By Jack Carman, FASLA, RLA and Nancy Carman, MA, CMC / Blueprints for Senior Living newsletter, October 2016 It is a well-known fact that spending time outside in nature is good for us. Instinctively we have always known this. We heard it from our parents when we were growing up, and we tried to escape whenever we could to play outside. It is only lately that research has come to light that validates what we inherently know. All the better: Because sometimes we just need to see the facts to motivate us. The evidence is a clear message that it is important to maintain a youthful connection to nature as we mature. Nature is synonymous for a wellness prescription regardless of our age. Cornell University in Ithaca, NY now offers a freshman course, “Take it Outside.” The course focuses on students going outside and exploring the gorges and other green spaces around the campus. Horticulture professor, Don Rakow believes that “it simply makes sense to use the environment that is naturally available to us to better our own health.” These benefits include decreasing depression, helping to reduce anxiety and offering a fresh perspective for students as well as faculty. Taking walks outside in the garden, the neighborhood, or better yet in the park, will result in better health. Dr. Robert Sallis, a family physician at Kaiser Permanente Fontana Medical Center in California has prescribed exercise for his patients for over 25 years. “If I could get them to do it (exercise on a regular basis, even just walking, anything that got their heart rates up a bit) I would see dramatic improvements in their chronic disease.” And this applies to older adults, as well! Weight bearing exercises improve bone density. A study of a group of nurses found that simply walking a total of four hours a week reduced their risk of a hip fracture by 41%. Physicians in England are encouraging patients to work in the garden. Outdoor areas are turned into gardens so patients can grow fruits and vegetables. Brockwell Park Surgery in South London has partnered with Lambeth GP Food Co-operative to grow more local produce. A lot of the patients are older adults who many times are socially isolated. Those who experience prolonged loneliness are at an increased risk of dying sooner than those who have regular socialization. According to Ed Rosen, director of the program, “It creates the opportunity for breaking down barriers between clinical staff and patients because they’re all going out and getting their hands dirty and growing food together.” Speaking of getting your hands dirty, certain bacteria (Mycobacterium vaccae) that are found in the soil can activate specific neurons in the brain to produce serotonin. This is the chemical that regulates mood. According to a study by the University of Bristol and colleagues at University College London, this soil bacteria can help to reduce depression and make us feel better, maybe for as long as three weeks. So, activities, such as gardening, can have a positive effect on our mood and on our mental health overall. Don’t be afraid to get your hands dirty! Time Magazine in a recent article, “The New Science of Exercise” highlighted studies pointing to exercise as a way to prevent or delay the onset of dementia. Scientists are studying how exercise alters the way the brain functions. The research is beginning to show that exercise can improve blood flow to the brain, which in turn increases the growth of new blood vessels and brain cells. According to Dr. Marcus Bamman, an exercise physiologist, “Exercise is regenerative medicine – restoring and repairing and basically fixing things that are broken.” A study conducted by Gregory Bratman, Emmett Interdisciplinary Program in Environment and Resources at Stanford University, has shown that walks in the park can sooth the mind and positively alter mental health. The results of the research indicate that people who walk through a lush, green natural environment are “more attentive and happier.” Walking outside in nature keeps us focused on the world around us. Watching trees change with the season maintains our connection to the larger world. “Trees are linked to our emotions…they provide smells, sights and touch and change over the year…that cycle of life can be very meaningful for us”, says Dr. Miles Richardson, a nature connection psychologist who has conducted surveys with 2,000 people. Roger Ulrich, Ph.D., Texas A&M University has described nature as a ‘Positive Distraction.’ Nature has the ability of taking our mind off of our ills. People who spend time outside, in a garden, walking in a park or being part of some form of the natural environment, can easily get ‘lost’ in nature. Nature offers a quiet fascination that cannot be replicated by electronic devices or other man-made means. It accepts us for who we are. That is why it is so important that we provide the opportunity for people to maintain this connection to the natural world as they age– for their health and quality of life.
