Effects of Horticultural Therapy on Asian Elderly' Mental Health

NCT02495194 | Unknown

• 1 other identifier: B-15-016
• Study Type: interventional
• Target: 69
• Locations: 1 country
• Sites: 1

Brief Summary

The objective of this study is to determine whether horticultural therapy would improve the psychological well-being of the older adults. 70 healthy elderly were randomized into the active horticultural therapy or the waitlist control group. Sessions will be conducted weekly for 12 weeks, and monthly for 3 months. Participants would be assessed at 3 time-points: at the start, at 3-months and at 6-months. It was hypothesized that as compared to the waitlist control group, participants in the active horticultural therapy will have (1) lower depression and anxiety symptomatology; (2) higher life satisfaction; (3) feel more socially connected; and (4) improved cognitive functioning.

Conditions

Mood (Psychological Function)

Keywords

Promotion of psychological well-being; Horticultural therapy; Randomized Controlled Trial; Gardening; Elderly

Outcome Measures

Primary Outcomes (11)

• Change from baseline Zung Self-Rating Depression Scale (SDS) at 3-months and 6-months

  The SDS (Zung, 1965) is a 20-item quantitative measurement of symptoms of depression. Participants rate each item regarding how they felt during the week preceding using a 4-point scale that ranges from 1 (a little of the time) to 4 (most of the time). A total raw score computed by summing the scores on the individual items will be converted into a percentage (the SDS index); the higher the SDS index, the greater the severity of depressive symptoms. Several studies have established the SDS as a reliable and valid instrument for measuring depressive symptoms (Biggs et al., 1978; Gabrys and Peters, 1985; Agrell and Dehlin, 1989).

  baseline, 3-months, 6-months

• Change from baseline Zung Self-Rating Anxiety Scale (SAS) at 3-months and 6-months

  The SAS (Zung, 1971) will be used to measure anxiety of the participants in the preceding week. It is a 20-item self-report assessment designed to measure anxiety levels, based on cognitive, autonomic, motor and central nervous system symptoms. Each question is scored on a Likert-type scale of 1-4 (a little of the time) to (most of the time). Some questions are negatively worded to avoid the problem of set response. Overall assessment is done by total score. The total raw scores range from 20-80. The raw score then needs to be converted to an "Anxiety Index" score; the higher the SAS index, the greater the severity of depressive symptoms.

  baseline, 3-months, 6-months

• Change from baseline Ryff's Scales of Psychological Well-being at 3-months and 6-months

  The Ryff Scales of Psychological Well-Being (Ryff and Singer, 1998) is an 18-item questionnaire which reflects the six areas of psychological well-being: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Respondents rate statements on a scale of 1 to 6, with 1 indicating strong disagreement and 6 indicating strong agreement.

  baseline, 3-months, 6-months

• Change from baseline Satisfaction with Life Scale (SWLS) at 3-months and 6-months

  Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen and Griffin, 1985) will be administered. SWLS is a 5-item scale designed to measure global cognitive judgments of one's life satisfaction (not a measure of either positive or negative affect). It is a psychometrically sound measure (Larson, Diener and Emmons, 1985) and has been validated in a geriatric population (Diener et al., 1985). Participants indicate how much they agree or disagree with each of the 5 items using a 7-point scale that ranges from 1 (strongly disagree) to 7 (strongly agree). Total scores were computed by summing the scores on the individual items and ranged from 5 to 35, with higher scores indicating higher level of satisfaction with life.

  baseline, 3-months, 6-months

• Change from baseline Friendship Scale (FS) at 3-months and 6-months

  Social connectedness scale will be measured using the Friendship Scale (Hawthorne, 2006). It is a 6-item questionnaire that measures both social isolation and social connectedness. Participants were asked to rate the frequency in which each statement describes them during the past four weeks on a 5-point Likert scale ranging from 0 (almost always) to 5 (not at all). Total scores were computed by summing the scores on the individual items and ranged from 0 to 24, with higher scores indicating higher level of social connectedness. The Friendship Scale was developed as a short, user-friendly, stand alone scale measuring perceived social isolation. It was validated with older adults with excellent internal structures, reliability and validity (Hawthorne, 2006; Hawthorne, 2008).

