Effectiveness of nature-based group intervention in loneliness and health-related quality-of-life in lonely older adults living in assisted living facilities-a randomised controlled trial.

INTRODUCTION

Nature experienced with peers may mitigate the harmful outcomes of loneliness on health and wellbeing. The H2020 RECETAS 'Friends in Nature (FiN)-Helsinki' group intervention for lonely older adults in Helsinki assisted living facilities (ALFs) aimed to investigate the effects on participants' loneliness and health-related quality of life (HRQoL). We also examined factors influencing effects between the intervention and the outcomes.

METHODS

Lonely participants were recruited from 22 ALFs in Helsinki area, Finland and randomised into two groups: (i) nature-based group intervention once a week for 9 weeks (n = 162) and (ii) usual care (n = 157). Loneliness (modified De Jong Gierveld Loneliness Scale = mDJGLS) and HRQoL (15D) were assessed as the primary outcomes at baseline, 3, 6 and 12 months.

RESULTS

Most participants (mean age 83 years, 73% women) were living with frailty (66%) and had dementia (55%). Whilst loneliness was reduced in the intervention group at three months (mean change -2.2 points [95% confidence interval (CI) -3.5 to -0.9] in mDJGLS, it remained at baseline level amongst controls (mean change -0.1 (95% CI -1.4 to 0.9); P = .025 between groups). During the 6- and 12-month follow-ups the difference was reduced. No difference emerged between groups in changes of HRQoL according to the 15D. However, the 'sleep' dimension in 15D improved in the intervention relative to controls during the 12-month follow-up. Frequent attendance in group sessions and extended time spent outdoors affected effects on both HRQoL and loneliness. High self-efficacy at baseline influenced effect on both HRQoL and mDJGLS. Being male, <85 years old, non-frail, having Mini-Mental-State Examination >20 and exhibiting a high Nature Connection Index at baseline influenced the magnitude of effect in reducing loneliness.

CONCLUSIONS

Group intervention with nature contacts had favourable effects on loneliness and sleep amongst physically and cognitively frail, lonely older adults in ALFs.

TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT05507684. Registration 19/08/2022.