The twinkling and soft glow of lighting in your therapeutic garden extends its use into these autumn months, when the dark of night begins to settle in earlier each day. Casting light onto walking trails, or illuminating focal point elements of the garden such as ornamental trees or rocks, transforms your garden into a sought-after destination, even after the moon rises. White mini lights, paper lanterns and mini uplighters all throw soft lighting, without casting unwanted glares into living quarters. Lighting serves as a safety function as well, inviting your night shift workers or older adults who can’t sleep to step outside — carefully — to seek silence and tranquility in the refreshing night air. Additionally, lighting announces the presence of your garden, lending curb appeal in the eyes of nighttime visitors. Using low voltage lighting that is residential, not commercial, will help to soften the atmosphere of your garden. The goal here is to increase the garden’s accessibility and safety, without installing light fixtures that shift the feel of your garden into that of a public park. Using low voltage, residential lighting helps to soften the atmosphere of your garden. Steer clear of commercial lighting, for these light fixtures can shift the feel of your garden from a serene ambiance to that of a public park. As we head into Halloween, and with the holiday season around the corner, consider setting a festive mood with seasonal lighting. Group pumpkins together on a patio table and surround them with orange mini lights to keep the Halloween spirit alive into the night. Adorn evergreen trees with glistening white lights to remind older adults of the Christmases of their youth. In spring, chili pepper lights under a canopy or pergola add an unexpected spice to Cinco de Mayo celebrations. Each season provides endless opportunity to incorporate lighting in your garden. After all, light transforms your space and, with it, the usability of your garden and the mood of those who visit it.
The Archdiocese of Philadelphia’s latest housing facility in East Kensington offers senior-friendly apartments designed by Cecil Baker + Partners.
Excerpt from article in The Wave… Jack Carman, a New Jersey State Licensed Landscape Architect, designs therapeutic outdoor environments that include JASA’s on Beach 19th Street. “Why are we denying seniors the opportunity to get outside?” was the question that inspired him to this line of his career. Hospitals, he said, are usually uncertain about bringing in a garden, “but here at JASA, it was a no-brainer.” Carman acknowledged the benefits of a community garden for seniors: reducing stress, providing a place to socialize, exercise, and Vitamin D from the sunlight that helps them sleep better. The pathway grounds are made from recycled material as well as the non-porous chairs that can be kept outdoors in any weather. “Community gardens are definitely becoming more popular,” said Carman. To view full article, click here.
This season, allow the tables to turn and present opportunities for older adults to serve as caregivers, instead of simply care recipients. With guidance, older adults of varying abilities can once again feel the sense of purpose and confidence that accompanies doting on living things within your therapeutic garden.
By: Eric Herr, For the Courier-Post 2:21 p.m. EDT August 19, 2016 When Jack Carman of Medford started his own business, Designs for Generations, more than 15 years ago, he did so with the intention of helping the healthcare community. Before becoming an entrepreneur, Carman, a landscape architect, worked for a local municipal engineering consulting firm. There, he realized he might make a difference by designing therapy gardens for people in hospital settings, as well as those living in assisted-living communities and even at home. MEDICAL BREAKTHROUGH: Rowan-led team’s Alzheimer’s test ‘100%’ accurate “As part of my job at the consulting firm, I would often review overall site plans for various healthcare environments and I noticed that in numerous instances, the primary focus was on the internal building design, with outdoor environments being virtually ignored,” Carman explains. Seeing a void in environmental aesthetics — and with encouragement from his wife, Nancy, a geriatric care manager, Jack began to look more closely at therapeutic gardens and how they might positively affect mental behavior, especially among those suffering from dementia, Alzheimer’s and other degenerative disorders. Carman discovered research conducted between 1972 and 1981, by an award-winning professor of architecture, Dr. Roger S. Ulrich, that supported his assumptions. Ulrich’s findings, which appeared in the April 1984 edition of The American Association for the Advancement of Science Journal, revealed some fascinating insights. Twenty-three patients in a suburban Philadelphia hospital who were recovering from gallbladder surgery were assigned rooms with windows looking out on a natural scene. These 23 patients exposed to nature had shorter post-operative hospital stays, received fewer negative evaluative comments in nurses’ notes and took fewer pain-relieving medications than did 23 patients in similar rooms with windows facing a brick building wall. Encouraged by Ulrich’s study, Carman has since become a leading authority in his own right, conducting seminars, writing articles and doing a wide range of both commercial and residential landscape consulting. In an article “What Is The Evidence To Support the Use of Therapeutic Gardens for the Elderly,” published in the September 2012 issue of the Journal of the Korean Neuropsychiatric Association, Carman along with other leading experts asserted that horticulture therapy not only improved attitudes and the overall quality of life — especially among aging