Table 1.

Characteristics of eligible qualitative studies or mixed-methods studies on the association between social connectedness and health outcomes among older adults living in nursing homes or assisted living facilities

(Author, Year) Method Location (Year data collected)	Objective	# of Residents and Description	Sample Description % Female Age (years) % Race/Ethnicity % Marital status	Main Findings
Qualitative studies
(Adra et al., 2015) Descriptive, exploratory Lebanon (2010 to 2011)	Explore the perspectives of quality of life for older residents, care staff, and family	Design: Semi-structured interviews Participants: 20 residents living in 2 nursing homes, 11 caregivers, and 8 family members	Residents: Female: 55.0% Age (Range: 65-91): 73.7 Race/ethnicity not reported. Marital status not reported.	Findings from residents: Maintaining family connectedness and maintaining and developing significant relationships contributed to quality of life. Conversations with family/friends were meaningful. Close bonds with others in the home created a feeling of continuity between past and present circumstances. Inadequate staffing/workload prevented more meaningful interactions between residents and staff.
(Bergland & Kirkevold, 2006) Descriptive, exploratory Norway (Dates of data collection not reported.)	Investigate mentally lucid residents’ perspective on what contributes to thriving in a nursing home	Design: Open-ended interviews and field observations Participants: 26 residents living in 2 nursing homes 16 residents included in the field observation	Female: 76.9% Women Age: 89.5 (Range: 74 to 103) Men Age: 89.0 (Range: 81 to 99) Race/ethnicity not reported. Marital status not reported.	The innermost core aspect was mental attitude towards living in a nursing home. Essential to thriving was the quality of care and caregivers. Two of the five additional aspects contributing to thriving were positive relationships with peers and family but were not considered to be the core aspect contributing to thriving.
(Bergland & Kirkevold, 2007) Descriptive, exploratory Norway (Dates of data collection not reported.)	Describe nursing home residents’ perceptions of the significance of relationships with peer residents to thriving	Design: Open-ended interviews and field observations Participants: 26 residents living in 2 nursing homes 16 residents field observation	Female: 76.9% Age: 89.4 (Range: 74 to 103) Race/ethnicity not reported. Marital status not reported.	Personal relationships with peer residents were not essential to thriving. The expectations, wishes, and capacity to interact with other residents varied, as did the importance of these relationships to thriving. Caregivers have a major impact on whether and how social encounters and interactions develop into positive relationships that contributed to thriving. Participating in activities did not help them form relationships that contributed to thriving.
(E. Cho et al., 2017) Descriptive with thematic analysis South Korea (2015)	Explore older adults’ perceptions of daily lives in nursing homes	Design: Semi-structured interviews Participants: 21 older adults with normal cognitive function living in 5 nursing homes	Women: 85.7% Age: 83.6±7.1 Race/ethnicity not reported. Marital status not reported.	One of five themes that emerged related to residents’ desire for meaningful interpersonal relationships was to improve their quality of life. Some reported that difficulty ambulating and living with others who have cognitive impairment made it difficult to develop personal relationships.
(Kaelen et al., 2021) Thematic content analysis Belgium (2020)	Understand psychosocial and mental health needs of nursing home residents during COVID-19	Design: Semi-structured interviews with residents Focus groups with direct care staff Participants: 56 residents living in 8 nursing homes without severe cognitive impairment	Women: 62.5% Age (Range: 58 to 101): <79: 34.0% 80-89: 37.5% >90: 28.6% Race/ethnicity not reported. Marital status not reported.	Residents reported losing their social connections both inside and outside of the nursing homes, with uncertainty about when their social life could resume. Some residents reported cognitive and physical decline, symptoms of depression, and suicidal ideation as a result.
(Leung et al., 2004) Exploratory Taiwan (Dates of data collection not reported.)	Compare components of quality of life among older nursing home residents to those living in the community	Design: 4 focus groups (2 groups of men from nursing homes, 2 groups of women from nursing homes) 2 focus groups from community (1 with men only, 1 with women only) Participants: 28 older nursing home residents 16 community-dwelling older adults	Women: 50.0% Age: 75.4±5.7 Race/ethnicity not reported. Marital status not reported.	Of six dimensions identified, one was related to social function. Within the social function domain, domains included: connectedness, exercise and leisure activities, social activities, and services. Regardless of setting, older adults noted that social connections with people (especially spouse, children, grandchildren) and society is important and that social activities are sources of self-efficacy. For those living in nursing homes, friendship and kinship were emphasized, as was self-needs whereas for community-dwelling older adults, relationships with family and family needs were emphasized.
