During the last century, the average American lifespan has almost doubled as people live longer, stay healthier, and remain active. Between 2000 and 2030, the U.S. population aged 65 years and older is expected to double to more than 71 million (U.S. Department of Health and Human Services, 2006). Seventy-eight million “baby boomers” will begin turning 65 years old in 2011, at an average of 10,000 per day.
As the population ages, the number of people moving from their homes to assisted living or long-term care facilities will increase dramatically. This residential shift requires an examination of the quality of life for the older adults who will reside in those facilities.
Mastery and self-rated health (SRH) have been found to be two of the most accurate predictors of the social concept of “successful aging.” Successful aging is defined as high mental and physical functioning, and active engagement with life (Rowe and Kahn, 1998). A large body of research has repeatedly found mastery and SRH to be leading and accurate indicators of future health outcomes, predictive of enhanced recovery from illness (Berkman et al., 1992), decreased use of health services such as hospitalization (Kennedy et al., 2001) and nursing home admission (Freedman, 1993), lessened depression (Jang et al., 2002), and lower mortality rates (Surtees et al., 2006). This research has demonstrated that mastery and SRH are strong indicators of present and future health as well as quality of life for older adults.
Mastery is the belief that one's actions and choices determine outcomes in their life (Mirowsky and Ross, 1990). Mastery can, but does not have to, decrease with age, especially in women (Ross and Mirowsky, 2002) and the disabled (Schieman and Turner, 1998). Evidence of the mind-body connection is demonstrated when research finds that a stronger sense of mastery and higher estimates of SRH are better predictors of future health outcomes and mortality than physician-assessed health (Mossey and Shapiro, 1982; Surtees et al., 2006).
Assisted living facilities (ALFs) are a relatively new and growing elder-housing phenomenon. This residential option gives the elderly a way to age-in-place, to maintain their independence and functionality, providing a bridge between their own home and a nursing home. Moving from their own home into the communal living of an ALF is a major life change, often a result of declining health or the death of a spouse (Hawes et al., 1999). Mental and physical health may decline for seniors required to move to a new environment (Hays, 2002). These life-transition facilities require major adjustments for most elders who can experience disruptions of their perceived well-being, creating a unique teaching opportunity for interventions designed to improve success of the transition process (Collins and O'Callaghan, 2007). However, little work has been done to create transitional education for assisted living residents.
The idea of horticultural benefits for older adults is not new and has been researched by social scientists as well as horticulturists. In the 1970s, two Yale psychologists examined the value of people-plant interactions in a Connecticut nursing home (Langer and Rodin, 1976). They found enhanced personal responsibility and choice between groups that were responsible for plant care compared with those who had staff care for their plants. Those who cared for their own plants were more alert, and interacted more with fellow residents and staff while requiring less staff care. They self-reported being active and happy (self-rated happiness) with increased perceptions of personal control. This small intervention showed dramatic results in an environment where decision-making otherwise seemed to be nonexistent. Other studies of nursing homes in the 1970s found active therapies such as gardening had benefits reflected in measures of life satisfaction and self-esteem (Willcox and Mattson, 1979).
The area of older adults and the relationship of responsibility to mastery, and SRH and self-rated happiness is a new exploration in the vulnerable assisted living population. One known way to improve the physical or emotional status of people who have diminished control over their lives is by encouraging them to take responsibility for another individual. This “other individual” may be animal or plant. There is little, if any, published research measuring responsibility in the assisted living population, or for low-income residents of these facilities. However, there is some data on the positive impact of personal responsibility with animal care in prisons and plant care in nursing homes. For instance, if they have had responsibility for animals while in prison, most inmates do not re-offend after release (Strimple, 2003). This reflects very positively in comparison with the national average for released inmates, over two-thirds of whom are re-incarcerated within 3 years (U.S. Department of Justice, 2002). In studies with the elderly, hands-on experience with plants was found to have a greater effect than passive observation of plants. As seen above in the 1970s study (Langer and Rodin, 1976) and also a more recent study of assisted living guidelines (Regnier, 2003), active interaction with plants and other residents is desired and beneficial.
Horticulture and gardening have been shown to benefit institutionalized populations. Research has demonstrated that seriously ill hospital patients and infirm elderly patients showed improved health outcomes when they were exposed to living plants. Facilities that work with elderly populations have begun using garden sites in their landscapes and as part of their therapeutic interventions (Barnicle and Midden, 2003; Bassen and Baltazar, 1997; Rappe and Kivela, 2005). These efforts take many forms from passive enjoyment to active group activities such as growing plants or produce, which research has demonstrated to enhance emotional health and participant involvement in older adults (Browne, 1992; Kweon et al., 1998; Predney and Relf, 2004).
Gardening is an activity that has been enjoyed by many older adults. The majority (90%) of nursing home residents surveyed in an Illinois study reported that they had enjoyed gardening in their past. Many expressed regret that leaving their homes would end their gardening activities (Rothert and Daubert, 1981).
Most ALFs have an activity director who surveys incoming residents to determine leisure interests. McGuire (1997) found that many senior care facility residents had previously engaged in some form of gardening, indicating that they might be receptive to participation in some form of horticulture activity.
Research has been conducted on residents of nursing homes and the new counterpart, long-term care centers. On the other hand, little research has been conducted on assisted living residents, especially a low-income population, because assisted living is a relatively recent housing option and these facilities for the low-income population are rare. Assisted living differs from nursing homes, housing a different population that tends to be more mobile and independent. ALFs focus on resident privacy in their own apartments and autonomy presented in a homelike atmosphere (Frank, 2002). Residents' lives involve more decision making, such as selecting the time of their meal service, ordering from a menu, choosing whether to participate in multiple activities and deciding how to decorate their private apartments. Moving to assisted living represents a crucial time when seniors decide whether to enjoy their own apartments in a safe and supportive environment with congregate meals or look at the move as an end-of-life place or “the old-folks home.” This creates a need to measure the effect of taking personal responsibility in this population.
The Silver Sky Project is Nevada's first affordable, nonprofit assisted living center with 90 accessible/adaptable apartments. The 5-acre (2.0 ha) campus is located in an upscale community. Assisted living is costly, with monthly fees ranging from $3000 to more than $5000. Silver Sky residents pay ≈20% to 50% of that for a one-bedroom apartment in a luxurious facility. In its first year of operation, staff and management found that the low-income residents tended to require yet another level of care. They appeared to have more needs than many assisted living residents, although not requiring the skilled healthcare of a nursing home or long-term care center.
One instructor began teaching wellness classes in 2006, just after Silver Sky opened. She was disappointed by low resident participation. Residents had limited involvement with all the activities offered, even the old standbys of bingo and playing cards. The Silver Sky director and activity director felt “they are just not interested.”
Residents did not seem to view assisted living as a choice but rather as their only option. They did not feel it was a new neighborhood with new neighbors. While working to develop an outdoor healing garden for Silver Sky, it became obvious that an interim step was needed. Social interaction in ALFs has been found to be predictive of quality of life and measures of happiness (Street et al., 2007). Theorizing that plants could make the residences feel “more like home,” this indoor gardening project was created.
The main question in this research was: What effect would a short-term horticulture program have on the psychological well-being of people in a low-income ALF? The purpose of this study was to measure the short-term impact of a 4-week interactive plant class to describe and measure the relationship between responsibility for a plant and sense of mastery, SRH, and self-rated happiness among low-income assisted living residents. It was hypothesized that the process of having responsibility for a plant might improve participants' sense of mastery, and the related area of SRH and their self-rated happiness, all of which are indicators of future health outcomes, sense of well-being, and quality of life.
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