Effectiveness of Information Technology-Assisted Horticultural Therapy Program on Heart Rate Variability, Stress, Depression and Happiness Among Older Adults Resident in Long-Term Care Facilities

Not Applicable

Recruiting

• Conditions: Heart Rate Variability; Stress; Depression; Happiness

• Registration Number: NCT06797804
• Lead Sponsor: National Taipei University of Nursing and Health Sciences

Brief Summary

This study aims to address existing research gaps by investigating the effects of technology-assisted horticultural therapy on stress, depression, and happiness among older adults residing in long-term care facilities. By examining the modulation of the autonomic nervous system, the findings will provide a foundation for developing comprehensive health promotion programs that integrate traditional therapeutic practices with modern technology to enhance the well-being of the aging population.

Detailed Description

The mental health needs of older adults are a growing concern, and as technology advances, integrating health information with technology can improve healthcare quality and dissemination efficiency. Integrating health information with technology holds promise for enhancing healthcare quality and dissemination efficiency in practical applications, thereby equipping more individuals with accurate health maintenance knowledge. Particularly notable is the increasing trend in internet usage among modern seniors, which contributes to achieving United Nations Sustainable Development Goals. Horticultural therapy has been widely acknowledged for its positive impact on human well-being in various settings. However, its integration with information technology remains relatively unexplored. Additionally, studies on its effectiveness in relieving stress have demonstrated inconsistent effects on heart rate variability. Therefore, this study aims to examine how technology-assisted horticultural therapy influences stress, depression, and happiness among older adult residents in long-term care facilities, with a specific focus on regulating the autonomic nervous system. The study will employ both subjective questionnaire surveys and objective measurements of heart rate. This study proposes a cluster randomized controlled trial. Using G-Power 3.1, a minimum sample size of 76 participants is calculated, accounting for an estimated 20% attrition rate. To ensure equitable distribution between intervention and control groups, each group will consist of at least 38 participants. The intervention involves technology-assisted horticultural therapy sessions conducted once a week, lasting 120 minutes per session, over a total period of 8 weeks. The research will employ several tools: (1) a basic demographic questionnaire, (2) the Mini-Mental State Examination (MMSE), (3) the 'Taiwan Scientific' Noninvasive Blood Pressure Meter (TS 0411), (4) the Perceived Stress Scale (PSS), (5) the Geriatric Depression Scale (GDS-15), and (6) the 5-item World Health Organization Well-Being Index (WHO-5). Data collection will span pre-, mid-, and post-intervention periods over 8 weeks for both experimental and control groups. The Efficacy of Horticultural Therapy Evaluation Form (EHTE) will also be used to conduct pre-test and post-test evaluations on the experimental group. Data will be analyzed using SPSS 27.0. Descriptive statistics will be applied to the demographic questionnaire data, while generalized estimating equations (GEE) will analyze pre-, mid-, and post-test questionnaire responses and objective measurements. Empirical evidence from this study will elucidate the impact of technology-assisted horticultural therapy on heart rate variability, stress, depression, and happiness among older adult residents in long-term care facilities. These findings will serve as a basis for developing health pro-motion programs aimed at enhancing the physical and mental well-being of aging populations.

Study Timeline

• Study Start: 2024-11-14
• Status Verified: 2025-01
• Study First Submitted: 2025-01-21
• Study First Submitted QC: 2025-01-21
• Last Update Submitted: 2025-01-21
• Study First Posted: 2025-01-28
• Last Update Posted: 2025-01-28
• Primary Completion: 2025-10-08
• Study Completion: 2026-10-08

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 76

Inclusion Criteria

1. Agree to participate in this study
2. Elderly persons aged 65 and above living in long-term care facilities
3. Live in long-term care facilities for at least three months
4. No gender restrictions
5. Be aware, able to communicate in Mandarin and Taiwanese, and be able to express opinions
6. The upper limbs can move freely and there is no disease that causes tremors in the hands (such as Parkinson's disease, hepatic encephalopathy, etc.)

Exclusion Criteria

1. Has participated in gardening-related activities within one month of receiving the case
2. Those diagnosed with terminal illness or whose health condition is rapidly deteriorating
3. Those suffering from Parkinson's disease, serious heart disease, dementia, mental illness (e.g. schizophrenia, bipolar disorder, etc.)
4. Mini-Mental State Examination (MMSE) with cognitive impairment (MMSE scores below 16 points for individuals with no formal education, below 21 points for those with elementary education, and below 24 points for those with junior high school education or higher.)
5. Those who are unable to participate in the event due to severe speech, vision or hearing impairment

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Heart Rate Variability, HRV	8 weeks after intervention (T2)	The most frequently used method for Autonomic Nervous System (ANS) test. Heart rate variability (HRV) represents total activity index of ANS; The higher the HRV, the better the ANS control.
Perceived Stress Scale, PSS	8 weeks after intervention (T2)	The total score serves as an overall indicator of stress levels. It demonstrates good internal reliability, with a Cronbach's alpha coefficient of 0.85. The scale comprises 14 items, the total score ranges from 0 to 56, with higher scores indicating greater perceived stress.
Geriatric Depression Scale, GDS-15	8 weeks after intervention (T2)	The Geriatric Depression Scale (GDS) is a widely used screening tool designed to identify depression in older adults. The GDS-15 has been translated and adapted for use in various cultural contexts, including Chinese-speaking populations. The scale demonstrated good reliability (Cronbach's α = .94). The total score ranging from 0 to 15. The higher scores indicate greater severity of depressive symptoms.
The 5-item World Health Organization Well-Being Index, WHO-5	8 weeks after intervention (T2)	The WHO-5 Well-Being Index is a brief, universally applicable global scale for measuring subjective well-being. The scale consists of five items, each scored from 0 to 5. The raw score ranges from 0 to 25, with higher scores indicating greater well-being. The raw score is often multiplied by 4 to convert it to a percentage scale ranging from 0 to 100.
The efficacy of horticultural therapy evaluation form; EHTE	8 weeks after intervention (T2)	The scale used to measure the well-being gained from horticultural therapy defines well-being as a state where an individual can demonstrate their abilities, cope with daily stress, be effective and productive at work, and contribute to society. The Cronbach's α value was 0.724, indicating good reliability. The total score ranging from 7 to 35. The higher the score and the larger the difference between pre- and post-tests, the greater the well-being gained by participants in the horticultural therapy.

Trial Locations

Locations (1)

National Taipei University of Nursing and Health Sciences; 🇨🇳 Taipei, Taiwan