Garden therapy: An effective treatment for Alzheimer’s
By Cecilia Seppia
Monoclonal antibodies, intelligent molecules capable of cleansing the brain of Beta-Amyloid accumulation, experimental drugs developed in overseas laboratories, transcranial magnetic stimulation, cognitive training supported by virtual reality: all are part of treatment plans for Alzheimer’s patients today.
However, despite ongoing research, there is still no cure for the illness, other than what experts call 'containment' and a slowing down the disease. And when a grandfather, a grandmother, a parent or a loved one succumbs to dementia, the only thing one wants to do, apart from exhausting trips to and from hospital, is to stop time and to stop fighting it.
That’s what happens here, in Rubano in the province of Padua, in the Therapeutic Gardens of the Mother Teresa of Calcutta Centre, where greenery regenerates and heals, and the lives of patients and caregivers flow in a state of rediscovered normality.
Giovanni, digging into the potted soil, looks after his seeds and knows that once they are planted, he must water them and check on them every day, as one does with a brother, a friend whom to care for. Anna walks up to the big cherry tree and raising her head, breathes deeply, a twinkle in her eye. Right above her a squirrel hops between the branches. And a smile lights up her face. Piero wanders through the flowering bushes, reaches for the rosemary, takes it in his hands, breathes it in, his face buried in the stems; he looks happy, serene.
Since setting foot in the Therapeutic Garden, Rina has recovered the memories of her home garden, of when she was young. She is convinced that she is back there and wants to take care of it herself. So, for her, the staff have set aside her own green space, apart from the other patients. Immersion in an environment rich in different scents, colours, contact with trees, flowers, aromatic plants: this is the therapy that has proven effective for Alzheimer's patients, winning recognition in a national award from Innovation Lab and, at the international level, from Sydney's Urban Innovation and Entrepreneurship.
After two years of experimentation, the results of the Padua project, known as the Verbena project (Greenery and Alzheimer's Wellbeing) have been certified in a study conducted by the University of Padua’s Department of Psychology and by Tesaf, in collaboration with the Giotto Social Cooperative and Opsa (Opera Provvidenza Sant'Antonio), the University of Padua’s Departments of General Psychology and Agro-Forestry Systems.
Two books have also come out of the initiative: 'Taking Care of Greenery' and 'Saving Yourself with Greenery', published with the guidelines and results of the experiment.
More memories, less anxiety
"After the Jubilee of the year 2000," says Monsignor Roberto Ravazzolo, director of Opsa and the Mother Teresa Centre, "the diocese reflected on emerging needs and realized that there were no specific centres dedicated to these people with cognitive disorders and their families.
The foundation stone of the Mother Teresa Home was laid in the year 2000, then with the commitment of everyone, and the prophetic vision of Father Roberto Bevilacqua, himself an Opsa physician, the facility began operating in 2006 and currently accommodates 34 people in two residential centres and 50 others in two daycare centres.
There are many activities, all supported by doctors, psychologists and experienced staff. But we could say that, initially conceived simply as a decorative element of the Home itself for moments of recreation and walks, the Gardens have become the true rationale behind this place".
The more time they spend among the oaks and laurels, olive trees, maples and magnolias, the more the patients recover their memories. A kind of miracle which has moved children and spouses to tears. But that is not all.
The benefits are manifold: patients become more autonomous, less anxious and restless, less apathetic and depressed, more inclined to socialize and able to recover important cognitive functions such as language and reasoning, but above all, says the Centre's psychologist, Dr Andrea Melendugno, the number of drugs, a whole slew used to treat this pathology, has consistently been reduced.
It would seem that the greenery here almost has the power to repair damaged neurons, to create new ones, just like the tiny sprouts which emerge in Springtime.
Creating the Gardens
The gardens (three in all) are only a small portion of the Centre’s expanse of 22 hectares and form a sort of 'hortus conclus', to use a biblical expression. Yet patients cannot get lost because, although wide and varied, the pathways are circular; that is, they always return to the starting point.
Everything here is studied down to the smallest detail, not to 'pander' to the disease, but to treat it: the plants, the location, the division of space, the types of garden. Each area was planned by the international garden designer Andrea Mati, who specializes in green spaces for people with frailties.
"The ultimate frontier is patient care," Monsignor Ravazzolo explains. “This is not a home for the elderly or the sick where people with Alzheimer's disease are 'parked' and simply looked after. Just think that before setting up the Garden, we identified 480 studies on the subject, carried out a painstaking reconnaissance of the site, and very carefully selected the plants, because every plant, every tree must have a certain shape, a precise development, even the projection of the shade of the trees was studied ad hoc. For Alzheimer's patients, in fact, a shadow is frightening, it worsens the inexplicable feeling of a 'black hole' that they experience in their minds and which fuels anxiety and depression.”
