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Effects of Horticultural Therapy on Asian Elderly' Mental Health (HTRCT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02495194
Recruitment Status : Unknown
Verified May 2016 by Roger Ho Chun Man, National University, Singapore.
Recruitment status was:  Active, not recruiting
First Posted : July 13, 2015
Last Update Posted : May 9, 2016
Sponsor:
Collaborator:
National Parks Board, Singapore
Information provided by (Responsible Party):
Roger Ho Chun Man, National University, Singapore

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.


Condition or disease Intervention/treatment Phase
Mood (Psychological Function) Behavioral: Horticultural Therapy Not Applicable

Detailed Description:

Participants Study participants are community-dwelling elderly.

Assessments Demographic data will be collected at the start. Psychological tests for depression, anxiety and psychological well-being as well as neuropsychological tests of cognitive functioning will be done at the start, at 3-months and at 6-months. Blood samples will also be collected at all three time points.

Intervention Sessions This is an intervention study with a waitlist control group design. The strength of this design is its experimental nature with randomization.

The Horticultural Therapy intervention is delivered by a trained practitioner at various locations and consists of 1 hour sessions weekly for first 3 months, followed by monthly session for the next 3 months. The extension of monthly sessions for 3 months is to determine sustainability and longer-term changes. The intervention is designed to cultivate an interest in gardening and promote relaxation. This will be achieved in stages, facilitated by trained volunteers and practitioners. The plant would be selected based on subjects' profiles e.g. familiarity, preference, safety and its maintenance would be followed up every fortnight. Park venues were selected based on patients profiles and park features e.g. familiarity, comfort under weather, safety.

The control group will be placed on a waiting list and only be contacted for assessments. They will receive intervention after the active treatment group at a later date.

The horticultural therapy is conducted solely for the purpose of this research.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 69 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Official Title: Effects of Horticultural Therapy on Asian Elderly' Mental Health: A Randomized Controlled Trial
Study Start Date : April 2015
Actual Primary Completion Date : October 2015
Estimated Study Completion Date : October 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Mental Health

Arm Intervention/treatment
Experimental: Active Horticultural Therapy
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
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

Waitlist Control Group
Participants will receive the same horticultural therapy program at the end of the assessments
Behavioral: Horticultural Therapy
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




Primary Outcome Measures :
  1. Change from baseline Zung Self-Rating Depression Scale (SDS) at 3-months and 6-months [ Time Frame: baseline, 3-months, 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).

  2. Change from baseline Zung Self-Rating Anxiety Scale (SAS) at 3-months and 6-months [ Time Frame: baseline, 3-months, 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.

  3. Change from baseline Ryff's Scales of Psychological Well-being at 3-months and 6-months [ Time Frame: baseline, 3-months, 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.

  4. Change from baseline Satisfaction with Life Scale (SWLS) at 3-months and 6-months [ Time Frame: baseline, 3-months, 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.

  5. Change from baseline Friendship Scale (FS) at 3-months and 6-months [ Time Frame: baseline, 3-months, 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).

  6. Change from baseline Interleukin 6 (IL-6) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    10ml of fasting blood will be collected using CPT tube

  7. Change from baseline Interleukin-1 beta (IL-1β) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    10ml of fasting blood will be collected using CPT tube

  8. Change from baseline C-reactive protein (CRP) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    10ml of fasting blood will be collected using CPT tube

  9. Change from baseline Cortisol at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    10ml of fasting blood will be collected using CPT tube

  10. Change from baseline Brain-derived neurotrophic factor (BDNF) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    10ml of fasting blood will be collected using CPT tube

  11. Change from baseline Dehydroepiandrosterone sulphate (DHEAS) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    10ml of fasting blood will be collected using CPT tube


Secondary Outcome Measures :
  1. Change from baseline Montreal Cognitive Assessment (MoCA) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    Montreal Cognitive Assessment (MoCA) (Nasreddine, Phillips, Bedirian, Charbonneau, Whitehead, Collin, et al., 2005) will be administered by trained research assistants and/or research nurses as global measures of cognitive function.

  2. Change from baseline Clinical Dementia Rating (CDR) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    Clinical Dementia Rating (CDR ) is a 5-point scale used to characterize six domains of cognitive and functional performance applicable to Alzheimer disease and related dementias: Memory, Orientation, Judgment & Problem Solving, Community Affairs, Home & Hobbies, and Personal Care.

  3. Change from baseline Rey Auditory Verbal Learning Test (RAVLT) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    Rey Auditory Verbal Learning Test (RAVLT) evaluates declarative verbal learning and memory.

