It’s a quintessential spring morning at the University of Georgia’s State Botanical Garden. The sun is starting to peek out from behind a patchwork of pale gray clouds, warming the air.
It’s an idyllic setting for another session of Meet Me at the Garden. This pilot program, delivered by the education teams at UGA’s Cognitive Aging Research & Education (CARE) Center and the State Botanical Garden, wants to “expand the bubble” of persons living with dementia and their caregivers through interactive education and sensory activities.
Four pairs of people with dementia and their caregivers signed up to participate in this pilot program, attending four sessions over four months. Each two-hour session has a learning theme – today’s is all about greens – and CARE Center team members, cheerfully referred to as garden gurus, support each pair throughout the session by answering questions and serving as personal guides.
The pairs and their gurus gather at the Children’s Garden among a semi-circle of raised beds chock full of winter vegetables and flowers. Today, they are planting and harvesting greens and herbs. “Oh, that’s exciting!” exclaimed Odette, one of the participants. “Tony, we get to take home some plants. Won’t that be nice?” she asked her husband Tony, who stands at her side.
Odette takes a few steps back as Tony leans over a spray of kale and cabbage leaves. Yellow and purple pansies stand out against a background of bright green. Children’s Garden curator Katie McCollum shows Tony where to snip the stems of the kale he wants to take home and hands him a pair of scissors.
Odette is watching from a few feet away. She takes a few pictures of Tony, then turns to survey another raised bed of lettuces next to her.
Two months ago, at the first session of Meet Me at the Garden, Odette stuck close, seemingly reluctant to leave Tony alone for too long. It’s become habit. For the last year and a half, Odette has watched as Tony’s processing speed, memory and ability to take care of himself have slowly slipped away due to Alzheimer’s disease.
The CARE team knows this dynamic all too well.
When someone becomes a caregiver, one thing that happens,” said CARE Center Co-Director Lisa Renzi-Hammond, “is that relationship dynamics shift in a way that is uncomfortable for both caregivers and for patients.”
“Spouses, for example, who were equal partners in a relationship end up becoming unbalanced and asymmetrical,” she said. “So, instead of both partners jointly making decisions together, problem solving together, one partner ends up having to make the bulk of the decisions and telling the other partner what to do.”
Odette is learning to care for Tony in this new dynamic.
Tony was a chemical engineer who loved working with his hands and getting out into nature. He used to garden, and once built a catamaran from scratch, even sewing the sail himself. And, Odette and Tony loved taking walks at Sandy Creek Park with their dog, Zoro.
Now, Odette says, Tony just wants to watch TV most days.
“My main goal [of participating in Meet Me at the Garden] was to see Tony interacting and how he enjoys being creative still,” she said.
Stimulating the senses
Art and music therapy are commonly recommended to help persons living with dementia because they help them tap back into their creativity and engage their senses.
“Senses are the gateway to the brain,” said Renzi-Hammond. “If you are going to stimulate a brain and have it do something magnificent, it usually happens through the senses.
“While no one should expect that people living with Alzheimer’s or dementia will improve their processing speeds, memory or executive function, we should be able to engage senses.”
The CARE Center is engaged in multiple levels of research to better understand and prevent Alzheimer’s disease. The center also provides outreach to communities in order to offer better support and education on an issue that impacts over 6.5 million people in the U.S. and an estimated 150,000 Georgians.
When State Botanical Garden Director Jenny Cruse-Sanders approached the CARE team about adapting a Meet Me at the Garden program she’d learned about at the Naples Botanical Garden in Florida, they jumped at the opportunity.
“We believe strongly that connections to plants and nature are essential for a good life,” said Cruse-Sanders. “We also believe that those connections should be accessible to everyone. With this program, we could adapt our preexisting curriculum to connect us with an audience that is becoming ever larger in our country.”
The garden’s Director of Education Cora Keber was connected with Master of Public Health student Lydia Burton to start developing a curriculum for the program.
Each session, they decided, would have things available to taste, touch, smell, manipulate and to take home to look back on and remember. The participants also get to take home a lesson about the topic du jour. The group has learned about the history of coffee and tea, chocolate, how eating greens helps your brain, and native plants and pollinators.
Burton is delivering the program curriculum as part of her capstone project, which is required for all MPH students. At the end of each session, Burton and the garden gurus help their pairs fill out a questionnaire that asks about how the day’s session made an impact on both the dementia patients and their caregiver.
“We want to see if their quality of life has improved from learning and being out in nature and seeing new things or new sides of the person that they love,” said Burton. “I’m hoping to see changes and improvements in quality of life, their bond together, and I’m hoping to see that they are engaged with the activities.”
The benefits of a bigger bubble
As Alzheimer’s disease or dementia progresses, people living with the disease and their care partner tend to stay at home where the environment feels familiar and safe, rarely socializing with others.
“When people are in that bubble together, they’re isolated. Every day is exhausting, it’s just getting to the next day. This is something that’s accessible,” said Burton.
Meet Me at the Garden was designed to offer a space where everyone can be on equal footing and the responsibility of caregiving is distributed around the room.
Garden Guru Hannah Huff is happy to take on this responsibility. She’s been working with Tony and Odette since they first contacted the CARE clinic hoping to get a diagnosis.
“I just think it’s great that I’m able to be here to support them so that they can experience these things without Odette having to be like, ‘OK, I’m the caregiver. I need to be a caregiver 24/7. No, I can just exist and be here with my husband and go on a walk in the sensory gardens,’” said Huff. “It’s really nice to see her exhale and let her explore.”
Odette also has more opportunities to interact with other caregivers and talk about the challenges and the difficult days.
Odette says she does see a difference in Tony on the days they come to Meet Me at the Garden. He’s engaged with the activities and moves around a lot more. When Odette tells Tony they’re going to the Botanical Garden, he smiles.
“When I see him involved in something that he likes, of course it makes me feel good,” Odette said. “And also, it breaks our schedule being able to meet other people, because it’s me and him all the time, or doctors and appointments. So, it’s nice. It’s refreshing, and I feel supported. This is like my second family. My first family, really, because I don’t have anybody here.”
These are the types of benefits that the team wants to demonstrate to apply for funding. Additional funding will allow them to expand the program to benefit more people across Georgia.
The pilot program wrapped up in April, but the team is planning to take the program to the CARE Center this summer and use raised garden beds. Eventually, the programming will be developed so that rural counties that have been working with the CARE Center through the UGA Archway Partnership can adopt Meet Me at the Garden for their communities.
Today, Odette and Tony are going home with a bag of kale, a salad dressing they made together with fresh thyme, and plenty of photos of Tony that Odette will share with her cousin.
Renzi-Hammond hope that each of the participants, whether in this pilot or in future programs, will take home more than souvenirs of their day at Meet Me at the Garden.
“We hope that people look at the things that they take home from the garden, the plants that they bring back into their spaces, as a way of remembering that it is still possible to connect with their loved one and engage with them,” she said.