Effects of Horticulture on Frail and Prefrail Nursing Home Residents: A Randomized Controlled Trial

Claudia K.Y. Lai, Yiu Cho Kwan, Shirley K.L. Lo, Connie Y.Y. Fung, Jordan K.H. Lau, Mun Yee Mimi Tse

Research output: Journal article publicationJournal articleAcademic researchpeer-review

22 Citations (Scopus)


Objective: Frail nursing home residents face multiple health challenges as a result of their frail status. The aim of this study was to examine the effects of HT on the psychosocial well-being of frail and prefrail nursing home residents. Design: Randomized controlled trial. Setting: Nursing homes. Participants: One hundred eleven participants were randomly allocated into the intervention [horticultural therapy (HT)] and control (social activities) conditions. Intervention: HT group participants attended a weekly 60-minute session for 8 consecutive weeks. Control group activities were social in nature, without any horticulture components. Measurements: The outcome measures include happiness, depressive symptoms, self-efficacy, well-being, social network, and social engagement. The time points of measurement were at baseline (T 0), immediately postintervention (T 1), and 12 weeks postintervention (T 2). A modified intention-to-treat approach was adopted. A multivariate general estimating equation was used to analyze the data. Results: Forty-six and 50 participants received at least 1 session of the intervention and control condition protocol, respectively. A significant interaction effect between group and time was observed only on the happiness scale (β = 1.457, P =.036), but not on other outcome variables. In a follow-up cluster analysis of those who received HT, a greater effect on subjective happiness (mean difference = 6.23, P <.001) was observed for participants who were happier at baseline. Conclusion: HT was found to be effective in promoting subjective happiness for frail and prefrail nursing home residents. Its favorable effect suggests that HT should be used to promote the psychosocial well-being of those who are frail.

Original languageEnglish
Pages (from-to)696-702
Number of pages7
JournalJournal of the American Medical Directors Association
Issue number8
Publication statusPublished - 1 Aug 2018


  • aged
  • Frailty
  • happiness
  • horticultural therapy
  • nursing homes

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy


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