Healing Spaces Improve the Well-Being of Older Adults: A Systematic Analysis

Abstract

As the global population ages, improving health statuses and quality of life has become crucial. Healing spaces enhance older adults’ (OA) physical and mental health and well-being. However, the current research status and development trends must be systematically reviewed to guide future research directions. This study systematically examines the role of healing spaces in improving the health and well-being of OA through a bibliometric analysis. Results reveal three developmental stages: slow start, steady development, and in-depth refinement. Highly cited articles emphasize physical and environmental factors. The main research foundations encompass physical, chemical, biological, and ecological aspects of healing spaces and OA mental health. The research frontier is shifting towards a more comprehensive understanding of OA needs. Keyword analysis indicates a transition from a single physical environment focus to a holistic approach considering psychological, social, and spiritual needs across various disciplines. The field is progressing toward interdisciplinary integration, personalized demand, and systematic development. Future research should prioritize OA spiritual needs, develop scientific evaluation systems for spiritual healing, optimize personalized treatment environments using innovative technologies, and address diverse health and well-being needs. Strengthening international cooperation and integrating global research efforts are also essential for advancing the field.

1. Introduction

The World Health Organization reports that the global population is aging rapidly, with 1 billion people expected to be 60 years or older by 2020, and 1.4 billion, or one-sixth of the world’s population, expected to be 60 years or older by 2030 [1]. As the elderly population ages, elderly people experience reduced body function and activity ability and an increased likelihood of illness [2]. Consequently, population aging has become a central focus of architectural function transformation, highlighting the growing importance of healing spaces for OA. Population aging is a defining demographic reality of our time, associated with an increased social burden of providing care to older individuals with chronic diseases or frailty [3]. For older patients, hospitalization often leads to new or worsening disability, which can be attributed to the cumulative effects of aging, frailty, comorbidity, and the diseases that necessitate hospitalization, as well as issues in healthcare management and the healing environment [4]. Healing is a holistic, transformative, physical, and spiritual process of repair and recovery that produces positive change, finds meaning, and moves toward self-fulfilling wholeness, regardless of disease [5]. Creating an environment with healing characteristics and utilizing the healing space’s shape, level, and structure can stimulate the user’s resilience and improve their healing ability from psychological and physiological perspectives [6]. In modern times, the term healing spaces acknowledges the impact of architectural spaces on patient health [7], and this connection has garnered the attention of researchers [8]. The role of individual elements in architectural spaces on health and well-being has also been explored [9,10], with studies investigating the environmental qualities of healing spaces from the perspectives of light [11], sound [12], air [13], and temperature [14]. Correlations have been found between specific features of the built environment and the well-being of building users [15]. Lemprecht [16] argued that well-designed spaces can promote rehabilitation and shorten hospital stays. Norberg–Schulz and Loci [17] describe architecture as the spirit of a place, a combination of multiple elements such as mental and environmental states. Effective therapeutic space design principles should include a homelike atmosphere, proximity to nature, sun exposure, noise control, and accessibility considerations [18].

Healing spaces provide an emerging research strategy for studying health and well-being in older populations [19]. Functional augmentation can be achieved by diversifying the synthesis of healing spaces [20,21] and updating spatial materials [22], enabling a more effective delivery of services to older populations. Healing space research is a well-established area of health research that can be applied to physical health outcomes [23,24]. In countries with severe population aging, the development of healing spaces for OA has driven many changes, including economic [25], cultural [26], and social concerns [27]. From a micro perspective, the healing space is a treatment dimension [10]. The healing environment benefits various health indicators, such as anxiety, blood pressure, postoperative recovery, analgesic use, and length of hospital stay [28]. A well-designed healing space may even promote recovery from certain psychological disorders [29]. While the healing space cannot directly lead to healing, it can facilitate the engagement of behaviors and emotions that support the healing process. The ideal environment fosters positive emotions such as happiness, contentment, and relaxation. This physical and mental health healing environment contributes to improved emotional regulation and is a prerequisite for physical and psychological healing [30]. Furthermore, in a well-designed healing space, the pain experienced by elderly individuals may be reduced [31]. Moreover, healing spaces significantly impact elderly populations with specific medical conditions [32]. For the terminally ill elderly, healing spaces provide home-like end-of-life care that mitigates the distress associated with death [33].

Current research on the impact of healing spaces on OA is gaining attention worldwide, particularly in countries with rapidly aging populations [34]. However, most attempts to review the scope of this research area have focused solely on the physiological healing response that healing spaces elicit in OA [10,35]. Previous literature has demonstrated a strong association between healing spaces and various aspects of health and well-being in older populations. Epidemiology, psychology, and architecture researchers are increasingly investigating the influence of healing spaces on a range of health outcomes among OA [36]. Prior studies have examined the role of healing spaces in the physical health of older populations. Several studies have explored the composition of the theory of perception and established the concept of the optimal healing environment (OHE), defining it as the social, psychological, physical, spiritual, and behavioral components of healthcare environments that support and stimulate the body’s innate capacity for self-healing [37]. While these studies contribute to the understanding of healing spaces in the health of OA, they focus on only one of the many applications of healing spaces in research on elderly populations. Several rapidly emerging articles review the characteristics of healing spaces for OA [36] and explore the feasibility of their use [38]. Nevertheless, these approaches concentrate on physiological features such as pain reduction and enhanced healing. Such studies are primarily application-oriented and lack a systematic theoretical framework. Furthermore, the application of healing spaces in research on OA lags behind its development. Currently, there is no systematic review and evaluation of existing applications of healing spaces. This review aims to address this gap and identify areas for future research to capitalize on this new and expanding significant data source.

