Abstract
As stated in the introduction, the goal of this book is to illuminate the importance of outdoor spaces in health care settings and to present case studies and research-supported guidelines for designing and using such environments. To this end, this book largely succeeds in meeting these goals. The authors provide historical and theoretical context on therapeutic landscapes followed by chapters focused on specific settings (e.g., hospital, hospice) and populations (e.g., frail elderly, military veterans). Several chapters stand out as especially useful for researchers and practitioners focused on older adults and their care (the focus of this review). The authors also dedicate chapters to research design and evaluation of therapeutic landscapes which summarize existing literature and guide future research efforts. High-quality, color photographs are placed throughout the book that bring to life concepts and topics, provide examples of actual gardens and outdoor spaces, and help pique the interests of readers.
The book begins by laying out the history of therapeutic landscapes beginning in ancient Greece and finishing in modern times (Chapter 1). This concise yet thorough review provides a solid foundation for readers who are new to therapeutic landscapes (note: the authors use this term to include outdoor gardens and nature spaces). This is followed by a comprehensive overview of theory and research as it relates to the benefits of nature in lives of people (Chapter 2). The authors present each theory and then provide design considerations in light of the theory. Connecting theory with practice can be cumbersome at times, yet the authors use a deft hand in making this link. Some of the design suggestions are common sense and the authors note that there is often a sense of “My mother could have told you that” (p. 32). The authors caution, however, that we need to connect theory, research, and practice to produce credible evidence to support our mothers’ advice! This is reinforced in Chapter 20 in which the authors discuss “postoccupancy evaluations” (POEs) of therapeutic landscapes and include a valuable resource list of example POEs (pp. 315-316).
In considering the content of this book as it relates to aging, Chapter 6 presents guidelines for designing therapeutic gardens and outdoor spaces for general health care facilities. The authors guide readers through a step-by-step, detailed process. Many of the guidelines relate directly to older adults, such as designing landscapes with adequate shade areas and opportunities for seating, adequate wayfinding, and wheelchair access. In Chapter 9, the authors present a review of the literature on gardens for older adults, much of which is focused on individuals living in assisted living facilities and nursing homes. As with other chapters, the authors then use this literature to present design guidelines, both “required” and “recommended.” There is a depth of detail that will be appreciated by designers and researchers, from ensuring that doors are easy to open and thresholds can be easily rolled over to the importance of insect control and the careful use of scented plants. The Banfield Pavilion Rooftop Patio Garden (pp. 143-146) is a beautiful example of these design considerations put into practice.
Chapters 10 and 11 focus on outdoor spaces for facilities that specifically serve residents with dementia and patients in hospice, respectively. Much of the content in these two chapters build off of the literature and general design considerations presented in Chapter 9. Many of these design considerations will resonate with geriatric professionals and researchers, such as ensuring that staff are included in the design process, incorporating open sight lines for safety monitoring, and designing gates that blend into fences. The authors also suggest that individuals with dementia be included in the maintenance plan for the gardens. In doing so, the garden becomes an active horticultural therapy intervention. Matching individual competencies with tasks is critical to maximizing the success of these interventions and preventing excess stress and frustration (Jarrott & Gigliotti, 2011). Landscapes that promote peace, tranquility, and reflection are emphasized for hospice settings in Chapter 11. The authors suggest the use of “familiar landscapes” to promote a sense of home, “transcendent image” to allow patients to escape from the everyday, and “soothing natural sounds.” Outdoor spaces for hospice and long-term care settings can also be a venue for intergenerational exchange where older adults and children interact. An interesting point is raised regarding the use of “memorial gardens”—landscapes that include plaques, stones, and other memorials to specific patients who have died. In the United States, this is a common practice, whereas in the United Kingdom this practice is generally frowned upon (p. 168). The authors use this point to stress the importance of cultural (and regional) competence in designing therapeutic landscapes. As previously mentioned, each of these chapters is filled with wonderful photographs and illustrations to help readers visualize the suggested design elements. The photo of exhausted nurses taking a break in an outdoor garden in Florida (p. 72), the highly detailed site plan for the adult day center garden in Michigan (p. 159), and the photo of the majestic grounds of a hospice in Idaho (p. 175) invigorate the text and illustrate the power and potential of therapeutic landscapes.
In considering the possible audiences and applications for this book, I could easily envision it serving as a primary text in an introductory, undergraduate course on landscape design. The chapters are concise and written at a level that is easily digestible for such an audience. I could also envision selected chapters assigned as primary or supplemental readings for courses focusing on person-in-environment in human development, family studies, social work, physical and occupational therapy, and other related health care disciplines. As the authors state, this book is also intended for use by practitioners and for those interested in incorporating outdoor spaces in their health care facilities. Selected chapters may be of particular interest to these groups, such as the section on funding therapeutic landscapes (Chapter 19).
The few critiques of this book lie in the fact that some chapters tend to be brief (e.g., 10 or 11 pages) and do not provide enough depth or content. The intent may have been to have these chapters serve as a “jumping off points” to introduce readers to the topics and encourage further exploration of the literature. If so, the chapters do well in this role. There are also issues with the evidence presented to support some of the interventions suggested. In some cases, the supporting research lacks rigor and the body of literature is not well developed. The authors acknowledge the need for more quality research, as have others in this field particularly as it relates to older adults (for reviews, see Gonzalez & Kirkevold, 2014; Wang & MacMillan, 2013). On the whole, however, this book effectively presents the state of knowledge regarding therapeutic landscapes and provides a comprehensive and practical review of the latest evidence-supported interventions. The authors encourage readers to seek out ways to reconsider the natural environment in health care settings and to rigorously evaluate the effects on patients, residents, staff, and family members—perhaps the most valuable aspect of this book.