Living for the city: Feasibility study of a dementia‐friendly care farm in an urban area

Letter to the Editor, Care farms for people living with dementia have become increasingly common worldwide. Care farms are a strength‐based, recovery‐oriented, and nature‐based activity that use a suburban farm environment. We recently reported the positive effects of a care farm located in Niigata Prefecture, Japan. Considering the population inflow to urban areas and rate of population aging in cities, implementation of care farms in an urban setting is a promising approach that has not yet been fully explored. This study aimed to examine the feasibility of an inclusive care farm program that brings people with dementia together with older people from diverse backgrounds in urban areas, which has not previously been implemented in Asia. In December 2020, a research team was launched in Tokyo that brought together community healthcare and welfare workers. We prepared a small block of land at the Volunteer Center, which is located in a former elementary school (see Figure 1). Various people were gathered through invitations from stakeholders and word of mouth. Soil preparation began in February 2021; a deserted flowerbed that was full of weeds and stones was transformed into a small farm. Gradually, local older adult residents and people with dementia began coming to the farm, planting vegetable seeds and seedlings, and enjoying the harvest. In addition, kindergarten children from the neighborhood came to watch the work and eat fresh tomatoes. Baseline and post‐surveys were conducted with 17 older adults who had participated in the care farm continuously for at least 6 months from February to December 2021. We used the Mini Mental State Examination (Japanese version; MMSE‐J), which has a cutoff score for dementia of 23/24. We also assessed self‐ perceived health, frequency of hobby activities, face‐to‐face interactions, indirect interpersonal interactions (e.g., telephone and letter interactions), the presence of depressive symptoms (by two question methods), and mental well‐being (using the World Health Organization‐Five Well‐Being Index) in which the cutoff score for depression is 12/13. Semi‐structured interviews were conducted for the post‐survey, in which participants were asked about what they liked about the care farm and any changes in themselves. Six stakeholders were asked about the effort expended in the care farm, positive aspects, and challenges. The data obtained were analyzed using thematic analysis. The study protocol was approved by the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology. Written informed consent was obtained from all participants. During the observation period, there were no injuries or accidents among care farm participants and the activities were conducted safely. Participants’ mean age was 78.4 � 6.0 years (range 68–87 years), and the mean MMSE‐J score was 25.1 � 4.2 (range 15–29), including five participants that scored <23. Over half of the participants were male (52.9%), 58.8% had farm work experience, and the mean number of times they participated in activities was 15.1 � 12.3 (range 3–46). The results of the Wilcoxon signed‐rank test revealed that the frequency of direct interpersonal interaction (p = 0.031), the frequency of indirect interpersonal interaction (p = 0.022), the presence of depressive symptoms by the two question methods (p = 0.046), and MMSE‐J scores (p = 0.006) were significantly improved at the post‐survey. In the interviews, participants made many comments related to the benefits of the farming work itself (e.g., it was inspiring to see the vegetables grow, it was rehabilitative to use one’s hands and feet) and interpersonal benefits (e.g., meeting new people, having fun chatting). In addition, all stakeholders reported that the farm activities were safe and the effort they expended was small. Good points that were raised by stakeholders included a renewed awareness of the need for a community space such as the care farm, a connection to the community, and a change in perspective when making care plans. Identified challenges included how to effectively attract participants and publicize activities, and how to recruit human resources to support people with dementia. These results suggest that care farm programs are feasible, even in urban areas, and may have positive impacts on participants’