Association between green space exposure and elderly health: a systematic review and meta-analysis

Abstract Background Exposure to green spaces is associated with many health benefits across various stages of life. However, no comprehensive synthesis currently exists to consolidate this evidence into a systematic body of knowledge that captures the overall impact of exposure to green space on the health of older adults. This systematic review seeks to address this gap by generating a thorough, integrated evidence base and offering valuable insights for future research directions and practical applications. Methods We adopted an extensive search strategy, drawing from multiple electronic databases as well as the National Institute for Health and Clinical Excellence (United Kingdom) and the Guidelines International Network. The electronic databases searched included the Cochrane Library, Medline, Embase, CINAHL, PubMed, Web of Science, Scopus, Global Health, and CNKI, using the PEOS search framework. The search encompassed publications from the inception of each database to November 2024. A total of 5,749 records were initially identified, and, following a dual-reviewer screening and selection process, 27 studies were ultimately included in the review. Results Exposure to green spaces was associated with effects on circulatory system disorders, mental health conditions, nervous system diseases, cognitive decline, metabolic disorders, and overall life satisfaction in older adults. Evidence regarding cardiovascular outcomes was mixed, with some studies indicating a U-shaped relationship for hypertension. Exposure to green space demonstrated a protective role against metabolic diseases and was positively associated with enhanced life satisfaction among older adults. Meta-analyses revealed that exposure to green space was associated with a lower risk of Alzheimer’s disease ( OR= 0.856, 95% CI: 0.769–0.943) and depression (OR= 0.724, 95% CI: 0.549–0.900). Conclusions This systematic review synthesizes the multifaceted health effects of green environments on ageing populations, critically evaluating empirical evidence on exposure to green space and health outcomes in older adults. The findings present a robust, evidence-based framework that underscores consistent associations between the accessibility and quality of green spaces and key indicators of geriatric health, thereby laying the groundwork for designing targeted, nature-based behavioral interventions. Trial registration PROSPERO (CRD42024619700).