Pilot Evaluation of Technology-enhanced Horticultural Activities Among the People With Dementia and Their Family Caregivers

Study Overview
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Brief Summary
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Horticultural therapy is one of the effective interventions for the person with dementia(PWD) which could increase their time engaging in leisure activities and decrease their time doing nothing. However, there are some limitations and constraints for PWD to participate in the horticultural therapy especially in the high-density cities (e.g. Hong Kong). This study aims to investigate the feasibility and preliminary effects of adopting home-based technology-enhanced horticultural activities. The program will consist of three face-to-face (F-T-F) horticultural activity training session for a group of 6-8 participants and then biweekly telephone follow-up for 8-week home-based horticultural intervention. Program evaluation will be conducted through focus groups with 15 participants with different levels of stress reduction after the intervention. It is hypothesized that the PWD and their caregiver will have a significant improvement in the cognitive function and behavioral symptoms of the PWD, an increase in the positive caregiving experience in the family caregivers, a reduction of the caregivers' level of stress and depressive symptoms, and enhancement of the quality of life of the family caregivers after the intervention.

Detailed Description
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Objective This study aims to investigate the feasibility and preliminary effects of adopting home-based technology-enhanced horticultural activities to: a) improve the cognitive function and behavioral symptoms of the PWD; b) promote the positive caregiving experience in the family caregivers; c) reduce the caregivers' level of stress and depressive symptoms; and d) improve the quality of life of the family caregivers. To the best of our knowledge, it is the first program adopting Smart Grower for horticultural intervention among the PWD and their family caregivers in Hong Kong. Method The home-based technology-enhanced horticultural activities will be delivered for the people with dementia and their family caregivers through a smart grower. The smart grower is a hydroponic indoor grower that builds a controllable environment with auto optimization for growing healthy plants, fresh vegetables, herbs, and fruits. A mobile app will be connected to the grower for controlling the growing environment (e.g. lighting, watering), tracking the progress of the plants, guiding the older people with dementia and their family caregiver to conduct the horticulture activities. The program will consist of three face-to-face (F-T-F) horticultural activity training session for a group of 6-8 participants and then biweekly telephone follow-up for 8-week home-based horticultural intervention. The home-based program contains different horticultural, cognitive and multisensory stimulation activities such asking the PWD and the family caregiver to record the sense of touch and odor when taking care of the plant and the various changes of the plants by using the smart grower. Program evaluation will be conducted through focus groups with 15 participants with different levels of stress reduction after the intervention. The aims of the focus groups is to identify the strengths, limitations, and difficulties of the home-based technology-enhanced horticultural program. Significance and Value In this project, we would like to collaborate with the elderly center to deliver the technology-enhanced horticultural activities for PWD in the community and make this program sustainable in the community. Meanwhile, we will collect the users' feedback and further modify the program to fit the needs of the people with dementia and the family caregivers. In the future, we hope that the program will not only benefit the community-dwelling older people but also those receiving service in the respite center, day care center, hospice and nursing home as they are also facing the challenges of manpower shortage, issues of loneness and poor psychological health. We will base on the data and results collected from this proposed study and further revise the program and software for servicing the older people in nursing through a group-based approach.

Official Title
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Pilot Evaluation of Technology-enhanced Horticultural Activities Among the People With Dementia and Their Family Caregivers

Conditions
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Dementia

Intervention / Treatment
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* Device: The Aspara @ smart grower


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The PWD Aged 65 or above who had been diagnosed with any type of dementia at the early to moderate stage Are Community-dwelling (i.e., non-institutionalized), Are Able to understand Cantonese and follow simple instruction The family caregivers Aged 18 years or above; the blood or by-marriage relatives (e.g. spouses, siblings, children, and grandchildren) of a person who has been clinically diagnosed with dementia, regardless of its types and these relatives are taking up the caring responsibilities ranging from physical aids to emotional supports, in the form of transportation, financial assistance, personal hygiene, and decision-making.; Providing most of the daily care and support for PWD (daily contact for at least four hours); and Able to speak Cantonese Exclusion Criteria: The PWD and the family caregivers Are diagnosed with a mental disorder such as bipolar disorder, schizophrenia, dementia, or depression; and/or, Are taking anticonvulsants, or any kind of psychotropic drugs, and/or identified with a self-reported suicidal thought or drug abuse in the past 6 months.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention Arm<br>The program will consist of three face-to-face (F-T-F) horticultural activity training session for a group of 6-8 participants and then biweekly telephone follow-up for 8-week home-based horticultural intervention. | Device: The Aspara @ smart grower<br>* The program will consist of three face-to-face (F-T-F) horticultural activity training session for a group of 6-8 participants and then biweekly telephone follow-up for 8-week home-based horticultural intervention. The home-based program contains different horticultural, cognitive and multisensory stimulation activities such asking the PWD and the family caregiver to record the sense of touch and odor when taking care of the plant and the various changes of the plants by using the smart grower. Program evaluation will be conducted through focus groups with 15 participants with different levels of stress reduction after the intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Chinese version of Positive Aspect of Caregiving scale (PAC) | The PAC scale demonstrates the acceptable levels of internal consistency Cronbach's alpha 0.85 among the family caregivers of PWD in Hong Kong. Higher scores indicating more positive self-perceptions of caregiving. Comparisons of changes of Positive Aspect of Caregiving scale (PAC)will be considered as follows: T0 - T1 | At baseline (T0) and 11th week (immediately post- intervention; T1 | 
| The Chinese version of Perceived Stress Scale (PSS) | Perceived Stress Scale contains 10 items with 5-point Likert-type scale rating from 0 (never) to 4 (very often). The total score can range from 0 to 40 with higher scores indicating higher perceived stress. Comparisons of changes of Perceived Stress Scale will be considered as follows: T0 - T1 | At baseline (T0) and 11th week (immediately post- intervention; T1 | 
| The WHOQOL-OLD BREF (HK) | The WHOQOL-OLD BREF (HK) comprised 28 items and each item is rated on a 5-point Likert-type scale that ranged from 1 (very dissatisfied) to 5 (very satisfied), with a higher score indicating a better QoL. Comparisons of changes of The WHOQOL-OLD BREF (HK) will be considered as follows: T0 - T1 | At baseline (T0) and 11th week (immediately post- intervention; T1 | 
| The Chinese version of Center for Epidemiological Studies Depression scale(CESDS) | The Chinese version of Center for Epidemiological Studies Depression scale is a self-reported measure of depression containing 20 items. Comparisons of changes of Center for Epidemiological Studies Depression scale will be considered as follows: T0 - T1 | At baseline (T0) and 11th week (immediately post- intervention; T1 | 
| MoCA-5-min | MoCA-5-min assess participants' cognitive function over the telephone. MoCA-5-min comprises four domains: attention, executive function/language, orientation, and memory.Comparisons of changes of MoCA-5-min will be considered as follows: T0 - T1 | At baseline (T0) and 11th week (immediately post- intervention; T1 | 
| The Chinese version of the Neuropsychiatric Inventory-Questionnaire (NPI-Q) | The Neuropsychiatric Inventory-Questionnaire evaluates the frequency, severity, and caregiver distress of 12 neuropsychiatric symptoms by using a 5-point rating scale..Comparisons of changes of the Neuropsychiatric Inventory-Questionnaire will be considered as follows: T0 - T1 | At baseline (T0) and 11th week (immediately post- intervention; T1 |