Due to the growing importance of healing spaces targeted at enhancing the well-being of older adults in the 21st century, a comprehensive and systematic review is necessary. This paper focuses on a multidimensional analysis of the different disciplines reflected in the literature using bibliometric software. The paper uses co-citation analysis and co-occurrence analysis to systematically review the trajectory of research in the therapeutic space for older adults. The main objective of this paper is to provide a thorough understanding and systematic overview of healing space research in OA. Quantitative and qualitative analyses were conducted using bibliometric methods and visualization tools to gain insight into the current status and future directions of healing space research in OA. First, the changes in the number of publications in different years were summarized, and the main subject areas were identified; second, the distribution of influential countries, authors, and disciplines in the field was found, and the main research directions and representative literature were identified. Meanwhile, keyword clustering analysis was conducted to reveal emerging research hotspots for promoting the transformation of well-being in old age through the therapeutic space. Finally, the future development trends in the field were outlined. This study is structured as follows:

• Section 1 is the introduction.
• Section 2 describes the main research methods and data sources, which include the research process.
• Section 3 explores the general characteristics of OA healing spaces, as well as the needs and main application areas of OA healing spaces in the knowledge phase, based on the conclusions of the data visualization.
• Section 4 provides an in-depth analysis of the significant impact of healing spaces in improving the well-being of older adults in a number of domains in response to the data in Section 3.
• Section 5 and Section 6 summarize the discussion of current trends and discuss priorities for future evaluation research.

2. Research Methods and Data Sources

2.1. Data Sources

The bibliometric analysis began by selecting the Web of Science (WOS) platform as the primary database. Launched in 1997 by integrating SCI, SSCI, and AHCI, WOS is a multidisciplinary online literature database with over 20,000 high-impact academic journals and conference proceedings across diverse fields [39]. Its comprehensive coverage, authority, and scientific rigor render it an objective and reliable data source. Additionally, WOS is among the most authoritative and widely used scientific databases [40], justifying its choice for this study. Scopus was also utilized to provide citation data and integrated patent information from significant patent offices worldwide, offering a convenient and impactful interface [41]. While Google Scholar enables free access across document types, languages, and disciplines, its fragmented information, complex data, and lack of transparency for some content precluded its inclusion. A comprehensive perspective on international research landscapes and frontiers was obtained by complementing WOS and Scopus. A tailored search string further enhanced the scientific rigor [42].

Keyword selection was the second step, focusing on healing spaces and their role in enhancing elderly health and well-being, following the 2001 United Nations Second World Assembly on Ageing, which prioritized improving aging populations’ health, supportive environments, and development [43]. Literature from January 2001 to December 2023 was collected. This 22-year timeframe captures research developments aligned with the UN’s recommendations on healing spaces and increased societal attention to OA. Meanwhile, healing spaces relate to children, adults, and OA [44,45]. Considering the incompleteness of data in 2024, this study selected the 22-year period from 2001 to 2023 as the research timeframe. This time span can comprehensively reflect the recent development trends in this field, ensuring the timeliness and representativeness of the research results. By analyzing and reviewing the relevant literature within this period, it is conducive to clarifying the evolutionary trajectory of the research topic, grasping the cutting-edge dynamics of disciplinary development, and providing forward-looking suggestions for future research directions. This study concentrated on aging populations as healing spaces are more targeted in their health and well-being [46]. This article selects “Topic” as the retrieval type to retrieve titles, abstracts, authors, and keywords from the WOS core and Scopus collection. This paper uses the following search form to search (TS (theme simulation) = (“Healing” OR “Healing space” OR “Healing built” OR “Healing architecture” OR “Healing Environments” OR “Healthcare Design” OR “Holistic Healing environment” OR “Mental Healing”) AND TS = (“The elder” OR “The old” OR “The aged” OR “older people” OR “elderly”) AND DT = (“ARTICLE” OR “REVIEW”) AND LA = (“ENGLISH”)). The same keywords were used in Scopus to narrow or expand the search by finding synonyms, acronyms, and other alternative terms. This inclusiveness strengthens the critical search and ensures no related terms are ignored. Further searches were conducted for lead authors, essential sources, and important papers, and references to included articles were added after excluding rejected articles. Finally, these records were exported in a plain-text format and full-citation format. Then, the CiteSpace 6.2R7 software was imported for analysis (see Figure 1 for details).

2.2. Research Process

Bibliometric analysis offers a rigorous and widely adopted approach for exploring and analyzing large-scale scientific data [47], capable of revealing nuances and emerging trends within a domain [48]. Knowledge mapping, an advanced bibliometric and scientometric technique, directly represents quantitative research findings on specific topics [49]. Due to the extensive literature corpus, this review employed visualization tools to facilitate automatic data extraction, thereby validating the promoting effect of therapeutic spaces on elderly welfare. Visualization-analysis tools can efficiently extract key information from a large volume of literature and intuitively present data patterns and intrinsic connections [50], providing empirical support for the influence mechanism between therapeutic spaces and elderly welfare. Through a data-driven research approach, this paper aims to elucidate the intrinsic associations between the two and explore the application prospects of therapeutic spaces in improving the quality of life for the elderly. While software like HistCite [51], RefViz 1.0 [52], VOSviewer [53], and SATI [54] are available, CiteSpace 6.2R7 was selected as the primary tool for comprehensively analyzing the literature, particularly the subject’s evolution. Its co-occurrence, co-citation analysis, and time-series capabilities enable targeted examinations [49,55]. CiteSpace 6.2R7, a Java-based information visualization software for knowledge mapping, presents scientific knowledge’s structure, patterns, and distribution through visual analytics. After eliminating reviews, book chapters, news, and other non-research items, 428 valid publications were analyzed. CiteSpace facilitated exploring the role of healing spaces in enhancing elderly health and well-being through spatiotemporal distributions from 2001 to 2023, examining changes over time and across countries, institutions, and research topics. Collaborative networks were analyzed by setting node types as country and institution. The evolution of the research topic was visualized through a timeline view using the category node type. Keyword co-occurrence and cluster analyses identified frontier and hot issues at different stages. Integrating these analyses, this paper describes research trends on healing spaces’ role in promoting elderly health and well-being, forecasting potential issues and breakthroughs meriting future attention. Metrics like “Centrality”, indicating the likelihood of shortest paths through nodes [56], supplemented the interpretations. The study-design process is illustrated in Figure 1.

