Effects of nature-based group intervention on lonely older adults in assisted living facilities – RCT

Abstract Introduction Loneliness has adverse health and wellbeing effects even in long-term care settings. Nature contacts experienced with peers may reverse these harmful effects. The “Friends in Nature” (FIN) group intervention RCT for lonely older adults in Helsinki assisted living facilities (ALFs) aimed to explore the effects of nature-based experiences shared in peer groups on participants’ loneliness, health-related quality of life (HRQoL), cognition and nature connectedness. Methods Lonely participants were recruited from 22 ALFs in Helsinki metropolitan area, Finland, and randomised into two groups: 1) nature-based group intervention once a week for nine weeks (n = 162), and 2) usual care (n = 157). Demographics and diagnoses were retrieved from health records, and functioning, frailty, cognition, HRQoL, and loneliness were assessed. Primary trial outcomes were participants’ loneliness (modified De Jong Giervald Loneliness Scale=mDJGLS) and HRQoL (15D). Results Most participants (mean age 83 years, 73% women) were living with frailty (66%) and had dementia (55%). Whereas loneliness was reduced in the intervention group at three months (mean change -2.2 points (95% CI -3.5 to -0.9) in mDJGLS), it remained at the baseline level among the controls (mean change -0.1 (95% CI -1.4 to 0.9) (p = 0.025 between the groups). During the 6- and 12-months follow-up the difference was diluted. There was no difference between the groups in changes of HRQoL according to the 15D. However, the dimension “sleep” in 15D improved in the intervention group compared with the controls during 12-months follow-up. Cognition and nature connectedness also improved by Clock Drawing test and Nature Connection Index in the intervention group compared to the controls. The intervention participants doubled their time being outdoors compared to controls. Conclusions FIN intervention had several favourable effects in this physically and cognitively frail population of lonely older adults in ALFs. Key messages • Nature-based group intervention reduces loneliness among frail lonely older adults. • Nature-based group intervention improves executive function, sleep and nature connectedness.