Does a Structured Gardening Programme Improve Well-Being in Young-Onset Dementia? A Preliminary Study

By Hewitt, Peter; Watts, Claire et al. | British Journal of Occupational Therapy, August 2013 | Go to article overview

Does a Structured Gardening Programme Improve Well-Being in Young-Onset Dementia? A Preliminary Study


Hewitt, Peter, Watts, Claire, Hussey, Jacqueline, Power, Kath, Williams, Tim, British Journal of Occupational Therapy


Introduction

Dementia is a chronic condition that results in a progressive decline in a person's ability to think, remember and reason (World Health Organization [WHO] 1999). Young-onset dementia (YOD) refers to the onset of symptoms before the age of 65 years (WHO 1999) and has an estimated prevalence of between 67 and 81 per 100,000 in the 45 to 65 year old age group (Ratnavalli et al 2002, Harvey et al 2003). In this article we use the term young-onset dementia' to refer to all dementias presenting in people at an early age, with the exclusion of Huntington's disease, which has a particular symptom profile, and people with pre-existing developmental disabilities such as Down's syndrome. People who develop YOD are likely to be in work, be physically active and may find it difficult to rationalise losing skills at such a young age. This poses particular issues for affected individuals, their families and the care services provided.

In an overview of the social aspects of YOD, Werner et al (2009) stated that people with YOD experience a loss of independence because they become unable to carry out tasks of everyday living. This, in turn, affects the relationships of the individual with peers and family members, as roles and self-identities change (Haase 2005, Harris and Keady 2009); when this results in a loss of employment, it has been shown to have an impact on an individual's self-esteem and self-worth as well as bringing a lack of meaningful occupation (Harris 2002). Harris and Keady (2009) identified feelings of loss, fear and abandonment as being prevalent in the lives of people with YOD because individuals and their families often have limited access to external help and support.

YOD also has distinctive clinical characteristics. Symptoms include loss of short term memory, depression and anxiety (Ferran et al 1996, Werner et al 2009). Harvey et al (1998) found that the most prevalent symptoms among people with YOD were non-cognitive and behavioural symptoms such as aggressive behaviour (61%), delusions (53%) and hallucinations (44%). The unique clinical and social aspects of YOD have specific effects on family members and caregivers that differ from those experienced by people affected by dementia when older. For YOD, 66% of carers experience high levels of stress (Williams et al 2001), possibly due to a lack of structured support and/or care duration (Arai et al 2007). Carers may also feel socially isolated and excluded (Freyne et al 1999).

Specialist services for people with YOD are uncommon and are often combined with services available for older people (Chaston et al 2004, Coombes et al 2004, Freyne et al 1999, Haase 2005, Royal College of Psychiatrists and Alzheimer's Society 2006, National Audit Office 2007). Behavioural interventions can result in improved quality of life for individuals with dementia and, subsequently, their caregivers (Gigliotti et al 2004) and the development of tailored provision for service users aged between their late 40s and late 50s is one of the priorities listed in a recent United Kingdom (UK) Government report (Department of Health 2009). Harris (2002) argued that specialist services providing peer socialisation that allows individuals to engage in meaningful and productive activity are needed to help people with YOD and their families. Opportunities of this kind would enable individuals to generate a sense of meaningful occupation, as well as helping them to build relationships with peers in a supportive environment.

Parr (2007) identified community gardening as one such meaningful activity, enabling participants to be recognised as active, capable and useful. The productive nature of horticulture enables a sense of accomplishment and success, which maximises the benefits for people with dementia (Beuttner 1999). The benefits include improved mental state (including reduced depression), reduced behavioural problems and improved quality of life--three aspects that are prevalent among patients with YOD. …

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