Health outcomes and design elements of dementia-friendly gardens: A narrative review

As the global population ages, the prevalence of older adults with dementia continues to rise, and non-pharmacological interventions for this population are receiving increasing attention. The existing literature suggests that garden environments may influence patients' well-being and health outcomes through various mechanisms, but their actual effectiveness depends on appropriate design and use. This narrative review aims to systematically synthesize the published evidence, focusing on the potential health benefits of gardens for older adults with dementia, and to identify garden design elements that are beneficial to this population. This study searched six databases (Cochrane Library, Web of Science, PubMed, Embase, CNKI, and Wanfang Data) in October 2025. 10 studies were analyzed. Using thematic synthesis, we grouped the findings into two overarching themes: (1) the multidimensional impacts of gardens on older adults with dementia, and (2) the essential design attributes of dementia-friendly gardens. Preliminary evidence suggests that gardens may offer multiple benefits to older adults with dementia on physiological, psychological, and social levels, including improvements in abnormal behaviors and negative emotions, a potential association with the delay of cognitive decline, and an enhanced sense of self-identity. Regarding design elements, existing evidence suggests that garden size, location, plant species and combination, spatial openness, and supporting facilities may all influence the effectiveness of garden use; specific design considerations should be tailored to the characteristics of the care recipients and the care objectives. This review included a limited number of studies and exhibited considerable heterogeneity; the findings require confirmation through higher-quality prospective studies.