and educational therapy to the family and professional caregivers, in order to ease the patient's return to his or her previous way of life. Studies on green spaces and healing gardens in health-care settings have revealed objective and measurable improvements in the patient's well-being. The Plan officially stipulates for the first time the need to make healing gardens an integral part of these Units, but it does not provide specific recommendations or criteria for implementing such gardens. Although green spaces and gardens are available in many French Care Units, they are rarely specifically adapted to the needs of AD patients. In Nancy, the Art, Memory and Life garden, a specific concept guided by a neuropsychological approach, was developed and complemented by an artistic vision based on cultural invariants. The main objective of this article is to describe the various steps of the process that led to the creation of this garden: the collection of experiences and information by a pilot group, surveys of patients, visitors, and caregivers before and after establishment of the garden, and implementation of a multi-professional group project. The specifications, the organizational criteria, the therapeutic project, and the criteria for the conception of such a garden stemming from our clinical experience with the Art, Memory and Life garden in Nancy, are described herein. We also present the first assessment following the implementation of the project.

The Vascular Side of Chronic Bed Rest: When a Therapeutic Approach Becomes Deleterious

“…However, when the absence of activity is added to the natural aging process, and inactivity becomes chronic, the diminished blood flow in response to the diminished metabolic demand due to diminished movement, leads to significant decrement of the most important stimulus for the endothelial function: the shear-rate ( Figure 3). The decline in frequency and intensity of this signal due to the physical constraint contributes to physiological inactivity-mediated endothelial dysfunction [13,24,31]. Although the Bedridden showed significantly poorer vascular outcomes compared to the Old, we cannot totally exclude that medications taken by bedridden individuals might have had an additive role in the worsening of their vascular function.…”

Gray and Green Revisited: A Multidisciplinary Perspective of Gardens, Gardening, and the Aging Process

“…The intersection of gray and green is also reflected in the paradigmatic shift of “The Eden Alternative” in managing long-term care facilities [ 130 , 131 ]. For example, Lee and Kim [ 132 ] found that indoor gardening was found to be effective for improving several dimensions of sleep patterns, decreasing agitation, and improving cognition functioning of dementia patients (see also [ 133 ]). There are also significant publications on outdoor gardening activities for people who live in geriatric care settings [ 134 ], specifically for persons with dementia [ 135 ], and the importance of “patient-specific gardens” for the restorative effects of nature [ 136 ].…”

Spatial navigation: Cognitive variables involved in route retracing among an elderly population

“…One can thus think that in a large-scale environment, the richness of the landmarks, whose impact has already been demonstrated on the reproduction of the route (Denis et al, 2014), favours route retracing. Indeed, this garden, which aims, among other things, at multi-sensory stimulation (Rivasseau Jonveaux et al, 2013;Rivasseau-Jonveaux et al, 2012), has salient, distinctive landmarks (such as works of art, stylised furniture, and plants in bright colours). These landmarks can be expected to have helped participants complete the return route.…”