Compilation of therapeutic gardens design guidelines with emphasis on promoting the health of the elderly with alzheimer's - systematic review

The global elderly population is growing at an alarming rate. One of the main problems of the elderly is dementia, and the most common cause of dementia is Alzheimerchr('39')s disease. Behavioral and Psychological Symptoms of Dementia are present in most Alzheimerchr('39')s patients since no definitive medication has been approved for dementia and Alzheimerchr('39')s patients. Adopting non-pharmacological treatments through a variety of interventions -especially those involving nature -offers therapeutic benefits that are critical for Alzheimerchr('39')s patients.

In this regular review, 31 eligible sources were selected, following PRISMA guidelines, and searching for defined keywords in the Google Scholar and PubMed databases, as well as applying inclusion and exclusion criteria. In the final screening, the quality of qualified resources obtained from the screening process of the first stage(titles and abstracts of articles) and the second stage(full text) was assessed with MMAT. With the unanimity of all three authors, data extraction was prepared in the form of a standard checklist of output information. BPSD-related keywords were first identified using up-to-date and specialized sources in Alzheimerchr('39')s disease in the elderly. In the second stage, by reviewing multiple eligible studies, the relationships between BPSD and spatial qualities of the therapeutic garden were identified by coding. In the third stage, the spatial quality relationships affecting BPSD in the therapeutic garden were categorized and presented in the form of therapeutic garden design guidelines for the elderly with Alzheimerchr('39')s.

The results in the form of therapeutic garden design guidelines include the location (visual communication, light), safety (enclosure, lighting, legibility), shadow, access, movement-pause paths, the culture of the place, and horticulture-therapy. Also, the relationship between therapeutic garden design guidelines and behavioral and psychological symptoms of the elderly with Alzheimerchr('39')s disease was identified. Most of the therapeutic effects of the therapeutic garden are through the reduction of disturbing behaviors, which is strongly related to the design guidelines, including: inside and outside communication, enclosure, garden, legibility, paths, and accessibility. As a result, compliance with a set of safety considerations related to reducing disturbed behaviors is of particular importance in designing a therapeutic garden for the Alzheimerchr('39')s elderly.

Therapeutic gardens in supportive environments are among the most effective ways to support Alzheimerchr('39')s patients in a nursing home and improve BPSD. Considering the three spectrums of cognitive/perceptual, emotional, and behavioral disorders of patients on the one hand and the capacities of the therapeutic garden due to physical and non-physical dimensions, we can expect to reduce the symptoms of the disease by adopting user-oriented design policies. Horticultural activity, attention to route and access, and cultural considerations are among the most essential components of designing a Therapeutic garden for the elderly with Alzheimerchr('39')s.