Effectiveness of green health prescribing and nature-based interventions in primary care and community setting for older adults – A systematic review

Background Green Health Prescribing involves health and care professionals recommending structured, nature-based activities, 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 globally. Methods A systematic review was conducted of intervention studies reporting quantitative outcomes of nature-based interventions for adults aged 50 years and over in primary or community care settings. Eligible designs included randomised trials, comparative studies, 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. PPIE and poviders input informed the design and interpretation of findings. Results Twenty-one studies, including 11 randomised trials, evaluated a range of interventions among older adults living in the community or in residential care. Interventions included nature-based therapies, exercise in green spaces, indoor gardening, and horticultural therapy. Many studies reported improvements in at least one 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 due to 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. Because of the continued policy priority and funding for green space prescribing, there is a clear need for high-quality, pragmatic trials and implementation studies, particularly among older adults with limited access to green spaces, to better assess health outcomes and cost-effectiveness in primary and community care. Systematic review registration CRD42025603199