Concurrent Trials on Nature-Based Therapy for Inpatients in Dementia and Rehabilitation Medicine Wards (TGIF)

Changi General Hospital

Status: Not yet enrolling

Conditions: Acquired Brain Injury Including Stroke; Dementia

Treatments: Behavioral: Nature Immersion Therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT07059390

2025-032

Details and patient eligibility

About

Nature-based Therapy, such as forest bathing and horticultural therapy, has been shown to have physical, psychological and emotional health benefits. We posit that personalised and guided Nature-based Therapy, which leverages the benefits of therapeutic gardens in an urban hospital setting, improves the overall wellbeing of elderly inpatients with dementia (aged >65 years old) and their caregivers, as well as patients undergoing inpatient rehabilitation. To determine the effectiveness of Nature-based Therapy for these two inpatient populations, we designed a pilot study, TGIF, to be conducted at the dementia and rehabilitation medicine wards at Changi General Hospital in Singapore.

Full description

TGIF consists of two concurrent trials targeting two patient populations: elderly inpatients with dementia admitted to the dementia ward, and inpatients undergoing inpatient rehabilitation at the rehabilitation wards in a tertiary teaching hospital in Singapore. At the dementia wards, we aim to determine if Nature-based Therapy improved the neuropsychiatric symptoms such as agitation, restlessness and aggression among elderly inpatients living with cognitive impairment, defined as either delirium or dementia or both. Concurrent with the improved neuropsychiatric symptoms, the study team will also study the improved quality of life among the family, caregivers and hence reduced caregiver burden. At the rehabilitation medicine wards, we aim to determine if Nature-based Therapy improves mood, physical function, and quality of life.

Enrollment: 1,600 estimated patients

Sex: All

Ages: 21 to 100 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Patients with dementia:

1. Age 65-100 years old
2. Have a diagnosis of delirium/ dementia or both.
3. Have diagnosis of dementia with and without behavioural symptoms of dementia (BPSD)
4. Ability to communicate with the Nature-based Therapist (in languages such as English, Mandarin Chinese, Chinese dialects or Malay)
5. Manageable behavioural symptoms and able to focus attention for minimum of 30 minutes

Rehabilitation Medicine patients:

1. Age 21-100 years old
2. Acquired brain injury with residual impairments, which can be either in the i) motor, and/or ii) cognitive domains, and/or iii) suspected or diagnosed mood disorders (including adjustment disorder, depression and anxiety disorders) -patients would then be stratified according to the category(s) of impairments both for consideration of interventions and for outcome measures/analysis
3. Additional Physical/Cognitive Criteria required will depend on range of specific therapeutic activities that could be prescribed/administered (eg.at least 1 upper limb with Manual Muscle Testing (MMT) of at least 3/5, with ability for active grasp/release, ability to sustain attention for the duration of the session, cognitive Functional Independence Measure (FIM) score of at least 25 points etc)

Exclusion criteria

1. In isolation due to contact, droplet or airborne precautions
2. Unable to provide consent and lack of surrogate decision maker to provide consent
3. Poorly managed psychiatric or behaviour symptoms with threats to others surrounding them.
4. Age < 21 years
5. Patients who are haemodynamically unstable.
6. Patients on strict bed rest

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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1,600 participants in 4 patient groups

Dementia Patients - Intervention

Experimental group

Description:

Patients with dementia who undergo Nature Immersion Therapy

Treatment:

Behavioral: Nature Immersion Therapy

Dementia Patients - Control

No Intervention group

Description:

Patients with dementia who do not undergo Nature Immersion Therapy

Rehabilitation Patients - Intervention

Experimental group

Description:

Rehabilitation patients who undergo Nature Immersion Therapy

Treatment:

Behavioral: Nature Immersion Therapy

Rehabilitation Patients - Control

No Intervention group

Description:

Rehabilitation patients who do not undergo Nature Immersion Therapy