3. Results

3.1. Spatiotemporal Distribution Analysis

3.1.1. Number of Publications

The number of publications is the most tangible and objective metric for assessing a field’s research status, representing a crucial indicator of its developmental trajectory. Figure 2 depicts the specific data on publication counts. Analyzing the changing number of publications offers vital insights into the impact of research on healing spaces for OA. After the screening, 428 articles published from 2001 to 2023 exploring the role of healing spaces in promoting elderly health and well-being were obtained for analysis. Taking 2004 and 2019 as the watershed years, although there were some relevant studies before 2004, they failed to form a systematic research domain. In 2004, the World Health Organization released the “International Plan of Action on Ageing: Implementation Report”, providing guidance for countries to improve disease management and health promotion, leading to a steady increase in related publications. It was not until the COVID-19 pandemic outbreak in 2019 that specialized studies on therapeutic spaces for the elderly gained widespread attention and substantial publications in 2020. Therefore, the development of this research field can be broadly divided into three stages: slow start (2001–2004), steady development (2005–2019), and in-depth refinement (2020–2023). The publication trend reveals critical junctures and inflection points that demarcate these phases, shedding light on the field’s evolution. By examining the quantitative changes in publication output over time, this study elucidates the overall development of healing space research for aging populations, its momentum shifts, and potential drivers underlying the observed patterns. These analyses lay the groundwork for a nuanced understanding of the field’s research dynamics and intellectual trajectories.

The study’s initial phase, from 2001 to 2004, exhibited slow and fluctuating growth. In 2001, the World Health Organization prepared the discussion paper Health and Ageing for the Second World Assembly on Ageing [57]. That same year, the United Nations held this assembly in Spain, approving WHO’s active ageing policy framework. Subsequently, WHO published the Active Ageing Policy Framework [58], advancing global aging initiatives and stimulating extensive research. Consequently, studies on elderly well-being and health increased from 2002 onward. Additionally, a series of international aging conferences, such as the 16th and 17th Global Conferences of the International Federation on Ageing (held in Perth, Australia, in October 2002 and Singapore in September 2004), proposed the active aging concept and its three pillars of health, participation, and security. This gradually raised awareness and understanding of the importance of elderly healthcare. Furthermore, in 2004, WHO released the International Plan of Action on Ageing: Report on Implementation [59], guiding countries in improving disease management and health promotion. Consequently, relevant publications peaked during this initial stage in 2004 due to the increasing focus on aging and health.

The period from 2005 to 2019 witnessed a steady increase in publications. The World Health Organization established the Commission on Social Determinants of Health in 2005, operational until the end of 2008 [60], leading to a consistent rise in publication output during this time, with a brief decline after 2008. The 2007 World Health Report highlighted population aging as an increasing concern in developed nations and an emerging social issue in developing countries [60]. In 2012, the United Nations Conference on Sustainable Development proposed clear and practical steps for implementing sustainable development in the construction of architectural spaces [61]. Since 2012, targeted research has gained prominence in academia, and the number of publications has fluctuated upward. In 2015, the WHO released the World Report on Ageing and Health, emphasizing the urgent need for comprehensive public health actions to address population aging issues and the necessity of social, economic, and governmental support for the well-being of OA [62]. Consequently, academic research in this stage became more specialized, and the number of papers steadily increased. The role of healing spaces in improving the health and well-being of OA has been widely studied.

From 2020 to 2023, the number of publications remained relatively stable at around 25 per year. During this phase, research delved deeper into examining the role of healing spaces in enhancing elderly health and well-being with greater detail and nuance. A significant event impacting this field was the global spread of the COVID-19 pandemic [63]. After COVID-19, developing and investigating specialized, functional healing spaces tailored for elderly populations gained substantial momentum. This was driven by the increased vulnerability and long-term sequelae observed in aging demographics during the pandemic. Consequently, many publications emerged, focusing on designing targeted healing environments that cater to the unique needs of elderly individuals with lowered resistance and residual health impacts from COVID-19. This research thrust reflects the field’s responsiveness to emerging public health challenges and the recognition of designing supportive spaces customized for this vulnerable population.

3.1.2. Analysis of Key Countries

Analyzing the regional distribution of collaborative publications sheds light on the significance and influence of significant cross-national research partnerships. It also elucidates the roles played by different countries in advancing knowledge on how healing spaces can improve elderly health and well-being. These insights can inform potential research directions and themes for future in-depth exploration in this field [64].

Using CiteSpace, the national collaboration landscape was examined, revealing 59 link strengths and 55 networks with a density of 0.0397 (Figure 3). Between 2001 and 2023, 138 publications resulted from international collaborations, marking the highest output. Researchers in New Zealand contributed the most, with 37 papers, followed by the United Kingdom, with 32 publications. This analysis uncovers the key nations driving cross-border research efforts and knowledge exchange in this domain. Understanding these collaboration networks is crucial for identifying influential country-level research hubs, facilitating future inter-institutional partnerships and aligning research agendas to tackle shared challenges in designing supportive healing environments tailored to aging populations globally.

As depicted in Figure 3, the United States published the most papers, with a centrality of 0.18, indicating the most significant number of cross-country collaborative relationships and the broadest range of connections. Although ranking fourth in publication output, the United Kingdom exhibited the highest centrality value of 0.21 (

Table 1. Top five countries in terms of centrality.

Rank	Centrality	Frequency	Country
1	0.21	25	United Kingdom
2	0.17	37	Netherlands
3	0.16	20	Australia
4	0.18	138	United States
5	0.08	4	Switzerland

), underscoring its pivotal role in information flow within this research network. The United States maintained close collaborative ties with New Zealand, the United Kingdom, Germany, Canada, and Japan. However, a lack of communication and cooperation was observed between Sweden, the United States, and Italy. Enhancing collaboration among these nations could potentially drive the globalization of research in this field, thereby fostering significant advancements. This centrality analysis highlights the influential country-level hubs shaping the collaborative landscape. The United States emerges as the primary producer of research output, while the United Kingdom acts as a critical bridge facilitating information exchange across national boundaries. Strengthening partnerships, especially among countries with limited current collaboration, can accelerate knowledge sharing, resource pooling, and cross-pollinating ideas vital for tackling the multifaceted challenges of designing healing spaces tailored to elderly populations worldwide.