populations — but could also, by extension, be linked to cost savings. “Good therapy for patients and their families notwithstanding, therapy gardens also provide a welcome change of pace for doctors, nurses and other caregivers, whose jobs are both demanding and often very stressful,” observes Carman. LOCAL COLOR: August brings butterflies to gardens Perhaps no one understands that aspect better than Amy Quick, director of Virtua Health, Camden CASTLE Program. CASTLE, or Children Achieving Success through Therapeutic Life Experiences, is a Medicaid-funded initiative that provides assistance and support to children ages 3 to 15 who have behavioral and emotional issues affecting their lives at home or at school. Staffers began discussing a garden in 2013, “recognizing the need to take care of themselves, first, as a means of providing and maintaining optimum care for all our patients, whether they be in CASTLE or other departments within our healthcare center,” explains Quick. A once-neglected and overgrown 3,000-square-foot courtyard area was subsequently transformed into a vibrant natural habitat that incorporates a variety of plants and shrubs, a space for growing herbs and vegetables, plus yoga and meditation areas, walking paths constructed of recycled rubber, shaded alcoves and more. According to Quick, the initial design was simply to have the garden only for viewing, but it soon became apparent access for patient activities, family time and even staff meetings would benefit everyone. “The garden offers a soothing environment for patients and their families to enjoy and is a great stress-free place for our staff to relax and unwind,” notes Quick. Another perk is that children in the CASTLE programlearn about horticulture by actively working in and maintaining the garden. In an annual event, butterfly larvae, raised by the children, hatch and mature into butterflies that are taken out into the meditation garden and released. The final phase of another therapy garden project that Carman designed for Virtua’s Voorhees location was completed last year. Like Quick and her colleagues at Virtua Health, Lisa Heinkel, director of health services at Medford Leas Continuing Care Retirement Community, along with on-site horticulturalist Debbie Lux, use their recently completed garden for multiple purposes. “This space has literally come alive since we opened it this spring for our residents and staff,” says Heinkel, adding it’s the perfect staging area for a variety of ongoing programs and activities. Lux points out the area, which opened in May, incorporates many native plants, shrubs and trees as well asa water feature that attracts numerous birds and butterflies. “The best part,” observes Lux, “is that when the weather gets too cold to go outside, our residents can still enjoy the view of the garden from the adjoining dining area.” Michelle Bieszczad is director of Aging Services for Sisters of Mercy of the Americas Mid-Atlantic Community, a religious order serving Pennsylvania, New Jersey and parts of New York, with administrative offices in Merion, Pennsylvania. She met Carman at a long-term care conference in Los Angeles back in the late 1990s. “Jack and his wife Nancy were conducting a workshop on creating natural outside therapeutic environments for seniors and I was immediately fascinated by the whole idea,” recalls Bieszczad, who lives in Voorhees. Bieszczad hired Carman to develop and design gardens for a nursing community in Northeast Philadelphia, where she then worked in a similar administrative capacity. Their longstanding relationship has continued, with discussions underway about a new garden at the Merion location and elsewhere to benefit those suffering from Alzheimer’s and related memory challenges. By most accounts, the size of the garden may not be as important as the design and configuration elements for practical use. “The total sensory experience is always key in designing any therapeutic garden,” explains Carman. “The scent of fresh basil, rosemary and mint, along with the wonderful fragrances of various flowers, together with the tranquil sound of wind chimes and water features, for example, can evoke fond memories for those of all ages.” Non-toxic plants, shaded areas, smooth level paths, seating and the many aspects of direct and indirect lighting are all equally important design basics to consider. If the intrinsic beauty and overall positive effect of the gardens isn’t enough incentive, there’s always the all-important bottom line. “Lets face it, budgets are tight everywhere and sometimes aesthetics such as gardens get cut,” observes Carman. “But, what’s important to understand and what research proves is that when a calm, relaxing and pleasing natural environment is created, there are significantly improved overall health outcomes, for patients and their caregivers alike. That, in turn, can translate into huge cost savings at many levels across the board.” To view the original published article, please visit The Courier Posts page at: http://www.courierpostonline.com/story/life/2016/08/19/therapeutic-gardens-healthcare-alzheimers-mental-health/88643926/
One pound of zucchini will yield approximately one cup of zucchini butter. Ingredients: 1 lb. zucchini ⅛ cup butter or olive oil 1 minced shallot or garlic (or a combination of both) Salt and pepper, to taste Optional: mint, red onion, thyme, Pecorino Romano cheese Directions: Coarsely grate zucchini. Let drain in a colander for five minutes. Squeeze water out of drained zucchini using a clean, cloth towel. Heat butter/olive oil in skillet. Sauté the shallot or garlic briefly. Add zucchini, as well as salt, pepper and optional additions. Mix. Cook over medium-high heat and continue to stir periodically for 10 to 15 minutes until zucchini cooks down into a spreadable consistency.
