Horticulture therapy for dementia can provide enjoyable opportunities for people living with dementia to spend time with plants, gardens and nature.
More accurately known as horticultural therapy, it can involve activities such as planting, watering, growing herbs, arranging flowers, harvesting vegetables or simply spending time in a thoughtfully designed garden.
Research suggests that these activities may support mood, engagement, daily functioning and quality of life for some people with dementia.
However, horticultural therapy should not be described as a cure or treatment that reverses dementia. The research is encouraging, but the quality of the available evidence remains limited.
What Is Horticultural Therapy?
The American Horticultural Therapy Association defines horticultural therapy as participation in horticultural activities facilitated by a trained horticultural therapist to achieve specific goals within a treatment, rehabilitation or vocational plan.
There is also a broader practice called therapeutic horticulture. This involves plant-based activities designed to support a person’s wellbeing and may be facilitated by other appropriately trained professionals.
This distinction is useful.
Simply enjoying a garden can be valuable, but formal horticultural therapy involves purposeful activities and specific goals.
What Does Research Say About Horticulture Therapy for Dementia?
Research into horticultural therapy and dementia has grown considerably.
A 2024 systematic review and meta-analysis examined nine randomized controlled trials involving 655 older people diagnosed with dementia.
The researchers reported improvements in several areas among people participating in horticultural therapy compared with conventional care.
These included:
- Cognitive test scores
- Symptoms of depression
- Activities of daily living
- Quality of life
The findings are encouraging.
However, the researchers also emphasized that the included studies were of low quality and that better-designed research is needed to confirm the results.
For this reason, it is more accurate to say that horticultural therapy may be beneficial for some people with dementia rather than claiming that its effects have been conclusively proven.
Possible Benefits of Horticultural Therapy for Dementia
Gardening naturally combines several forms of activity.
A person may move their body, use their hands, make choices, interact socially, experience different smells and textures and see the results of something they have cared for.
This combination may help explain why horticultural activities can be meaningful for people living with dementia.
Possible benefits include:
- Greater engagement in meaningful activity
- Enjoyment and a sense of purpose
- Gentle physical activity
- Social interaction
- Sensory stimulation
- Reduced boredom
- Support for mood and emotional wellbeing
- Opportunities to maintain existing skills
- A possible reduction in agitation for some people
- Improved quality of life
Not everyone will respond in the same way.
Activities should be based on the person’s abilities, interests, previous experiences and stage of dementia.
Gardening Activities for People With Dementia
Gardening can be adapted to suit many different levels of physical and cognitive ability.
Activities might include:
- Watering plants
- Planting seeds
- Filling pots with soil
- Growing herbs
- Picking flowers
- Arranging flowers in a vase
- Harvesting fruit or vegetables
- Removing dead flowers
- Sorting seeds or gardening materials
- Smelling herbs and flowers
- Walking through a garden
- Sitting outdoors and watching birds or insects
The aim does not need to be producing a perfect garden.
For many people, the value is in the activity itself.
Someone who gardened throughout their life may particularly enjoy returning to familiar tasks. This can provide a sense of identity, competence and connection with their past.
Gardening may also combine well with other group activities for people with dementia.
Therapeutic and Memory Gardens
Specially designed gardens are increasingly used in residential aged care and memory care settings.
These environments can provide a safe way for people to enjoy nature, walk, sit outdoors and engage with plants.
A dementia-friendly garden may include:
- Clear, looping walking paths
- Accessible seating
- Shade
- Raised garden beds
- Non-toxic plants
- Familiar flowers and herbs
- Interesting colors, textures and scents
- Good visibility and simple navigation
Raised beds can be particularly helpful for people who find bending difficult or who use a wheelchair.
A garden does not need to be large.
Even a small courtyard, balcony, patio or collection of indoor plants can provide opportunities to interact with living things.
Horticultural Therapy Can Be Done Indoors
Access to a large outdoor garden is not essential.