3.1.3. Authors’ Collaborative Distribution Analysis

Analyzing patterns of author co-authorship, cross-collaboration, and co-citation offers fundamental insights into research trends on the role of healing spaces in promoting elderly health and well-being. This analysis can inform new research directions driven by emerging interdisciplinary integration [65]. Leveraging CiteSpace, collaborative and cross-referencing relationships among critical researchers in this field were identified. Examining these research groups, their scholarly outputs were accessed to collect relevant data for analysis in CiteSpace. The author’s collaboration network comprised 517 nodes and 521 connections with a density of 0.0039. Figure 4 details the leading authors and their affiliated institutions, while

Table 2. The top five primary authors of publications.

Rank	Frequency	Year	Author
1	13	2016	Capolongo, Stefano
2	11	2017	Gola, Marco
3	8	2017	Settimo, Gaetano
4	4	2021	Lundin, Stefan
5	4	2015	Macallister, Lorissa

presents the top five publications by citation count. This co-authorship analysis unveils the influential researchers shaping the intellectual base and driving collaborative efforts within this domain. Understanding these interconnected clusters of scholars is critical for mapping the knowledge landscape, identifying emerging interdisciplinary synergies and recognizing the potential for future cross-pollination of ideas and research integration. Highly collaborative author groups and their outputs can signal fertile areas for multidisciplinary inquiry into designing healing environments optimized for elderly populations.

The author distribution exhibits a scattered landscape, albeit with several collaborative groups, which is indicative of a k-core cooperation structure. The largest cluster of co-authors is affiliated with Politecnico di Milano. Among the top five most prolific researchers, the top three are Italian: Capolongo, Stefano (13 publications), Gola, Marco (11), and Settimo, Gaetano (8), followed by Lundin, Stefan from Sweden (4), and Macallister, Lorissa from the US (4). Notably, five of the top ten authors are Italian scholars (Table 2), suggesting a concentration of discourse within the Italian research community on the role of healing spaces in promoting elderly health and well-being. The team, led by Settimo, Gaetano, and Gola, Marco, has focused on enhancing treatment efficacy through indoor air-quality interventions [66]. Collaborators Gola, Marco, and Capolongo, Stefano have investigated how healing spaces influence elderly well-being in the post-pandemic era [67]. Meanwhile, Lundin, Stefan, and Macallister, Lorissa have explored the psychological impacts of healing environments on patients [68,69]. While author collaborations exist, the distribution suggests weak cooperative ties among scholars in this research domain. Furthermore, a lack of communication and cooperation persists in specific sub-areas, indicating an absence of strongly interconnected, core academic teams with robust leadership driving advancements in understanding healing spaces’ role for elderly populations. The academic community should prioritize strengthening interdisciplinary collaboration and in-depth exchanges among scholars from diverse fields. Concurrently, efforts should be directed toward establishing leading, cohesive research teams to spearhead progress in this vital area.

3.1.4. Research Field Distribution

By setting the node type to category and the time slice to 1 year, a collaboration network across disciplines is generated. This information offers insights into the transdisciplinary landscape of research on the role of healing spaces in promoting elderly health and well-being. The CiteSpace analysis yielded a knowledge map of 45 nodes and 60 link strengths. The most influential discipline, Health Care Sciences and Services, exhibited a centrality of 0.48. Public, Environmental, and Occupational Health emerged as the second-most central domain with a centrality of 0.30, followed by Medical Informatics at 0.16 centrality (

Table 3. The top 10 research fields ranked by centrality.

Rank	Frequency	Centrality	Year	Title
1	9	0.48	2007	Health Care Sciences and Services
2	28	0.30	2007	Public, Environmental, and Occupational Health
3	4	0.16	2003	Environmental Studies
4	5	0.16	2013	Medical Informatics
5	2	0.06	2011	Engineering, Manufacturing
6	2	0.06	2014	Computer Science, Artificial Intelligence
7	2	0.06	2017	Clinical Neurology
8	2	0.06	2017	Ergonomics
9	4	0.03	2012	Construction and Building Technology
10	3	0.03	2012	Engineering, Environmental

). This interdisciplinary network highlights the core knowledge domains shaping the intellectual basis of healing space research for aging populations. The centrality metrics pinpoint the pivotal disciplines exerting the most significant influence, while the interconnected structure illuminates collaborative synergies driving conceptual and methodological cross-pollination. Visualizing this transdisciplinary ecosystem is crucial for identifying fertile areas for integrated research, potential knowledge gaps, and opportunities to bridge disparate perspectives through interdisciplinary dialogue and collaboration.

Within this research landscape, Health Care Sciences and Services and Clinical Neurology have significantly shaped the understanding of elderly healing spaces by integrating knowledge from medicine, nursing, psychology, and social sciences, facilitating the identifying and fulfilling of ageing populations’ unique needs [45]. Public, Environmental, and Occupational Health, Engineering, Environmental Sciences, and Environmental Studies provide a critical theoretical foundation and practical guidance. These disciplines elucidate the intricate interactions between individuals and their environments, informing the design of healing spaces that promote physical, mental, and social well-being among OA Besterman–Dahan, et al. [70]. Moreover, Medical Informatics, Computer Science, Artificial Intelligence, and Ergonomics enable personalized healthcare delivery by collecting and analyzing large-scale health data. In geriatric healing environments, this data-driven approach allows medical teams to tailor treatment plans and care programs according to each elderly individual’s health status, medical history, and preferences, enhancing treatment accuracy and efficacy [71]. Engineering, Manufacturing, Construction, and Building Technology further contribute by applying engineering principles to create ageing-friendly healing spaces that accommodate OAs’ physiological and psychological requirements, supporting their health recovery, quality of life, independent living, and social engagement [72]. As research progresses historically, more profound and broader interdisciplinary communication and collaboration will be fostered. The academic community should remain attuned to pertinent societal issues and conduct comprehensive, cross-disciplinary investigations into the role of healing spaces in promoting elderly health and well-being. This will facilitate the updating or creation of novel spatial design systems tailored to geriatric healing. Consequently, the Social Sciences Citation Index is pivotal in advancing this multifaceted research domain.

