Imagine yourself seated against a wall in a large impersonal room. Fluorescent fixtures reflect a cool white light off blank walls. Other people around you make disturbing noises—grunts, groans, and nonsense syllables. Expressionless, you sit glassy-eyed, transfixed on the opposite wall, where others are lined up returning your stare. Somewhere, a blaring television broadcasts Bob Barker, inviting the next contestant to "Come on down!" The noisy room remains mysterious, as hints of reality, memories, and emotions come and go in fits and spurts. You are an Alzheimer's patient—one of about four million with this progressive mind-robbing disorder.
Derek Kalp, a graduate student in landscape architecture, believes that better integrating the landscape into the design of nursing homes can influence such patients' moods and contribute to their overall well-being. In a preliminary study, Kalp is introducing a variety of bird feeders to a garden-like space adjacent to a nursing home's day room. "I want to see if the patients become more engaged and open their eyes to more things," Kalp says. "In this disease, anything like that is said to be beneficial."
Kalp became interested in Alzheimer's during a visit he took with other landscape architecture students to a state hospital. The group toured the geriatric unit, which included a day room. "There was a man who kept walking to the end of a short hallway in the room," Kalp remembers. "At the end of the hallway, there were locked doors with small windows at eye level. He would walk down to the end, rattle the bar, look through the window, then go back into the day room. A few minutes later he would do the same thing." This repetitious action, clinically called "wandering," is often a symptom of Alzheimer's patients, Kalp notes. "It was just heart-breaking. That really left an impression on me. He seemed to have this basic desire to get somewhere, but he just couldn't do it." Kalp hopes that seeing birds, as well as squirrels and small mammals, butterflies and other garden creatures might redirect such patients' attention, making repetitious behaviors less common.
"People have an intuitive belief that nature and outdoor environments are beneficial. We say things like, 'I need a breath of fresh air,' and, 'I need a walk,' " Kalp says. Although such comments are often said without much thought, scientific data supports the idea that contact with the outdoors is beneficial.
Researchers in British Columbia published a report in 1992 that showed a "direct relationship between the design and use of the outdoor environment of Alzheimer's facilities and the behavior and overall well-being of residents," Kalp says. The data revealed that "resident use of the outdoors greatly reduced the number of undesirable aggressive outbursts as well as resident falls." Other research by collaborators at Texas A&M University and the University of Delaware in 1991 showed that the influence of nature caused a more positively toned emotional state, positive changes in physiological activity levels, and an increased attention span.
Kalp will begin his research at a central Pennsylvania care facility, where he will observe the residents and interview family members and staff. Then he will change the landscaping adjacent to a day room and introduce bird feeders. "I will look at three factors: Do the patients look at the bird feeder? Do they attempt to talk about it? And do they relocate themselves to better view the feeder?"
Kalp's personal experience supports his hypothesis that an engaging outdoor environment will enrich Alzheimer's patients' lives. He and his wife often have trouble finding things to talk about when they go to visit his wife's grandmother, who suffers from Alzheimer's, he says. "In retrospect, the subject is often what was going on outdoors."
By bringing the random flight of wild birds to the sterile environment of a nursing home, Kalp hopes to replace a few blank stares with curious smiles.
Derek L. Kalp (email@example.com) is a master's degree student in landscape architecture in the College of Arts and Architecture. His adviser is Sidney Cohn, Ph.D., professor emeritus of urban design, College of Arts and Architecture, 204 Engineering Unit E, University Park, PA, 16802; 814-865-0876; firstname.lastname@example.org.