I'm an activity geek. I guess that's why I became an Occupational Therapist. I've always found the activities of our life—whether Activities of Daily Living or Leisure activities—to be fascinating and far more beneficial than one may think.

Activities are the things that a person or a group does. We all engage in “activities” each day, but what we engage in is unique based upon who we are and what is required of us in life. What are the activities that you do? Which do you value the most, and why do you do them?

There are many types of activities including:

Activities of Daily Living (ADLs): those basic tasks such as dressing, grooming, bathing, and eating.

Instrumental Activities of Daily Living (IADLs): the “higher level” ADLs required for independent living such as driving, shopping, managing money, housekeeping, and cooking.

Leisure or Recreational Activities: hobbies like playing an instrument or sport, knitting, playing cards or gardening. And let’s not forget . . .

Work and Sleep: these include the activities we all engage in, in some form or fashion.

The Activities We Engage in Are as Unique as We Are

For example, I “work” full time as President of Dementia Care Specialists, using my Occupational Therapy skills. Someone else may “work” at home as a full-time parent. I take the fast track to sustenance by cooking simple meals or eating out, while others enjoy preparing fabulous meals. I like to spend leisure time outdoors—biking, playing pickleball, walking—but someone else may engage primarily in indoor activities.

What we do each day is related to what is needed of us in life, and our preferences. Our activities fulfill us.

Did you know activities are one of the most important elements of healthy living? Let's explore.

Activities, how we spend our time, hold tremendous value, including offering cognitive and physical stimulation as well as providing opportunities for purpose, joy, socialization, and pleasure. This is true for all of us, even for those living with dementia.

Those who are living without limitations may be able to engage in what they want, when they want, independently. But when a person is living with dementia, they become more dependent on others to help them to successfully participate in the activities they want and need to do. Due to their cognitive limitations, they need support to initiate, engage or complete. But the need for cognitive support should never be confused with a person not wanting to engage in activities. And we must never assume activity participation loses its rich value and positive impact on health and quality of life.

The Benefits of Gardening

It's spring, so how about we talk through the many amazing therapeutic benefits of one of my beloved activities? Let's explore some of the wonderful health and well-being benefits derived from gardening:

Physical Exercise: strength, range of motion, balance, flexibility, and fine and gross motor coordination.

Cognitive Exercise: planning, problem-solving, prioritizing, sequencing, and all types of memory and attention.

Emotional Enrichment: a sense of purpose and pleasure. If gardening in a group, we can also find the emotional benefits of socialization. For many, like myself, there is peace and joy derived from simply being outside, where most gardening activities occur. We may connect with memories that bring us happiness. There are just too many benefits to list.

Now, let's talk about a wonderful resource book to enable those with dementia to successfully participate in gardening.

I'm excited to introduce you to a wonderful resource book, authored by Caryl Gurski, that will enable you to provide the cognitive support needed for those living with dementia who find gardening to be a valued activity.

Caryl Gurski was a passionate Occupational Therapist who specialized in dementia care, and like me she used the Allen Cognitive Levels and Model in her practice. Caryl was equally passionate about gardening and studied Horticulture Therapy. I had the pleasure of knowing Caryl both as a work colleague and a friend. She personally taught me much of what I know about gardening, and she taught me to LOVE it. Her passion was contagious!

She combined these two passions into a wonderful resource book called The Garden Book: Stage-Specific Therapeutic Gardening Activities for Older Adults and Persons with Dementia. In the book, Caryl identified activities for all four seasons and created protocols related to Allen Cognitive Levels/dementia stages. Someone could use these gardening protocols to support a person at any stage of dementia to participate in gardening at their best ability level at home, senior living communities, or adult day care and senior centers.

As an Occupational Therapist, Caryl received a grant to lead these activities for seniors living with dementia throughout the Milwaukee area. She was able to conduct and later publish research related to the many positive outcomes achieved through implementation of the wonderful dementia stage gardening activity protocols she organized for us in her resource book.

