While the relationship between landscape architecture and cardiac health may not be immediately obvious, there are important lessons that each discipline can learn from the other, especially when design supports diet and exercise.

There are many inherent challenges in long-term care environments that can benefit from this union.

For seniors moving to a new community, this is a time of many changes—physically, socially, and emotionally—that can affect their health. For example, moving to a smaller home often leads to less cooking, especially for those living alone. There may be less interest in meal planning, shopping, and food preparation. Meals become streamlined and centered on grains, simple proteins, and processed foods (which are generally high in sodium and fat), while vegetables, which generally require lengthier cooking times, tend to be skipped.

At the same time, there are physiological changes in aging that can diminish the sense of taste, and certain medications and nutrient deficiencies (e.g., zinc) can alter flavors. Shifts in agricultural practices have also resulted in food that really does taste different.


When a person has little interest in food, less food is consumed. There is a decrease in energy, less capacity for exercise, and less appetite, all resulting in even less interest in food and possible adverse effects on memory and mood. It’s a cycle that has profound implications for the total well-being of seniors.

And specifically, without a healthy diet, several risk factors for cardiovascular disease may emerge. The major ones are high blood pressure, high cholesterol, and diabetes.

 

Growing season
When considering how to promote healthy nutrition in senior living communities, the inclusion of a food-producing garden on the premises is the most direct way to provide fresh food to residents.

Most senior living communities have space to plant a garden—a simple 15-foot-by-30-foot rectangular space is sufficient area to grow up to 25 different kinds of vegetables throughout the growing season, which in the mid-Atlantic can support almost six months of harvest.

Plants in the garden should be inviting, relatively easy to grow, and supportive of nutritional goals for increased potassium, soluble fiber, vitamins, and color. These may include: carrots, beets, broccoli, spinach, radishes, cabbage, lettuce, Swiss chard, eggplant, parsley, basil, cauliflower, slicing tomatoes, cherry tomatoes, sweet peppers, bush beans, and pole beans. Fruits such as strawberries, blueberries, peaches, cherries, and apples can also be grown in or near the vegetable garden. Heirloom varieties of many vegetables may harbor special flavors that residents remember and may actually taste better than modern varieties.

Increasing potassium intake improves blood pressure. Chard, collards, kale, and beet greens are excellent sources of this mineral. The dark green color of these plants indicates that they’re rich in vitamin A, and they’re also great sources of folic acid and fiber. Increasing soluble fiber with sources such as eggplant, lima beans, okra, pears, or apples can lower “bad” or LDL cholesterol, a strategy that may allow some reduction in medications.

 

Fruits of labor
The garden may also provide activities that revolve around seasonal produce, foster community, and encourage residents to be engaged with the growing of the garden. In addition to the obvious physical benefits, these activities can improve social and emotional well-being, as well.

Early starts. Residents can be encouraged to develop interest in the garden with plants that germinate early in the spring. These include onions, radishes, beets, parsnips, and peas. Starting seeds inside not only gets the garden going earlier, but it’s a process that’s easy for residents to monitor and get excited about. Small pots in a central location make progress visible.

Recipes. Developing and distributing recipe cards featuring what’s currently fresh in the garden helps residents find new ways to prepare foods they may not be familiar with, or find new ways to prepare old favorites.

Outreach. Community outreach might include donations of extra harvest to local shelters or food banks to benefit families in the wider community that may not have access to fresh produce—programs that may give residents a renewed sense of purpose.

Food fun. Activities coordinated with the various harvests are as numerous as the foods themselves and can potentially spark some new interests. Apples can be picked for cider, blueberries can be gathered for pie making, ice cream can be made from any fresh fruit, and a sunflower seed harvest can feed the birds.

Social events. Resident cookouts and family gatherings can create a sense of community and encourage families to visit often, or stay longer. Vegetables on the grill stimulate the senses in obvious ways that encourage appetite and general interest in food.