There comes a time in every gardener’s life when they look at the bounty they’ve grown and think, “This is too much.” Typically, in August “too much” means an overabundance of fresh zucchini, tomatoes, basil or peppers. However, there is no such thing as too much of a good thing when it comes to the plethora of produce culled from your therapeutic garden. Before you step into the kitchen to bake that 8th loaf of zucchini bread, though, pause and consider potential opportunities to socialize and build meaningful relationships within the community. Five ways to make the most out of your surplus: Organize a delivery of fresh produce to your local food bank or homeless shelter. Host a recipe swap with taste testing stations. Encourage residents and staff to share their favorite recipes for soups, appetizers, entrees and desserts. Hold a bake-off. Deliver the tasty treats to local police, firefighters and EMTs, to thank them for their service to the community. Assemble a basket of fresh produce and baked goods for local teachers, wishing them well as they start another school year. Make zucchini butter to use as a spread or a dip. Recipe here. Facilitating community connections and socialization fosters emotional and physical well-being for older adults, helping them stay happy and healthy.
A landscape architect explains why safe and accessible outdoor environments are important for all ages Universal design, within homes and community buildings, is on the top of many ‘to do’ lists. Unfortunately, the implementation of universal design principles in outdoor environments is slower to gain acceptance. Yet at the same time, an increased focus on maintaining access to nature has given rise to a need to strengthen our indoor/outdoor connections. It has been proven that our interactions with the natural world improve health, increase physical strength, boost mental alertness, and encourage socialization. Simply put, outdoor environments with universal accessibility offer an improvement in quality of life for everyone, especially older adults. Research has shown that a view of nature helps us to recover quicker from illness; that there is a natural absorption of bone-strengthening Vitamin D from sunlight; that blood pressure and stress levels drop simply by viewing the outside world. In a more intuitive way, we know that people generally feel better after they have taken a walk in the park, experienced the vibrant colors of a sunset, or picked an arrangement of wildflowers. Maintaining our connection to the natural world around us is essential to who and what we are as inhabitants of this planet; therefore, providing access to outdoor environments for seniors is a basic necessity of a balanced lifestyle. Thoughtful design considerations are key in creating outdoor settings for senior communities. The need for shade, comfortable seating, appropriate walking surfaces, and minimally sloped walks are just a few of the elements that allow a person to move about safely in the outdoor landscape. The ability of an older adult to be able to move easily from one place to another is the foundation of the outdoor environment’s design. We all want to be able to decide in which direction to go, how we would like to get there, and the opportunity to do this effortlessly: Maintaining this independence is extremely important for older adults. Easy in, easy out Physical access to the outdoors is the first step to eliminating obstacles. Many homes and/or buildings prohibit outside access because of steps or changes in grade that limit unfettered movement. Eliminating the steps to a front door and/or porch is one of the first places to begin. A ramp that is minimally sloped (2 to 3 percent) and connected to the door makes it easy for a person to move in and out freely. Other universal design considerations include—but are not limited to—a landing in front of the door, a ledge to hold a packages, easy-to-use handrails, sufficient area lighting, and a wide, level walkway. Appropriate landscaping that allows a person to see their way clearly can also provide a secure and comfortable feeling. The value of a good garden Gardening is America’s favorite hobby, and elders are no different in wanting to enjoy time in their yard. Either a porch or deck can prove very beneficial in allowing older adults to transition from inside to out. A porch also offers shelter in case of inclement weather, giving a senior much-needed time to move indoors if it starts to rain or the heat becomes too intense. An elder’s eyes can