  4. Change from baseline Digit Span Task at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    Digit Span Task, which consists of a Digit Span Forward (DSF) and a Digit Span Backward (DSB) task is used to assess attention and verbal working memory.

  5. Change from baseline Colour Trails Tests (CTT) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    Colour Trails Tests (CTT) 1 and 2 assesses sustained attention and sequencing.

  6. Change from baseline Block Design at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    Block Design is a subtest that is administered as part of several of the Wechsler Intelligence tests, and it primarily measures visual-spatial and organizational processing abilities, as well as non-verbal problem-solving skills.

  7. Change from baseline Semantic Verbal Fluency at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    Semantic Verbal Fluency taps lexical knowledge and semantic memory organization.

  8. Change from Basic Health Screen (composite) at 3-months and 6-months [ Time Frame: baseline, 3-months, 6-months ]
    Blood pressure, Pulse rate, Height and Weight will be measured


Other Outcome Measures:
  1. Demographic questionnaire [ Time Frame: Baseline ]
    Their social, demographic, and lifestyle data (i.e. how often they usually visit the parks or do gardening) will only be collected at baseline. This is the same for the participants' medical conditions.

  2. Feedback questionnaire [ Time Frame: Baseline ]
    Feedback questionnaire will be conducted to convey participants' subjective experience and thereby expanding our understanding of the impact of the horticultural therapy intervention. The survey will ask participants to identify what was the most helpful part of the class, what suggestions they have for improvement, and whether they had continued gardening and/or visiting the parks. This brief survey will only be administered once during the post-intervention assessment. Participants' responses will be informally tallied and listed in categories.



Information from the National Library of Medicine

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Ages Eligible for Study:   60 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria:

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

Exclusion criteria:

  1. Those who do not meet the above inclusion criteria (ie. Do not have a MCI diagnosis),
  2. Does not have a minimum score of 22 and above on the Montreal Cognitive Assessment OR
  3. Currently suffering from or have history of severe medical conditions e.g. cancer, stroke, Parkinson disease OR
  4. History of severe psychiatric conditions e.g. schizophrenia, bipolar disorder OR
  5. Dementia OR
  6. Undergoing another therapy at the same time OR
  7. Significant visual or hearing impairment OR
  8. Marked upper and lower limb motor difficulties, which may affect their ability to participate in the study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02495194


Locations
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Singapore
Training and Research Academy; Jurong Point Shopping Centre
Singapore, Singapore, 460077
Sponsors and Collaborators
National University, Singapore
National Parks Board, Singapore
Investigators
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Principal Investigator: Roger CM Ho, FRCP National University of Hospital

Publications:
Barnicle, T., & Midden, K. S. (2003). The effects of a horticulture activity program on the psychological well-being of older people in a long-term care facility. HortTechnology, 13(1), 81-85.
Chu, C. M., & Simpson, R. (1994). Ecological public health: from vision to practice. Centre for Health Promotion, University of Toronto: ParticipACTION.
Grahn, P., & Stigsdotter, U. A. (2003). Landscape planning and stress. Urban forestry & urban greening, 2(1), 1-18.
Hancock, T. (1999). Health care reform and reform for health: creating a health system for communities in the 21st century. Futures, 31(5), 417-436.
Hartig, T., Evans, G. W., Jamner, L. D., Davis, D. S., & Gärling, T. (2003). Tracking restoration in natural and urban field settings. Journal of environmental psychology, 23(2), 109-123.
Hayashi, N., Wada, T., Hirai, H., Miyake, T., Matsuura, Y., Shimizu, N., Kurooka, H. & Horiuchi, S. (2008). The effects of horticultural activity in a community garden on mood changes. Environmental Control in Biology, 46(4), 233-240.
Kam, M. C., & Siu, A. M. (2010). Evaluation of a horticultural activity programme for persons with psychiatric illness. Hong Kong Journal of Occupational Therapy, 20(2), 80-86.
Kua E.H., Ko, S.M., Fones, C.S.L., & Tan S.L. (1997a). Epidemiology of depression in elderly Chinese living in Singapore. Journal of American Medical Association (Suppl), 13: 29-32.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Roger Ho Chun Man, Consultant Psychiatrist, National University, Singapore
ClinicalTrials.gov Identifier: NCT02495194     History of Changes
Other Study ID Numbers: B-15-016
First Posted: July 13, 2015    Key Record Dates
Last Update Posted: May 9, 2016
Last Verified: May 2016
Keywords provided by Roger Ho Chun Man, National University, Singapore:
Promotion of psychological well-being
Horticultural therapy
Randomized Controlled Trial
Gardening
Elderly