  baseline, 3-months, 6-months

• Change from baseline Interleukin 6 (IL-6) at 3-months and 6-months

  10ml of fasting blood will be collected using CPT tube

  baseline, 3-months, 6-months

• Change from baseline Interleukin-1 beta (IL-1β) at 3-months and 6-months

  10ml of fasting blood will be collected using CPT tube

  baseline, 3-months, 6-months

• Change from baseline C-reactive protein (CRP) at 3-months and 6-months

  10ml of fasting blood will be collected using CPT tube

  baseline, 3-months, 6-months

• Change from baseline Cortisol at 3-months and 6-months

  10ml of fasting blood will be collected using CPT tube

  baseline, 3-months, 6-months

• Change from baseline Brain-derived neurotrophic factor (BDNF) at 3-months and 6-months

  10ml of fasting blood will be collected using CPT tube

  baseline, 3-months, 6-months

• Change from baseline Dehydroepiandrosterone sulphate (DHEAS) at 3-months and 6-months

  10ml of fasting blood will be collected using CPT tube

  baseline, 3-months, 6-months

Secondary Outcomes (8)

• Change from baseline Montreal Cognitive Assessment (MoCA) at 3-months and 6-months

  baseline, 3-months, 6-months

• Change from baseline Clinical Dementia Rating (CDR) at 3-months and 6-months

  baseline, 3-months, 6-months

• Change from baseline Rey Auditory Verbal Learning Test (RAVLT) at 3-months and 6-months

  baseline, 3-months, 6-months

• Change from baseline Digit Span Task at 3-months and 6-months

  baseline, 3-months, 6-months

• Change from baseline Colour Trails Tests (CTT) at 3-months and 6-months

  baseline, 3-months, 6-months

Other Outcomes (2)

• Demographic questionnaire

  Baseline

• Feedback questionnaire

  Baseline

Study Arms (2)

Active Horticultural Therapy

EXPERIMENTAL

15 sessions of Horticultural Therapy program teaching the elderly about gardening techniques and for them to benefit from the therapeutic effects of the parks

Behavioral: Horticultural Therapy

Waitlist Control Group

OTHER

Participants will receive the same horticultural therapy program at the end of the assessments

Behavioral: Horticultural Therapy

Interventions

Horticultural Therapy BEHAVIORAL

The Horticultural Therapy intervention consists of 1 hour sessions weekly for first 3 months, followed by monthly session for the next 3 months. They will be taught on the basic gardening techniques such as sowing, weeding and fertilization during the hands-on sessions. They will also be taken on walks to the various parks to enjoy the therapeutic effect of the park greenery

Active Horticultural Therapy; Waitlist Control Group

Eligibility Criteria

• Age: 60 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Community-living elderly aged between 60 to 85 years AND
• able to provide informed consent AND
• function independently AND
• With a minimum score of 22 and above on the Montreal Cognitive Assessment.

You may not qualify if:

• Does not have a minimum score of 22 and above on the Montreal Cognitive Assessment OR
• Currently suffering from or have history of severe medical conditions e.g. cancer, stroke, Parkinson disease OR
• History of severe psychiatric conditions e.g. schizophrenia, bipolar disorder OR
• Dementia OR
• Undergoing another therapy at the same time OR
• Significant visual or hearing impairment OR
• Marked upper and lower limb motor difficulties, which may affect their ability to participate in the study.

Sponsors & Collaborators

• National University of Singapore: lead
• National Parks Board, Singapore: collaborator

Study Sites (1)

Training and Research Academy; Jurong Point Shopping Centre

Singapore, Singapore, 460077, Singapore

Location

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MeSH Terms

Interventions

Horticultural Therapy

Intervention Hierarchy (Ancestors)

Complementary Therapies; Therapeutics; Psychotherapy; Behavioral Disciplines and Activities

Study Officials

• Roger CM Ho, FRCP

  National University of Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Consultant Psychiatrist

Study Record Dates

• First Submitted: June 24, 2015
• First Posted: July 13, 2015
• Study Start: April 1, 2015
• Primary Completion: October 1, 2015
• Study Completion: October 1, 2016
• Last Updated: May 9, 2016

Record last verified: 2016-05

Locations

SG (1)