take up to approximately 8 minutes to adjust to the brightness of the outdoors; an overhang can give them an opportunity to pause and adapt to sunlight. Raised planters help older adults garden by providing convenient opportunities to get their hands in the soil at a variety of heights. Stable, comfortable, and attractive outdoor furniture encourages elders to simply sit and enjoy nature. The seat of a chair should be 18 to 19 inches high and have sturdy arms to provide support for getting in or out. Furniture should be movable, allowing for a variety of inviting areas to socialize. Safety first Moving from the yard to the surrounding neighborhood should also be a simple transition. Sidewalks should be a minimum of five feet wide and have smooth, level walking surfaces to provide easy access. Street trees that provide ample shade are important so that heat from the sun does not become excessive. Glare can also be reduced by coloring or tinting the concrete pavement surface. Maintaining plantings adjacent to the sidewalk is important so the walkway does not become overgrown and unsafe. Low hanging branches from street trees, shrubs that grow over the walks, and leaves on the pavement can make for hazardous conditions as well. Not only is it important to provide a safe physical environment, but also one that is psychologically safe. Perceiving that the neighborhood is walkable goes a long way in increasing willingness to participate fully in the outdoor environment. When outdoor environments are created applying the principles of universal design, everyone enjoys them the same way. There are no differences due to age or abilities, and nothing screams “disabled adult.” Aesthetics, access and design are all interwoven, and everyone feels welcome. Eliminating obstacles will allow a person to remain independent and stay connected to both nature and the world around them. People need opportunities to interact with nature, whether visiting a neighborhood park with family or simply going to the local store to buy a newspaper and cup of coffee; it is truly essential to maintaining quality and enjoyment of life for everyone. This article was adapted from one previously published in Icon Magazine; it was also featured in Blueprints for Senior Living, the Design for Aging Knowledge Community’s quarterly e-newsletter. Jack Carman, FASLA, is a landscape architect and founder of Design for Generations, LLC, specializing in the design and development of therapeutic gardens and landscapes for senior communities and healthcare facilities.
Shading people and plants from the direct rays of the fierce July sun help to protect the health and wellbeing of both. Creating a shaded, welcoming oasis this month will coax older adults and their caregivers into continuing to enjoy your therapeutic garden, even as the summer temperatures soar. The eyes of older adults take an average of five to eight minutes to fully adjust to outside light, making it that much more important to offer shaded areas that take into account their diminished visual acuity. Improving the physical comfort of your older adults encourages them to get outside and connect with the world around them as they continue using your garden. Although mature, well-established deciduous trees offer the strongest shelter from the sun, a plethora of options exist to build a soothing, cooler garden. Consider adding canopies, pergolas or shade sails to serve both as shields and as aesthetic focal points that encourage socialization and relaxation. The structures will reduce the surface temperature of nearby benches and other seated areas, turning hot summer spaces into places of tranquility. A ceiling fan slowly swirling circulates and cools the air, while also creating the psychological sensation of cooler weather. In addition, plants in general contribute to pulling humidity out of the air (by means of water evaporation), changing people’s perception of the temperature. Climbing vines against brick or concrete walls, moss covered stones and the sounds of water from nearby water structures all trigger the impression of cooler temperatures. Shade will transform your therapeutic healing garden into an inviting, cooler oasis that continues to serve as a destination for residents and families throughout the summer.
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Design For Generations, LLC
Jack Carman F.A.S.L.A.
92 Tallowood Drive
Medford NJ 08055
Voice – 609-953-5881
Fax – 609-953-1625
jack@designforgenerations.com
www.designforgenerations.com