Indoor benefits. Even in winter, elements of the garden produce beautiful berries, branches, and foliage. Creating a centerpiece featuring these elements can be a reason to take a short walk outside.

 

Maximizing the site
Outside of activities tied to garden plants and their uses, there are many ways a landscape can be a venue for health. Thoughtful arrangement of site elements such as walking paths, furniture, and stormwater facilities, for example, can have a big impact on the ability of residents to access and use the outdoors.

Every site is different, but all sites have opportunities, and looking at all elements on and around a site can provide clues about maximizing those opportunities.

For example, the benefits of walking are well-documented, improving bone density, reducing heart attack risk, and boosting general health. Introducing walking paths to the garden and outlying areas can supplement exercise and comes with social and emotional benefits.

By planting the right species in thoughtful locations, birds, butterflies, or small wildlife may animate the trail, not just visually but with sounds, such as the calls of frogs or geese marking the changing seasons. More purposeful activities could include walking a dog or feeding ducks. In an environment where there’s often not much for children to do during visits, this can be a way to occupy their time.

In urban settings, connecting to an existing sidewalk network can mean access to a bank, library, museum, or other local retail. Staying engaged in a neighborhood provides enormous emotional stability and sense of belonging.

Additionally, food can be easily incorporated into the wider landscape, not just the vegetable garden. Fruit-bearing trees and shrubs can replace more traditional landscape plants easily; where dogwoods or ornamental cherries might be considered, apple or pear trees could be substituted, and a blueberry patch along a woods edge could replace more commonly used flowering shrubs.

Herbs and spices are beautiful plants and can be included in an overall landscape plan. While a formal herb garden might feel intimidating as a high-maintenance element, herbs such as chives, thyme, oregano, or parsley can be tucked in with other more traditional plantings with little or no additional effort. Located near an entrance, these can be conveniently picked.

 

Seeds of design
Creating a heart-healthy garden and landscape ideally begins with the design and planning of the building, with the entire site seen as an opportunity for wellness. If a project involves a renovation or expansion rather than new construction, many of these opportunities still exist, and can give the facility a whole new look and purpose.

Start with a thoughtful site design. Consider all areas of the site as opportunities for people of all abilities to engage with the outdoors as much as possible. Consider everything as a potential amenity.

Provide easy access for residents and staff. Make the walk from the parking lot comfortable and pleasant. Provide sidewalks wide enough that two people can walk together. Distance markers can be reinforcing and help measure progress.

Focus on vegetation. Food plants aren’t just for the vegetable garden, so use whatever space is available to incorporate them. Include a plant palette that will provide all four seasons of interest, remembering that interesting elements include bark, fall color, and wildlife inhabitants, not just spring flowers.

Provide active and passive nature interactions. A vegetable garden can be a tool for physical therapy, social interaction, and stress relief, in addition to the healthy harvest it generates. But for some residents, sitting nearby may be the only way they can enjoy it. Provide seating accordingly.

Optimize views. Borrow a landscape whenever possible. Bring a pathway and seating to a great view where sunsets can be enjoyed, birds can be watched, or where children are playing at a school nearby.

Plan big but start small. Design your facility with as many opportunities as possible for residents and staff, but not everything has to be built at once. Budgets and interest may be incremental, so plan for a phased approach.

 

Food for thought
Access to good nutrition in ways that directly engage residents, staff, and families will improve heart health. Incorporating a vegetable garden can be so much more than the obvious source of fresh food, and the rest of the site can easily serve all manner of wellness activities, including social, emotional, and, of course, physical.

Regardless of the care level of your population—independent, assisted, or skilled—the concepts and activities outlined here will improve the healthcare environment for everyone.

This article has been derived from a presentation of the same title given at the 2012 Environments for Aging Conference in Orlando, Fla., in conjunction with Robin Spence, dietician for cardiovascular services at MedStar Union Memorial Hospital in Baltimore.

Lydia Kimball, PLA, LEED AP BD&C, is a principal with Mahan Rykiel Associates in Baltimore. She can be reached at lkimball@mahanrykiel.com.