3.2. Co-Citation and Cluster Analysis

3.2.1. High-Citation Articles

Citation analysis offers valuable insights into a field’s knowledge base and research trends. Articles were retrieved from the WOS Core Collection and Scopus databases to identify the most frequently cited publications and imported into CiteSpace.

Settimo [73] was cited five times. The second-most frequently cited literature, each cited four times, are the works by Nartova–Bochaver and Mukhortova [74], Moscato, et al. [75], and Gola, et al. [76]. Details of the other cited articles are shown in

Table 4. Top five most cited articles.

Rank	Frequency	Year	Reference
1	5	2017	Settimo [73]
2	4	2009	Nartova–Bochaver and Mukhortova [74]
3	4	2017	Moscato, Borghini, and Teleman [75]
4	4	2017	Gola, Mele, Tolino, and Capolongo [76]
5	3	2017	Settimo, et al. [77]

. This citation analysis pinpoints the seminal and influential publications that have significantly shaped the intellectual foundations of research on healing spaces for elderly populations. The impact of these works, as quantified by their citation counts, underscores their conceptual or methodological contributions that have resonated across the field. Evaluating citation patterns illuminates the key ideas, theories, and empirical findings that have gained traction, guiding subsequent inquiries and driving the evolution of knowledge in this domain. These highly cited publications collectively represent scholarly outputs that have catalyzed discourse, spurred new lines of investigation, and advanced the understanding of designing supportive healing environments tailored to aging populations’ needs.

3.2.2. Cited Article and Citing Reference

Employing CiteSpace for cluster analysis reveals six thematically correlated clusters, as depicted in Figure 5 and detailed in

Table 5. Clustering of cited articles.

Cluster ID	Size	Silhouette	Year	Clusters
0	49	0	2014	Physical–chemical
1	40	0	2003	Patient
2	38	0	2017	Biological environmental factor
3	35	0	2006	Business case
4	34	0	2005	Environmental design
5	31	0	2009	Mental health

. These clusters are labeled using indexing terms derived from the literature. These clusters were labeled as index terms, among which cluster #0 had the most significant number, which focused on the research on the physical environment of the healing environment, such as air quality, lighting, temperature, and humidity, which may affect the health condition of the patients. Environmental design focuses on the study of the physical environment of the healing environment, such as air quality, lighting, temperature, humidity, etc., which may impact the health status of patients. The clusters’ biological environmental factors, mental health, and patients focus more on the elderly user group. Clusters are more concerned with the psychosocialization factors of the elderly recipient group, with the psychological feeling of the use of OAs as the base of the study. The biochemical environment and psychological state will affect the healing effect differently. The business case cluster focuses on the economic benefits of geriatric healing spaces, and the cost of using the space may also impact the degree of healing.

The timeline graph (Figure 6) illustrates the temporal evolution of the identified clusters. Node size corresponds to citation counts, while interconnecting lines represent relationships between cited works. The initial clusters were #1 (2001–2006) and #4 (2001–2009), with #4’s most extended duration spanning from 2001 to 2009. Cluster #5 is built upon the foundations of #4 and #0. Notably, Clusters #0 through #4 have maintained activity for over 5 years, underscoring their enduring representativeness within this research domain. Simultaneously, Clusters #0 and #2 demonstrate the highest levels of continuity, indicating their sustained status as research hotspots attracting consistent interest and citations over time. The thematic analysis revealed that Clusters #0 and #4 focused on the impacts of physical–chemical factors and environmental design on therapeutic spaces for the elderly, prompting reflections on commercial value in Cluster #3. From 2001 to 2010, the research foci of the patient, business case, and environmental design clusters converged on the human welfare and economic dimensions of elderly rehabilitation spaces. Since 2010, physical–chemical factors have emerged as a hotspot, peaking around 2015 and overlapping with research on biological environmental influences. This time-sequential analysis unveiled the knowledge trajectory and thematic shifts in the exploration of therapeutic spaces for the elderly population. Clusters #1 and #2 paid more attention to biological environmental impacts, fostering the rise of psychological research in Cluster #5. The evolving cluster landscape reflected the developmental trajectory of this field, transitioning from an initial emphasis on human-centeredness and economic considerations to the study of physical–chemical and biological–environmental influences. By mapping the temporal dynamics, the analysis elucidated how the constantly changing research foci, theoretical perspectives, and methodologies have collectively shaped the knowledge accumulation in this domain over the past two decades.

Among the cited article base and citing reference hotspots on the role of healing spaces in improving the health and well-being of OA, the clusters of physical, chemical, biological, environmental factors, environmental design, and mental health have been studied for a long time and have emerged as relatively new practices compared to the other clusters. The environmental design and mental health clusters that have been studied for a long time are relatively new to the emergence of practice compared to other clusters and have more significant implications for the role of healing spaces in improving health and well-being among OA. The topfour important clusters’ citing articles and cited references information for each cluster are listed below (Cluster #0, Cluster #2, Cluster #4, Cluster #5):

• Cluster #0: physical–chemical

Cluster #0 centrally examines the impacts of biological, chemical, and physical risks present in therapeutic environments on the health and well-being of elderly users. These risks affect various aspects, such as physiological mechanisms [26], self-care capacity [78], and more. Specific examples include physical risks from inadequate microclimatic parameters causing thermal discomfort, chemical risks of toxic/harmful contamination, and biological risks from microbial exposure [79]. All are closely tied to the well-being and health of aging populations.

Among this research cluster, the cited references include Capolongo [80] and Nyhan, et al. [81], representing the foundational research in this field. The article references are Capolongo and Settimo [79] and Gola, et al. [82], presenting the cutting-edge research in this area with specific information provided in

Table 6. The top three articles cited in Cluster #0.

Cluster #0: Physical–Chemical
Cited References		Citing Articles
Cites	Author (Year)	Coverage %	Author (Year)
3	D’Alessandro, et al. [83]	14	Capolongo and Settimo [79]
2	Capolongo [80]	12	Gola, Settimo and Capolongo [82]
2	Nyhan, Sobolevsky, Kang, Robinson, Corti, Szell, Streets, Lu, Britter and Barrett [81]	-	-

.