Indoor horticultural activities can include:
- Potting small plants
- Growing herbs on a windowsill
- Arranging cut flowers
- Planting seeds in containers
- Decorating plant pots
- Sorting flowers, leaves or seeds
- Caring for indoor plants
These activities can be useful when weather, mobility or health makes outdoor gardening difficult.
Even simply looking at and caring for plants may offer an enjoyable focus for conversation and activity.
Does Horticultural Therapy Reduce Agitation?
Some studies suggest that structured gardening and horticultural programs may reduce agitation or behavioral symptoms in some people with dementia.
This is potentially important because agitation, restlessness and distress can have a major effect on both the person and their caregivers.
Activities involving plants may provide gentle stimulation, physical activity and something meaningful to focus attention on.
However, horticultural therapy will not be appropriate or effective for every episode of agitation.
Sudden or significant changes in behavior should also prompt consideration of possible causes such as pain, infection, medication effects, hunger, thirst, constipation or an uncomfortable environment.
How Much Horticultural Therapy Is Needed?
There is no established medical “dose” of horticultural therapy for dementia.
The 2024 review found that some studies using activities at least twice per week reported positive results, but this does not establish a universal prescription.
Programs vary greatly in length, frequency, activities and the people taking part.
The best approach is usually to offer activities regularly while paying attention to whether the person enjoys them.
If someone becomes tired, frustrated or distressed, the activity can be shortened, simplified or tried again another day.
What Does a Horticultural Therapist Do?
A professional horticultural therapist uses plant-based activities to work toward defined goals.
According to the American Horticultural Therapy Association, registered horticultural therapists receive education in areas including horticultural science, human science and horticultural therapy, together with supervised practical experience.
Goals for a person with dementia might include:
- Increasing participation in activities
- Encouraging social interaction
- Supporting physical movement
- Maintaining practical skills
- Reducing boredom or distress
- Supporting emotional wellbeing
Formal therapy is not necessary for every gardening activity.
Family members, caregivers and activity staff can also offer simple and safe plant-related activities based on a person’s interests and abilities.
Safety Considerations for Gardening With Dementia
Gardening is generally a low-risk activity, but the environment should be adapted to the individual.
Consider:
- Using non-toxic plants
- Avoiding sharp or potentially dangerous tools where appropriate
- Providing supervision when needed
- Removing trip hazards
- Providing shade and sun protection
- Encouraging adequate hydration
- Using raised beds or lightweight tools for people with reduced mobility
- Avoiding pesticides or chemicals that could be accidentally handled or swallowed
The activity should support independence where possible without creating unnecessary risk.
Is Horticultural Therapy a Treatment for Dementia?
Horticultural therapy is best viewed as a supportive, non-drug intervention.
It does not cure dementia or stop the underlying disease process.
It should also not replace medical assessment, prescribed treatment or care for symptoms that require professional attention.
However, non-drug approaches can play an important role in helping people live well with dementia.
Activities that provide enjoyment, movement, social connection and a sense of purpose can contribute to overall wellbeing.
You can read more about non-drug and alternative approaches for dementia on ReaDementia.
Horticulture Therapy for Dementia: Closing Thoughts
Current research suggests that horticulture therapy for dementia may support cognition, mood, daily functioning and quality of life for some people.
A recent meta-analysis found encouraging results, but the researchers also cautioned that the existing studies were generally low quality and stronger research is still required.
The greatest advantage of gardening may be its simplicity.
It can provide gentle exercise, sensory stimulation, social interaction and meaningful activity at the same time.
For someone who enjoys plants or has gardened in the past, horticultural activities can also reconnect them with familiar skills and experiences.
There is no need to make extravagant claims about horticultural therapy.
Giving a person with dementia the opportunity to plant a seed, smell a flower, water a pot or spend a peaceful afternoon in the garden may simply be an enjoyable and meaningful part of good dementia care.