Gardening can empower someone living with dementia by tapping into their strength, which is their long-term and procedural (how-to) memory. Gardening can awaken someone by connecting to their emotional memory, and through senses like smell and touch. I have witnessed this awakening when I used the protocols when working in memory care senior living communities.

My Experience Using The Garden Book: Stage-Specific Therapeutic Gardening Activities for Older Adults and Persons with Dementia

I found the gardening activities to be perfectly adapted for every Allen Cognitive level/stage of dementia, and as a result the activity groups I led were a huge success. Through the sensory stimulation obtained from the garden activity, my clients in my gardening groups awakened in a way I hadn't previously been able to facilitate. As Caryl taught me both professionally and personally, being in the garden is a magical place to be. It has both healing and inspirational powers.

Meet Millie

I worked with a lady named Millie who was in Allen Cognitive Level 3/middle stage of dementia. Millie hadn't spoken a word for a long time, and it was reported by all that she seemed depressed. I learned she always enjoyed gardening. She couldn't remember how to garden and couldn't engage independently due to dementia, but I wanted to help her participate by engaging her interest and her remaining abilities.

I put the water bottle in her hand and cued her to spray. She was able to hold and pull the trigger on the water bottle to mist the plants. Yay! She was engaged and based on her facial expressions she looked happy and “in her element.” I continued. I gently put her hand in the soil and moved it around. I then lifted the flowers to her nose and said, “Smell the beautiful flowers.” She lifted her head, sat more upright, inhaled, and smiled. Her interest, capabilities, sense of self, and positive emotions all seemed to be blossoming.

I continued by providing one step directions to pot the plant. Together we created a hole for the new plant and dropped in the flower. Her facial expression totally changed and then she looked at me and said “Flower.” Wow! Isn't that cool? When we finished the gardening activity Millie looked like an entirely new woman. She looked happy, and so was I!

Meet Betty

In an activity group, Betty, one of our more quiet and reserved clients who was functioning in Allen Cognitive Level 4/early-stage dementia, spontaneously and surprisingly became our gardening group leader. After we put the herbs and all the supplies to plant the herb seeds on the table, she began to tell us all about the ways to plant the seedlings. She recalled how she had an herb garden and the many wonderful recipes she made through the years with her crops.

We were enthralled as she led us all to through the process of planting our seeds with care. Over time, we nurtured them to plants and used them for our food. Betty was so proud and couldn't wait to get up each day and tend to her plants that became an integral component of the daily meals all enjoyed within the senior living community.

How to use the Protocols to Lead Gardening Activities to Facilitate Success Stories Like Millie and Betty

Step 1: Select a favorite activity matching your client's preferences, within the current season, from many of the great options.

Step 2: Identify how many will participate and the cognitive level(s) of the participants.

Step 3: Use the supply list as a guide and gather all supplies needed

Step 4: Read the directions for suggestions on how to prepare the group

Step 5: Read the information describing primary abilities and activity adaptations for those at early-stage (Allen Cognitive Level 4), middle-stage (Allen Cognitive Level 3) and late- or end-stage (Allen Cognitive Level 2 and 1) dementia.

Assuming you understand the Allen Cognitive Levels you have all you need and should be ready to lead, participate and enjoy!

It's that easy, so why not get started today?

Spring is a great time of year to focus on the garden. If gardening is a valued activity, it can hold immense therapeutic benefits for all, including those living with dementia. The key is to adapt the activity to the right level of challenge to enable individuals to be successful at every dementia stage.

Caryl's Gardening Book is a real masterpiece. It is a tremendous resource you can use to help those you serve, and the garden you tend, come to life. Thank you, Caryl, for leaving us this wonderful legacy. You and your amazing work will continue to make a profound impact through the hearts and hands of compassionate and skilled care providers.

I close this blog with words from Caryl:

“I hope you will enjoy the rewards of working with your patients as they are empowered by their experiences with plants, and with you.”

~ Caryl Gurski, M.S., OTR

Kim Warchol, OTR/L, is the founder and President of Dementia Care Specialists at Crisis Prevention Institute.

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