This cluster analysis pinpoints the core focus on the intricate relationships between healing environments’ physical, chemical, and biological dimensions and their multifaceted impacts on elderly individuals’ health and well-being. The cited works elucidate this area’s fundamental concepts, theories, and empirical evidence. In contrast, the highly cited recent publications signal emerging perspectives, novel methodologies, and advanced findings, propelling the field forward.

• Cluster #2: biological–environmental factor

Cluster #2 is titled Biological–Environmental Factor. This cluster encompasses various factors closely related to the research topic, including biological–environmental health factors [84], social environmental factors of social engagement [85], and cognitive function and psychological health factors [86]. In this research direction, the studies by Gola and Settimo, et al. [87] can be considered foundational research. Simultaneously, the research by Settimo [73], Moscato, Borghini, and Teleman [75], and Settimo, Gola, Mannoni, De Felice, Padula, Mele, Tolino, and Capolongo [77] can be viewed as representing the cutting-edge perspectives of this field. Detailed information is provided in

Table 7. The first three articles cited in Cluster #2.

Cluster #2: Biological–Environmental Factor
Cited References		Citing Articles
Cites	Author (Year)	Coverage %	Author (Year)
3	Settimo [73]	20	Gola, et al. [88]
2	Moscato, Borghini, and Teleman [75]	18	Settimo, Gola and Capolongo [87]
1	Settimo, Gola, Mannoni, De Felice, Padula, Mele, Tolino, and Capolongo [77]	-	-

.

• Cluster #4: environmental design

Cluster #4 is titled Environmental Design. In exploring the impact of healing spaces on the health and well-being of the elderly, environmental design plays a crucial role. Environmental design encompasses not only architectural spatial layout [89] but also encompasses multiple dimensions such as landscape design [38] and information design [90]. The comprehensive application of these design aspects is an indispensable factor in achieving the goals of health promotion and well-being enhancement. Environmental design’s scientific and systematic nature is critical to supporting elderly health. In contrast, the multi-dimensional optimization of environmental design is crucial for realizing elderly health promotion and well-being improvement. Within Cluster #4, the research by Golden, et al. [91], Diette, Lechtzin, Haponik, Devrotes, and Rubin [31], and Kutash and Northrop [92] can be considered foundational. At the same time, Rashid [93] can be regarded as representing cutting-edge research. Detailed information is provided in

Table 8. The first three articles cited in Cluster #4.

Cluster #4: Environmental Design
Cited References		Citing Articles
Cites	Author(Year)	Coverage %	Author (Year)
2	Golden, Gaynes, Ekstrom, Hamer, Jacobsen, Suppes, Wisner, and Nemeroff [91]	21	Rashid [93]
2	Diette, Lechtzin, Haponik, Devrotes, and Rubin [31]	-	-
1	Kutash and Northrop [92]	-	-

.

• Cluster #5: mental health

Cluster #5 is titled Mental Health. In exploring the impact of healing spaces on the health and well-being of the elderly, mental health plays a crucial role. For the mental healing of the elderly population, it is necessary to focus not only on the individual mental characteristics of OA but also on the psychological impact that the physical environment of the healing spaces has on them. Within healing spaces, the mental state of OA greatly influences the occurrence of healing. Many mental states can even alleviate physical suffering for OA. These applications of mental care for OA are indispensable factors in achieving the goals of health promotion and well-being enhancement. Furthermore, mental health healing presents a deep interdisciplinary fusion of medicine, environmental studies, and psychology. Therefore, attention to mental health is crucial for realizing elderly health promotion and well-being improvement. Within Cluster #5, the research by Cleary, et al. [94], Caspari, et al. [95], and Applebaum, et al. [96] can be considered foundational. In contrast, the research by Connellan, et al. [97] can be regarded as representing cutting-edge research. Detailed information is provided in

Table 9. The first three articles cited in Cluster #5.

Cluster #5: Mental Health
Cited References		Citing Articles
Cites	Author(Year)	Coverage %	Author (Year)
2	Cleary, Hunt, O’Connor, and Snars [94]	31	Connellan, Gaardboe, Riggs, Due, Reinschmidt, and Mustillo [97]
1	Caspari, Eriksson, and Nåden [95]	-	-
1	Applebaum, Fowler, Fiedler, Osinubi, and Robson [96]	-	-

.

3.3. Research Hotspot Analysis

3.3.1. Keyword Co-Occurrence

Keyword co-occurrence analysis examines the co-occurrence patterns of selected keywords within a collected dataset. Compared to co-citation analysis, this approach more directly reveals the central content, methods, and core concepts explored in the literature on healing spaces’ role in promoting elderly health and well-being. The dataset spanning from 2001 to 2024 was imported into CiteSpace to generate a yearly keyword co-occurrence network visualization, as shown in Figure 7. This network consists of 595 nodes and 2530 link strengths, with a density of 0.0143. Node size represents the frequency of occurrence, while link thickness corresponds to the co-occurrence count of the connected keyword pairs. Leveraging CiteSpace’s word-frequency data,

Table 10. The top 10 keywords with co-occurrence frequency.

Rank	Frequency	Centrality	Year	Keywords
1	118	0.06	2001	Humans
2	87	0.16	2001	Healing environment
3	55	0.08	2001	Health care facility
4	37	0.09	2006	Hospital design
5	33	0.03	2001	Health facility environment
6	32	0.06	2003	Health care
7	29	0.06	2004	Patient care
8	28	0.19	2006	Evidence-based design
9	24	0.07	2003	Alternative medicine
10	23	0.05	2005	Hospital design and construction

presents the top 10 most frequently occurring keywords from 2001 to 2023, offering insights into the prominent themes and topics characterizing this research domain over the past two decades. This keyword co-occurrence analysis provides a robust overview of the intellectual landscape by illuminating the central concepts, theories, methods, and applications that have driven investigations into designing supportive healing environments tailored to ageing populations’ needs. The visualization captures the interconnected nature of these critical topics, while the frequency data pinpoint the areas of sustained focus and emerging priorities within this multifaceted field of inquiry.

