Effectiveness of green health prescribing and nature-based interventions in primary care and community settings for older adults: a systematic review of health, wellbeing and social outcomes.

Abstract

Background: Green Health Prescribing involves health and care professionals prescribing structured, nature-based interventions, such as gardening, walking in green spaces, or cultural activities outdoors. With population ageing and increasing pressure on healthcare systems, Green Health Prescribing has been proposed as a potentially cost-effective approach to support healthy ageing in older adults with long-term conditions. This review summarises evidence on the effectiveness of Green Health Prescribing and related nature-based interventions for older adults.

Methods: A systematic review was conducted of intervention studies reporting the effectiveness of Green Health Prescribing and nature-based interventions for adults aged 50 years and over in primary or community care settings. Eligible designs included randomised trials, other comparative designs, and before-after studies. Searches up to October 2024 were performed in major medical, psychological, social science, and environmental databases, alongside grey literature sources. Study selection, data extraction, and quality appraisal were undertaken independently by at least two reviewers. Quantitative findings were synthesised narratively using a Grading of Recommendations, Assessment, Development and Evaluation-informed approach, with reporting guided by established systematic review standards. Patient and provider input informed the design and interpretation of findings.

Results: Twenty-one studies, including 11 randomised trials, evaluated interventions among older adults living in the community or residential care. Interventions included activities in nature, exercise in green spaces, indoor gardening, and horticultural therapy. Many studies reported improvements in at least one health or wellbeing outcome; however, statistically significant effects compared with control conditions were uncommon. Evidence suggested potential benefits for quality of life, mental health, physical function, fatigue, loneliness, and social connectedness, but findings were inconsistent. Overall certainty of evidence was low or very low, largely because of small sample sizes, risk of bias, and limited replication across outcomes.

Conclusions: Evidence supporting the effectiveness of Green Health Prescribing and nature-based interventions for older adults remains limited. Given continued policy priority and funding for green space prescribing, high-quality pragmatic trials and implementation studies are needed, particularly among older adults, to robustly assess health outcomes, cost-effectiveness, and healthcare resource use in routine practice for Green Health Prescribing as a referral option in primary and community care.

Systematic review registration: CRD42025603199.