The potential of nature exposure to reduce agitation: lessons from a naturalistic observational study in a stage-adaptive, dementia-friendly therapy garden.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD), particularly agitation, are common among people living with dementia, negatively affecting their psychological well-being and quality of life. Non-pharmacological interventions such as therapeutic gardens may offer a holistic approach to managing these symptoms. AIMS: This study aimed to investigate whether participation in a multimodal, dementia-specific therapeutic garden intervention could reduce BPSD, with a particular focus on agitation, and improve psychological well-being among people with dementia. METHODS: A naturalistic observational study was conducted with 24 residents of a dementia-friendly garden. Participants engaged in tailored, nature-based therapy over 6 months. The intervention was adapted to individual cognitive and physical abilities and included motor, sensory and social activities within the participants' familiar living environment. Standardised assessments of BPSD and psychological well-being were administered, including evaluations reported by relatives. RESULTS: The intervention was associated with a significant reduction in agitation, as measured by the non-cognitive subscales of the Alzheimer's Disease Assessment Scale (p < 0.05). Furthermore, reduced agitation was linked to improved psychological well-being among participants. CONCLUSIONS: The findings suggest that multimodal therapeutic gardens can serve as an effective non-pharmacological intervention in reducing agitation and supporting psychological well-being in people with dementia. This study adds to the growing evidence that therapeutic gardens could contribute to the functional and emotional health of individuals living with dementia.