The keyword analysis reveals that in research examining the role of healing spaces in promoting elderly health and well-being, the term “humans” is among the most frequently occurring, followed by healing environment, health care facility, hospital design, and health facility environment. Notably, the convergence of alternative medicine and patient care concepts within healthcare embodies an exploration of holistic patient care approaches, tending to incorporate alternative treatment modalities alongside traditional healing practices [98]. The keywords, including hospital design, health facility environment, hospital design and construction, and healthcare facility, emphasize healthcare facilities’ physical structure and layout, utilizing research evidence to guide facility design and environmental construction to enhance support for patient rehabilitation [99]. Furthermore, health care and healing environments leverage health services’ research methodologies to systematically evaluate evidence on how various design factors impact the health of OA, thereby providing a scientific foundation for constructing optimal healing environments [10].

3.3.2. Keyword Clustering

This study conducted a cluster analysis of keyword knowledge maps to explore the developmental trajectories of research on the role of healing spaces in promoting elderly health and well-being across different stages from 2001 to 2024. The 50 most cited articles were selected, and CiteSpace analysis yielded Figure 8. The cluster areas and intersections represent the cluster size and relationships, while node size indicates the frequency of occurrence, with larger nodes denoting higher frequencies. As depicted in

Table 11. Clustering of the top 10 keywords.

Rank	Frequency	Centrality	Mean Year	LLR
1	92	0.718	2007	Healing Environment
2	78	0.744	2013	Healthcare Facilities
3	75	0.814	2017	Healing Architecture
4	67	0.812	2010	Male
5	43	0.854	2012	Air Quality
6	32	0.933	2012	Healthcare Design
7	27	0.863	2012	Health Services Research
8	26	0.918	2009	Social Change
9	24	0.980	2015	Spiritual Care
10	21	0.982	2011	Optimal Healing Environments

, the role of healing spaces in enhancing elderly well-being formed 10 clusters around key nodes, representing 10 research directions: healing environment, healthcare facilities, healing architecture, gender factors, air quality, healthcare design, health services research, social dynamics, spiritual care, and optimal healing environments (Clusters 0 to 9 in descending order of keyword richness). The cluster modularity Q = 0.7097 (ranging from 0 to 1) and the mean silhouette value s = 0.835 (ranging from 0 to 1, with values above 0.7 indicating persuasive clustering) validate the cluster structure’s robustness, detailed in Table 11. Three algorithms (LLR, LSI, and MI) were employed for cluster labeling, with LLR and MI emphasizing study characteristics. As the LLR algorithm proved more practical and less redundant through training, its results were selected as the primary cluster definitions.

4. Analysis of Results

4.1. Spatiotemporal Analysis

The theme of the role of healing spaces in improving elderly health and well-being has undergone a transformative journey over the past two decades, marked by initiation, steady development, and further refinement. The breadth and depth of research in this domain have dramatically increased. Regarding active countries, the existing literature predominantly originates from developed nations. This trend can be attributed to the earlier onset and greater prevalence of population ageing in these regions. However, by 2024, developing countries such as China, Thailand, and Turkey have also witnessed rapid growth in their aging populations, consequently spurring an emergence of research investigating the impact of healing spaces on elderly health and well-being in these regions. While some countries like the United Kingdom, the United States, and Japan have maintained a focused research agenda on the role of healing spaces in promoting elderly well-being, it is crucial to recognize that this is a global issue, and different countries and regions may face distinct challenges and research needs. Therefore, transnational cooperation and knowledge-sharing remain pivotal aspects in achieving the overarching goal of leveraging therapeutic spaces to enhance elderly health and well-being. Through international collaboration, drawing upon the successful experiences of various nations, research and practice in this area can be collectively advanced, providing more targeted and effective solutions for the global challenge of population ageing.

4.2. Co-Citation and Cluster Analysis

4.2.1. Analysis of High-Citation Articles

Citation analysis was employed to rank this study’s most frequently cited works (see Table 3 for ranking details). Among the highly cited publications, several focused on the impact of air quality (IAQ) on health and well-being. Settimo [73] underscored the critical importance of indoor air quality (IAQ) for health and advocated for developing a European IAQ strategy to optimize living and medical environments for OA. Moscato, Borghini, and Teleman [75] noted that in healthcare facilities, errors in the design, installation, and maintenance of air-conditioning systems can severely compromise IAQ, particularly for immunocompromised patients. Gola, Mele, Tolino, and Capolongo [76] analyzed IAQ monitoring in international hospitals, concentrating on chemical pollutants, and provided an overview of air biological pollution, aiming to review monitoring methods and key findings. Settimo, Gola, Mannoni, De Felice, Padula, Mele, Tolino, and Capolongo [77] investigated indoor air quality (IAQ) in medical institutions, assessing the effectiveness of improvement measures through monitoring formaldehyde, volatile organic compounds, and other parameters, reporting preliminary results on air quality in inpatient wards. Another highly cited work examined the potential of human–flora interactions for physical and mental health recovery, demonstrating the positive effects of interacting with the plant world on healing states [74]. These publications predominantly emerged during the second research phase, providing insights into this period’s leading content and trends. Examining these highly cited works can facilitate a nuanced understanding of the second phase’s research landscape.

4.2.2. Citation Cluster Analysis

To illustrate citation patterns, this research selected highly cited literature from the four most significant research areas identified by CiteSpace (#0, #2, #4, and #5). By conducting an in-depth analysis of these influential articles, characterized by high citation and co-citation rates, the research determined each research area’s foundational theoretical basis and cutting-edge dynamics. This process involved a systematic organization of their knowledge structures.

• Cluster #0: physical–chemical

• Research Basis

Many elements associated with biological, chemical, and physical risks in the therapeutic environment can impact the health and well-being of users. These factors affect physiological mechanisms [26], self-care capacity [78], and other aspects of the elderly population. For instance, physical risks may arise from changes in user well-being or thermal discomfort due to insufficient microclimate parameters, chemical risks from toxic, harmful, or carcinogenic contamination [81], and biological risks from microbial contamination or insufficient quantity [79]; each of these aspects is closely linked to the health and well-being of the users.

