{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:41:54Z","timestamp":1791477714751,"version":"4.3.4"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nature experienced with peers may mitigate the harmful outcomes of loneliness on health and wellbeing. The H2020 RECETAS \u2018Friends in Nature (FiN)-Helsinki\u2019 group intervention for lonely older adults in Helsinki assisted living facilities (ALFs) aimed to investigate the effects on participants\u2019 loneliness and health-related quality of life (HRQoL). We also examined factors influencing effects between the intervention and the outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2009=\u2009162) and (ii) usual care (n\u2009=\u2009157). Loneliness (modified De Jong Gierveld Loneliness Scale\u2009=\u2009mDJGLS) and HRQoL (15D) were assessed as the primary outcomes at baseline, 3, 6 and 12\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most participants (mean age 83\u00a0years, 73% women) were living with frailty (66%) and had dementia (55%). Whilst loneliness was reduced in the intervention group at three months (mean change \u22122.2 points [95% confidence interval (CI) \u22123.5 to \u22120.9] in mDJGLS, it remained at baseline level amongst controls (mean change \u22120.1 (95% CI \u22121.4 to 0.9); P\u2009=\u2009.025 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 \u2018sleep\u2019 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, &amp;lt;85\u00a0years old, non-frail, having Mini-Mental-State Examination &amp;gt;20 and exhibiting a high Nature Connection Index at baseline influenced the magnitude of effect in reducing loneliness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Group intervention with nature contacts had favourable effects on loneliness and sleep amongst physically and cognitively frail, lonely older adults in ALFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, ID: NCT05507684. Registration 19\/08\/2022.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afag009","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T12:30:10Z","timestamp":1768912210000},"source":"Crossref","is-referenced-by-count":6,"title":["Effectiveness of nature-based group intervention in loneliness and health-related quality-of-life in lonely older adults living in assisted living facilities\u2014a randomised controlled trial"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9659-6985","authenticated-orcid":false,"given":"Kaisu H","family":"Pitk\u00e4l\u00e4","sequence":"first","affiliation":[{"name":"Department of General Practice and Primary Healthcare, University of Helsinki , Helsinki, Uusimaa ,","place":["Finland"]},{"name":"Unit of Primary Care, Helsinki University Central Hospital , Helsinki, Uusimaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rautiainen","sequence":"additional","affiliation":[{"name":"Department of General Practice and Primary Healthcare, University of Helsinki , Helsinki, Uusimaa ,","place":["Finland"]},{"name":"Finnish Association for the Welfare of the Older People , Helsinki, Uusimaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannu","family":"Kautiainen","sequence":"additional","affiliation":[{"name":"Department of General Practice and Primary Healthcare, University of Helsinki , Helsinki, Uusimaa ,","place":["Finland"]},{"name":"Unit of Primary Care, Helsinki University Central Hospital , Helsinki, Uusimaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulla L","family":"Aalto","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Helsinki University Hospital and University of Helsinki , Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Kolster","sequence":"additional","affiliation":[{"name":"Department of General Practice and Primary Healthcare, University of Helsinki , Helsinki, Uusimaa ,","place":["Finland"]},{"name":"Health Services, Western Uusimaa Wellbeing Services County , Espoo, Uusimaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marja-Liisa","family":"Laakkonen","sequence":"additional","affiliation":[{"name":"Department of General Practice and Primary Healthcare, University of Helsinki , Helsinki, Uusimaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1951-2455","authenticated-orcid":false,"given":"Timo","family":"Partonen","sequence":"additional","affiliation":[{"name":"Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare , Helsinki, Uusimaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna-Maria","family":"Roitto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Clinicum, University of Helsinki , Helsinki, Uusimaa ,","place":["Finland"]},{"name":"Department of Geriatrics, HUS Helsinki University Hospital , Helsinki, Uusimaa ,","place":["Finland"]},{"name":"Department of Public Health, Finnish Institute for Health and Welfare , Helsinki, Uusimaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibylle","family":"Puntscher","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL, University for Health Sciences and Technology , Hall in Tirol, Tirol ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Rochau","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL, University for Health Sciences and Technology , Hall in Tirol, Tirol ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6425-7671","authenticated-orcid":false,"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL, University for Health Sciences and Technology , Hall in Tirol, Tirol ,","place":["Austria"]},{"name":"Departments of Epidemiology and Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science , Boston, Massachusetts ,","place":["USA"]},{"name":"Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alzbeta","family":"Bartova","sequence":"additional","affiliation":[{"name":"Centre of Expertise in Longevity and Long-Term Care, Charles University, Faculty of Humanities , Prague ,","place":["Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iva","family":"Holmerov\u00e1","sequence":"additional","affiliation":[{"name":"Centre of Gerontology, Centre of Expertise in Longevity and Long-Term Care, Charles University, Faculty of Humanities , Prague ,","place":["Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Coll-Planas","sequence":"additional","affiliation":[{"name":"Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences, University of Vic, Central University of Catalonia, Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research , Vic, Catalunya ,","place":["Spain"]},{"name":"Institute for Research and Innovation in Life Sciences and Health in Central Catalonia , Vic, Catalonia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill S","family":"Litt","sequence":"additional","affiliation":[{"name":"Barcelona Institute for Global Health (ISGlobal) , Barcelona ,","place":["Spain"]},{"name":"Universitat Pompeu Fabra , Barcelona ,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red (CIBER) Epidemiolog\u00eda y Salud P\u00fablica , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Strandberg","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Helsinki , Haartmaninkatu 4 Helsinki, Helsinki, Uusimaa 00029 ,","place":["Finland"]},{"name":"Department of Geriatrics, HUS Helsinki University Hospital , Helsinki, Uusimaa ,","place":["Finland"]},{"name":"Centre for Life Course Research\/Geriatrics, University of Oulu , Oulu, Pohjois-Pohjanmaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu H","family":"Jansson","sequence":"additional","affiliation":[{"name":"Department of General Practice and Primary Healthcare, University of Helsinki , Helsinki, Uusimaa ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"2026020419011025400_ref1","volume-title":"The Social World of Older People. 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