The therapeutic role of natural environments for aging populations in East Asian residential care during and following the COVID-19 crisis

The COVID-19 pandemic profoundly impacted long-term care facilities (LTCFs) for older adults in East Asia, where spatial constraints of high-density urban environments intersect with rapidly aging populations and cultural expectations around family-based care. Urbanisation and modernisation have disrupted traditional familial structures, increasing reliance on formal care services. The pandemic exposed vulnerabilities in these facilities, leading to high morbidity and mortality among residents. Resultant social isolation and mental health challenges highlighted the urgent need for effective wellbeing interventions for residents who spend most of their time indoors with limited nature access due to mobility and cognitive disabilities. This narrative review examines the restorative potential of nature-based design interventions adapted to these challenging contexts. Synthesising peer-reviewed literature across environmental psychology, gerontology and architecture, the review integrates theoretical frameworks with illustrative case examples of nature-based interventions. Evidence from case examples suggests that even small-scale nature integrations (indoor plants, greenery views) can reduce agitation and loneliness among LTCF residents, while virtual reality nature provides accessible alternatives for bedbound individuals. Culturally tailored designs drawing on Japanese Zen gardens, Chinese classical garden principles and Singapore’s therapeutic garden models may foster emotional connection and cultural continuity. However, rigorous empirical evaluation in East Asian LTCF settings remains limited, with the evidence base predominantly Western. The paper critically assesses opportunities and challenges for reintegrating nature into post-pandemic care, emphasising context-sensitive solutions including regulatory reform, targeted funding for space-optimised interventions, staff training in nature-based therapy and community integration models. Without coordinated action across policy, practice and research sectors, residents in resource-limited urban LTCFs will continue to lack access to nature’s therapeutic benefits.