150 years of serving humanity
20 September 2017
A Therapeutic Garden in Singapore boosts its design elements and user-friendly features to meet the needs of the elderly

The 850sqm Therapeutic Garden was opened in the HortPark, a public park in Singapore. Its creators took into account the needs of dementia and post-stroke patients. Younger visitors also can have a rest in the park, regaining their psychological and emotional wellbeing. The Garden comprises a Restorative Zone where visitors can simply enjoy the scenery and an Activities Zone where visitors can  participate in gardening activities and therapeutic programs.

Designing parks for the ageing population was one of the ideas raised by participants at the SGfuture (Singapore Future) engagement series. More than 8 thousand Singaporeans discussed new initiatives since November 2015, and in May 2016, the Therapeutic Garden was opened. It was not difficult to create, however, it was important to think over the details. In the Park, nothing indicates the age of visitors: what is good for the elderly is good for everyone. The Singapore National Parks Board developed the Park in consultation with Professor Kua Ee Heok from the Department of Psychological Medicine, National University Health System (NUHS). His recommendations can be easily applied for any park or even small personal garden development, ensuring that one’s rest is more comfortable and effective. Here are Professor Kua Ee Heok's recommendations:

1. A simple and clear garden layout which can be viewed from its entrance.

A simple looped, circular, or figure-eight pathway system minimises spatial confusion.

2. Appropriate destination points, such as a gazebo with ample seats. 

The gazebo encourages social interaction.

3. Choices in seating, pathway routes, views, and destinations. Garden benches face different directions

This provides visitors with a choice of different views. This design also caters to elderly with dementia as they are often restless.

4. An area specifically designed for gardening with moveable raised beds, customised benches for potting and convenient access to water. 

This makes it more convenient to participate in gardening, which, in turn, positively affects physical and psychological wellbeing. The Garden is also wheelchair friendly.

5. Strategic use of colours such as flowers or foliage in bright colours like red, yellow, or orange; and cool colours like blue, purple and pastels. 

Bright colours create an uplifting impact by stimulating the mind, while cool colours have been shown to be restorative by creating a calming experience.

6. A range of scented plants of diverse texture that can be enjoyed throughout the year. 

Smell is one of the last senses to fade, and smelling certain plants, or pinching their leaves, can evoke powerful memories in the elderly.

7. Plants that attract birds or butterflies. 

This creates opportunities for visitors to observe wildlife and biodiversity.

8. Features of interest and accents. 

The elderly with dementia benefit from landscape features that are easily recognisable and can act as a memorable waypoint, or evoke pleasant emotions.

9. Shaded areas.

The elderly with dementia have difficulty recognising when they are too hot and would not think to put on a hat or sunblock.

10. Bright, sunny areas, especially in the morning

The elderly with dementia exhibit a delay in the onset of agitated behaviour after exposure to bright morning light.

The Therapeutic Garden was developed based on evidence-based design principles, drawing upon the following environmental psychology theories: 

1) Biophilia Hypothesis

The term biophilia was first coined by social psychologist Erich Fromm and defined as “the passionate love of life and all that is alive”. The biophilia hypothesis states that people have an innate emotional affiliation to nature and other living beings and hence, derive benefits from contact with nature.

2) Attention Restoration Theory 

A person has several states of attention including directed attention and effortless attention. Directed attention requires effort and is used when concentrating on specific tasks, such as working on the computer. This requires voluntary effort and prolonged usage will lead to directed attention fatigue, resulting in ineffectiveness and human error. According to the Attention Restoration Theory (ART), restoration of directed attention fatigue can be derived from the use of effortless attention when a person is in a natural environment. Based on ART, gardens provide an opportunity for people to rest since they do not have to consciously exert effort to pay attention to their surroundings and this is termed as “effortless” attention. It provides a person with an opportunity to rest.

3) Stress Reduction Theory

The stress reduction theory states that contact with nature has been shown to reduce stress. People who are sick or caring for the sick tend to experience stress. Hence, green spaces help reduce the stress.

It is planned to create a network of therapeutic gardens in Singapore. Those will become a base for therapy programs and studies. Ongoing studies include Effects of Horticultural Therapy On Asian Elderly’s Mental Health. Interim findings indicate that horticultural therapy brings about improvement in the psychological well-being of seniors. The results demonstrated that participants in the active horticultural therapy group report a higher life satisfaction and feel more socially connected when compared to those in the control group. The participants in the active horticultural therapy group have lower levels of the proteins interleukins (IL)-1β and IL-6, which are linked to depression. 

Source: National Parks Board