园艺疗法对痴呆症老年患者干预效果的荟萃（Meta）分析

A Meta-Analysis of the Intervention Effects of Horticultural Therapy on Elderly Patients with Dementia

摘要

【目的】本研究旨在厘清园艺疗法对痴呆症老年患者不同评价维度干预效果的确切影响，并系统分析患者基本情况与干预方案特征所导致的异质性效果，以识别关键维度，从而为制定精准化干预方案提供循证依据。【方法】采用系统文献综述法，参考系统综述和荟萃分析首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南，最终纳入16篇文献，并使用R 4.5.2软件中的Meta包进行荟萃（Meta）分析、敏感性分析和偏倚风险评估。【结果】对评估指标进行归纳，将园艺疗法对痴呆症患者的干预效果系统性地整合为认知功能、心理健康和生理健康3个维度。亚组分析显示，对于中度神经认知障碍阶段患者，每周干预4~5次、室外及虚拟现实（virtual reality, VR）训练的园艺活动效果更优；盆栽种植干预效果强且稳定。敏感性分析证实结果稳健，发表偏倚校正后效应量呈中等正向效应。【结论】系统评估表明，园艺疗法能够改善痴呆症老年患者的认知功能、心理及生理健康。对于中度神经认知障碍阶段患者，在长期照护环境、高频率干预及室外园艺活动场景下，干预效果可能更为显著。本研究系统阐明了园艺疗法对痴呆症老年患者各维度的疗效特征，为后续制定分层化、个体化干预策略提供了坚实的循证支持。

Abstract

[Objective] Horticultural therapy is an important non-pharmacological intervention for dementia, but its impact on different evaluation dimensions remains to be clarified. This paper systematically summarizes the dimensions of the impact of horticultural therapy on patients with dementia, analyzes the heterogeneity of the intervention effects of patients’ basic characteristics and intervention program features, identifies the key modulating factors for optimizing intervention effects, and provides evidence-based support for the formulation of precise intervention programs. [Methods] This paper adopts a systematic literature review method, referring to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) framework, and collects and analyzes literature from multiple disciplines such as medicine, environmental science, and landscape architecture. Seven databases, including CNKI, Wanfang Data Knowledge Service Platform, SinoMed, Web of Science, PubMed, Embase, and Cochrane Library, were searched from the establishment of the databases until December 31, 2025. Data analysis was conducted using the Meta package in R 4.5.2 software, and subgroup analysis was performed based on pre-specified factors such as patients’ basic conditions and intervention program features. The stability of this study was evaluated through sensitivity analysis, and publication bias was tested using Egger’s test and funnel plots. [Results] After strict screening according to the pre-specified inclusion and exclusion criteria, 16 articles that met the requirements of this study were selected for meta-analysis, involving a total of 1,278 research subjects. The included literature covered more than 40 measurement scales and assessment indicators in areas such as physical function, biomarkers, neuropsychology, mental behavior, and quality of life. By summarizing indicators that reflect the same or highly related aspects, they can be systematically integrated into three dimensions: cognitive function, mental health, and physical health. Cognitive assessment covers screening, domain-specific, and quality of life impact; physical health evaluation integrates physical function, physiological systems, and daily activity ability; mental health assessment includes emotional disorders, mental behavior symptoms, and social psychological functioning. Subgroup analysis was conducted based on the sources of heterogeneity between studies, comprehensively considering patients’ basic conditions and intervention program features. Among them, patients’ basic conditions include three-dimensional factors such as disease stage, years of education, and intervention site. The effects of horticultural therapy vary in different disease stages, patients’ years of education, and intervention sites. The effect is most significant and the evidence is robust in the moderate disease stage (d_sm=0.68), similar but with heterogeneity in the mild stage, and weaker in the delirium stage; patients with the lowest years of education (<7) benefit the most (d_sm=0.82), while a “plateau effect” occurs in higher years of education; the effect is optimal and stable in long-term care institutions (d_sm=0.80), moderate to high in the community, and similar but with higher heterogeneity in hospitals, and the conclusions need further verification; intervention program features include four-dimensional factors such as intervention period, intervention frequency, intervention duration, and intervention method. The effect is the greatest in long-term intervention periods (≥32 weeks) but the evidence is inconsistent (d_sm=0.83); intervention frequency is significantly positively correlated with efficacy, with 4 to 5 times per week being the best (d _sm=0.99); intervention duration shows a negative correlation trend with effect, with ≤30 minutes being the most significant (d_sm=0.97), but the sample size is limited; among intervention methods, VR horticultural therapy has the highest effect size (d_sm=0.72), but there are few studies; outdoor horticultural therapy has the most stable effect (d_sm=0.62), and indoor horticultural therapy has higher heterogeneity. [Conclusion] Systematic reviews reveal that horticultural therapy demonstrates positive effects across three dimensions: cognitive function, mental health, and physical health. Cognitively, multisensory stimulation activates the brainstem reticular formation, enhancing attention, memory, and executive function. Psychologically, it effectively alleviates depression and anxiety, and reduces stress levels. Physiologically, it improves hand-eye coordination, muscle strength, sleep quality, and immune function. Although the overall effect is relatively small, it is statistically significant. In terms of application characteristics, patients in the moderate stage benefit the most, those with low educational levels have the greatest marginal benefit, and long-term care institutions and community settings are more effective than hospitals. Regarding intervention programs, long-term and high-frequency interventions are more effective; outdoor real environments are superior to virtual or indoor environments; and mid-term interventions strike a balance between novelty and adaptability. This study provides empirical support for non-pharmacological interventions. Horticultural therapy, with its low risk, high acceptability, and multiple benefits, is of great significance in the context of an aging population. Future research should conduct more rigorous large-sample, long-term studies to deeply analyze the effects of patient characteristics and intervention elements on therapeutic effects, providing a more solid evidence base for optimizing clinical applications.

关键词

老年医学 / 康复医学 / 痴呆症 / 园艺疗法 / 认知功能 / 心理健康 / 生理健康 / 系统评价

Key words

geriatrics / rehabilitation medicine / dementia / horticultural therapy / cognitive function / mental health / physical health / systematic review

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基金资助

国家心理健康和精神卫生防治中心“我国当代心理健康问题多学科融合防治策略”课题研究一般支持课题“基于自然干预的城市社区嵌入式老年心理健康服务体系研究”(GXDXK2025B-19)