(Moyle et al., 2011) Exploratory New South Wales and Queensland Australia (Dates of data collection not reported.)	Understand factors that influence quality of life for people living with dementia in long-term care	Design: Semi-structured interviews Participants: 32 residents living in 4 long-term care facilities, aged ≥65 years with dementia	Women: 68.8% Age group: 70-79: 9.4% 80-89: 78.1% ≥ 90: 12.5% Race/ethnicity not reported. Married: 37.5% Widowed: 56.3% Single/Divorced: 6.2%	Connections to family: Residents noted the importance of being with family and the opportunities this provided for meaningful conversations (e.g., recall previous memories, link them to the community). Family involvement improved their quality of life. Connections to staff: When family and friends no longer visited, some residents looked towards staff for companionship. But staff did not fulfil residents’ emotional needs and were too busy doing their jobs. Connections with other people (residents): Connections with other residents were important for quality of life. Limited relationships were blamed on others not reaching out (rather than under the control of the residents themselves). Forming of relationships was a challenge for some residents.
(Moyle et al., 2015) Descriptive with thematic analysis Brisbane and Melbourne, Australia (Date of data collection not reported.)	Understand what influences quality of life and strategies to improve quality of life of older people with dementia living in long-term care	Design: Semi-structured interviews Participants: 12 residents living in 4 long-term care facilities (3 from each) with early-stage dementia	People with dementia: Women: 75.0% Age: 89.0±8.3 Race/ethnicity not reported. Marital status not reported.	Social interactions and satisfaction were key factors improving quality of life. Residents commented on interactions with family, friends, and residents/staff (at times not being able to differentiate staff from residents). Family: For many, quality of life was about family as they provided meaning, enjoyment, and support. Friends: Most did not mention friends from outside the facility. Memory loss affected ability to maintain friendships. Residents and staff: Being in a facility provides company. Half thought the residents provided an important source of social interactions. One participant didn’t feel he could have good conversations in the facility. Others suggested they can’t walk around to have conversations. Staff lacked time to have meaningful conversations.
Mixed method studies
(Baldacchino & Bonello, 2013) Descriptive, exploratory and a cross-sectional study Malta and Australia (Dates of data collection not reported.)	Evaluate factors related to anxiety and depression	Design: Semi-structured interviews Participants: Older adults living in 6 nursing homes participated in the quantitative (137 residents) and qualitative study (42 residents)	Quantitative sample: Female: 75.2% Age: 72.8 Married: 13.1% Separated/Widowed: 53.3% Single: 33.6% Qualitative sample: Female: 73.8% Age: 71.9 Race/ethnicity not reported. Married: 14.3% Separated/Widowed: 61.9% Single: 23.8%	Three contributing factors to anxiety and depression included adaptation to institutional living, physical functioning, and personal outlook towards the future. Within the adaptation to institutional living theme, social support, social activities, and positive relationships with family, roommates, and pets were important factors to control anxiety and depression.
(Potter et al., 2018) Exploratory study using thematic framework and a prospective cohort study United Kingdom	Explore the relationship between the physical environment and depressive symptoms	Qualitative: Semi-structured interviews 15 residents in 4 care homes Quantitative: 510 residents in 50 care homes	Qualitative sample: Female: 80% Age (range: 68-95): 85 Quantitative sample: Female: 77.0% Age: 86.4±7.3 Race/ethnicity not reported. Marital status not reported.	The mean MDS 2.0 based index of social engagement was 4.6±1.8. The association between the index of social engagement and the geriatric depression scale (GDS-15) (adjusted for resident characteristics) did not hold when residential environmental characteristics were added to the model (β= −0.11; 95% confidence interval: −0.25 to 0.02).

^*Determined from lead author via email correspondence.

^**Mean Age±SD (years)

^***Described like assisted living homes.