How do nature-based interventions increase the resilience of older persons? A best fit framework synthesis

BACKGROUND: Nature-based interventions (NBIs) are currently gaining popularity as a non-medical approach in health promotion. Resilience is a logical target for this type of interventions aimed at older adults. While several recent frameworks describe resilience processes in older individuals, and others explain how nature-based interventions influence resilience in the general population, a framework addressing how nature-based interventions impact resilience specifically in older adults is, to our knowledge, still lacking. Furthermore, existing models give limited attention to contextual factors, the interaction between components and pathways, and the role of social processes. METHODS: In this review, we present a framework that illustrates how components of nature-based interventions interact and influence the resilience process in older adults. We used a best-fit framework synthesis approach, initially constructing an a priori model based on existing frameworks and refining it using evidence from a systematic review of primary research (PubMed, MEDLINE, Scopus and Web of Science). RESULTS: Our refined framework identifies four key considerations for designing and evaluating NBIs for older adults. First, it is essential to address the specific needs of older individuals when developing nature-based interventions. Second, although nature-based interventions often share similar components, their design creates varying contexts that influence outcomes. Third, positive affect and social processes act as central elements within the web of causal pathways. Fourth, effective facilitation and tailoring are crucial for optimizing intervention outcomes. CONCLUSION: Nature-based interventions hold significant potential as health promotion strategies to enhance resilience in older adults. However, their design must carefully consider the interplay between intervention components and contextual factors, as these interactions can lead to different outcomes for different individuals. CLINICAL TRIAL NUMBER: Not applicable.