Health-Promoting Design of Residential Care Facilities: Enhancing Nature Connection to Influence Modifiable Risk Factors Associated with Depression

This study examines how building design can enhance residents’ connection with nature in residential care facilities and synthesises existing evidence on their associations with depression. Guided by the Biophilic Design framework, the research explores direct, indirect, and virtual interactions with nature within built environments. A meta-analysis and systematic review of 51 peer-reviewed studies, conducted in accordance with PRISMA guidelines, integrated quantitative and qualitative evidence to identify nature-connected design features linked with reduced depression and its related risk factors, including agitation, loneliness, reduced autonomy, physical inactivity, and sleep disturbance. The analysis utilised the Pathway Domains Framework to examine how biophilic features of the built environment influence these outcomes via interconnected mechanisms: 1) Mitigation (reducing environmental stressors), 2) Restoration (supporting mood and attentional recovery), and 3) Instoration (building autonomy, purpose, and social connection). By applying these pathways to design evidence for the first time, the study identified the specific mechanisms linking socio-spatial design to health outcomes and developed a conceptual framework to guide evidence-based, health-promoting residential care facility design that may influence dementia risk or its progression over time.