Sustainability, recognizability, biodiversity
There are currently 138 different plant species and they are all local. In fact, you cannot create a garden with plants that thrive in another region; you must take into account climate, sun exposure, humidity and soil composition.
Furthermore, if a patient is familiar with a plant that is specific to the region, he or she experiences a state of greater security, knows and recognizes that plant, and may even be able to recover childhood memories. Thus, the ficus, elm, strawberry tree, maple, cherry and pomegranate trees that fill the gardens and countryside of the Veneto region create a recognizable and familiar environment for those who have lost memories. Thyme, sage, laurel, and rosemary are also important cognitive reminders. Plant selection is fundamental for memory.
"After the initial reconnaissance phase," the director continues, "we moved on to the experimental phase with two field studies, one for residents and one for day centre guests. In all, 45 guests were actively involved, from all stages of the illness, from the mildest to the moderate to the most severe. Multi-disciplinary teams and also a group of family members were involved in order to jointly identify things that did and didn’t work. This was followed by publications of the results in international scientific journals, in a monograph on the project which is now a user’s manual for those who are trying to do what we did, and in particular, the great strides made in treatment. Behind the choice of plants, which are strictly indigenous, lie two other reasons besides recognizability by guests. Namely, sustainability and biodiversity which are slowly disappearing in today’s world.” The issue of sustainability is very important; planting a garden also means ensuring maintenance and this has costs. “To be effective, the garden must be well maintained. From biodiversity also comes the most suitable stimuli for the sick, as well as, of course, nourishing the environment,” Dr Melendugno asserts.
Free and autonomous use
Since then, the experimentation has never stopped. The greenery has grown, the Therapeutic Gardens have filled with trees; the patients live immersed in nature and begin to feel better and better. And the results show.
"At the beginning," emphasizes Nicola Boscoletto, president of the Giotto Cooperative involved in the creation and maintenance of the Gardens, "the studies were pioneering; it was a great challenge. But more and more in recent years, also thanks to our project, we can confirm that the interaction of people with Alzheimer's and other types of dementia with appropriately created parks and gardens encourages the regeneration of cognitive resources."
In the gardens, patients can stroll at any time, without a schedule, on their own or with caregivers, even at night for those suffering from insomnia: they’re totally free to enjoy them. Under the calycanthus and among the arbutus trees, they meet friends and relatives, sit outside, cultivate their vegetable garden and flowers. Or, events are organized: music therapy, gardening, sensory activities. And, thanks to raised spaces, one can take care of a garden or a vegetable patch while sitting in a wheelchair.
Nature is a womb that welcomes and generates
"Thinking of these Gardens," adds Fr Roberto, "I imagine nature as a womb that welcomes and generates life and I cannot help but think of what Pope Francis tells us in the Encyclical Laudato si'. Man is himself part of nature. We sometimes think of nature as something extraneous to man, and man is merely a spectator. But let us not forget that each of us is part of God’s creative love that gives life to all things. And so, in the Pontiff's text, we have truly found the theological meaning that allows us to grasp this connection and to explain, from a theological perspective, why this is so - beyond the psychological, botanical, therapeutic studies. Through nature we are able to care for the sick who are too often forgotten or entrusted simply to the loving but exhausting care of family members. Here at the Mother Teresa Centre, we see come to fruition the successful union between man and the environment of which the Holy Father speaks, and how this can be therapeutic. "Care, fragility and community," Dr Melendugno points out, “are the three key words that emerge from our project and that draw directly from Pope Francis' encyclical. And when we talk about community, we are not only referring to the community of people, but also the community of plants. The plants in the Therapeutic Gardens must be able to co-exist with each other and provide a favourable environment for our guests.”
Less welfarism, more sustainability
In short, the Therapeutic Garden is really a healthcare facility in its own right. This benefits the guests, but also the staff working in the facility, and, not least, their families. It’s a win-win situation based on a policy of fewer welfarist, but sustainable and positive choices.
The objective is the wellbeing of the person, making both patients and families feel restored. And, it is precisely the families who give optimistic feedback, repeating that they see their loved ones more serene than they have been in a long time.
The end result of the Verbena project are the certified guidelines for setting up and using therapeutic gardens in healthcare facilities: 'Padua,' concludes Father Roberto Ravazzolo, 'is a forerunner, an example for a concrete change in the quality of life in assisted care homes for the elderly and vulnerable.’
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