Ask an answerable question (PICO)：
Depression in older adults not only affects their functional abilities but can also lead to life-threatening conditions. Literature review found the gardening interventions can assist the significant improvements in cognition, physiology, psychology, and social well-being for older individuals. Therefore, this article aims to explore the evidence supporting the potential of Gardening Interventions in alleviating depressive symptoms in elderly patients with depression.
The Method and Analysis of Literature Review：
According to the three initial steps of the Evidence-Based Health Care (EBHC) framework, namely "asking," "acquiring," and "appraising," a PICO question was formulated. MeSH (Medical Subject Headings), natural language, and synonyms were employed to identify keywords: P (elderly patient with depression), I (gardening interventions), C (regular care) and O (depressive symptoms). Boolean logic (OR) was used to connect keywords, with intersection (AND) between PICO elements. The search was limited to systematic reviews and randomized controlled trial studies published between 2019 and 2023, resulting in the retrieval of 82 articles from PubMed (10), CINAHL (30), and Cochrane Library (42). After eliminating duplicates and articles not addressing the impact of gardening interventions on depressive symptoms in elderly depression patients, two articles were included for review.
Critical Appraisal：
The quality evaluation of the selected articles were conducted using the 2020 version of the Critical Appraisal Skill Program (CASP) "CASP Randomized Controlled Trials Checklist" and the 2018 version of the CASP "CASP Systematic Review Checklist." Document 1, a randomized controlled trial, involved participants aged 65 and older with depressive symptoms and mild memory impairment. They received Gardening Interventions lasting 60 to 90 minutes, 20 times a week, for six months, the results indicate that gardening intervention significantly improves depressive symptoms in elderly patients with depression. Using the 15-item geriatric depression scale (GDS-15) as an assessment tool, there was a significant decrease in scores (p <0.01). Document 2, a systematic review, included 13 randomized controlled trials targeting individuals aged 60 and above with depressive symptoms. The interventions consisted of gardening interventions activities lasting 60 to 90 minutes, 1 to 2 times a week, for 6 to 24 weeks, it shows that the level of depression in elderly patients who underwent gardening intervention is significantly lower than in elderly patients who did not receive gardening intervention（Hedge's g = -1.785， p < 0.001). Both evidence-based studies reported no adverse reactions to gardening interventions. According to Joanna Briggs Institute (JBI) levels of evidence (2014), one randomized controlled trial was classified as evidence level 1.c and recommended with strength A. The other one systematic review was categorized at the evidence level of 1.a and similarly received recommendation strength of A.
Results, Conclusions and Recommendations：
The selected literature reviews indicate that the application of gardening interventions can indeed effectively ameliorate depressive symptoms in the elderly, without adverse effects on elderly patient with depression. However, clinical implementation necessitates consideration of the location and type of gardening interventions, as well as factors such as planting space, material requirements, and the operation of hazardous equipment. These aspects should be taken into account for clinical reference and application.
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