Architectural spaces serve as primary sites for healing. Building risks, such as managing significant external change, can increase physical, chemical, and biological risks that affect health and well-being. For example, construction activities are a known risk for the growth and spread of waterborne pathogens in building water systems [100], and environmental defects can negatively impact the building’s water supply, leading to disease, injury, and death [101]. In recent decades, indoor air quality (IAQ) in buildings has received growing attention from the scientific community, political institutions, and environmental governance, as it impacts occupants’ comfort, health, and well-being. Sources of indoor pollutants include outdoor infiltration (e.g., vehicle exhaust, industrial emissions) [81], as well as indoor sources (e.g., building materials, furniture, HVAC systems) [102]. These pollutants include a variety of harmful substances, such as carbon monoxide, ozone, radon, VOCs, particulate matter, fibers, bacteria, fungi, and pollen. For many people, the health risks associated with exposure to indoor air pollution may be more significant than those related to outdoor pollution. Notably, poor indoor air quality can be detrimental to vulnerable groups, such as children, young people, the elderly, or individuals with chronic respiratory and cardiovascular diseases. Therefore, for healing spaces or healthy buildings aimed at improving the health and well-being of OA, the design and construction process must address the above physical, chemical, and biological risk factors with even higher requirements. Not only should the functional spaces meet individual and collective needs, but the occupants’ basic safety, health, and well-being must also be protected [81]. This requires integrating skills from various fields, including materials, engineering, technical systems, urban planning, and the medical domain, especially public health, which can be developed during design.

2.

Research Frontiers

With the continuous improvement in the quality of life, the indoor breathing environment has become an important area of focus for researchers in the 21st century. Many studies have confirmed indoor air is more lethal than outdoor air [103]. Indoor air quality has received increasing attention in public health and has become one of the main concerns for governments. As a complex and dynamic issue, the physical factors, as well as biological and chemical pollutants generated in both outdoor and indoor environments, can affect users’ health. This is because it is related to many major chronic diseases, such as asthma, hypersensitivity pneumonitis, and Legionnaires’ disease, which are associated with the respiratory system, skin, mucous membranes, nervous system, and immune system [104]. In addition to these well-known diseases, there may also be some symptoms typically characterized by neurological sensory effects, which determine the state of discomfort, the decline in the health of occupants, and the negative perception of air quality [79]. All these ailments are caused by various aspects related to indoor air quality, which primarily impact vulnerable groups (OA, children, and those with pre-existing chronic conditions). In healing spaces, there have been increasing data analyses and research efforts to ensure and prevent the health of OA [79,82], with some studies even identifying indoor pollution as one of the most significant environmental risks to public health [88,105]. Particularly in the current pandemic-dominated era, more urgent actions are needed to address the burden of its impacts.

• Cluster #2: biological environmental factor

• Research Basis

The indoor environment is a complex ecosystem that combines the user population, microorganisms, and the built environment [106]. Biological environmental control is a critical factor for the healing of elderly patients. In elderly surgery, cancer treatment, and others, controlling an appropriate biological environment can effectively curb highly infectious infections and improve the healing outcomes of elderly patients [73]. The indoor biological environment in healing spaces differs from other spaces’ complexity. The continuous activities within the healing space bring about a constant influence of biological pollutants [107]. The concentration of biological pollutants is essential to the healing outcomes [108]. The biological pollutants that impact the healing effects in space are primarily airborne micro-pollutants, such as the influenza A virus (H1N1), the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and microorganisms like Aspergillus and Penicillium [109]. The use of HVAC systems can exacerbate the spread of biological pollutants within the indoor ecosystem. Environmental air quality, building materials, air circulation, appliances, cleaning products used, occupant habits (such as smoking), and building maintenance (such as energy-saving measures) can all influence the concentration changes of indoor biological pollutants [77]. Therefore, for specific population groups more sensitive to air quality, such as OA, it is necessary to continuously re-evaluate the importance of the healing space ecosystem and HVAC systems [75]. More efficient air-filtration systems, increased biological environment-quality monitoring points to precisely track microenvironmental changes, and regular air-treatment-system maintenance and upgrades can significantly improve OAs’ well-being in healing spaces [73].

2.

Research Frontiers

Biological environmental factors are the key to affecting the health and well-being of OA in healing spaces, with indoor air quality being the primary manifestation of these biological environmental factors [108]. High-quality indoor air quality can not only prevent the elderly from contracting hospital-acquired infections (HAIs) but also enhance their overall well-being [110]. Chemical pollution of indoor air is a focus that requires attention. Healing spaces are low-care environments easily exposed to chemical pollutants, exacerbating indoor air pollution (IAP) [108]. Therefore, factors such as the design and management of inpatient wards and management efficiency can influence indoor air quality [87]. The specific user needs, in-hospital infections, required technologies and ventilation systems, multi-departmental risk analysis, acceptable residual risk values, and related management procedures can all impact the air-quality outcomes in in-patient wards [111]. The construction and renovation of the biological environment for elderly healing must be adjusted based on the targeted impact factors (such as the light environment, humidity, thermal environment, and air environment), and the management and prevention system should be updated according to the health status of the users [88,112]. The dynamic monitoring of these impact factors and optimizing the management system are also the focus of future research [113]. Targeted design may directly affect the safety of the healing space, offsetting the probability of risk factors and harmful events, thereby improving the well-being and health of the elderly user population [88].

• Cluster #4: environmental design

• Research Basis

Research on the design and planning of healing spaces has emphasized the substantive relationship between physical environmental factors and health [8]. The key to the environmental design of healing spaces is the indicator of indoor environmental quality (IEQ) [114]. Good indoor environmental quality (IEQ) can not only directly affect the psychological health of patients but also influence the physiological and psychological state of patients’ families [115]. This is because the environmental design of healing spaces aims to promote the reduction of environmental stressors, facilitate the social, psychological, physical, spiritual, and behavioral components of healthcare support, and stimulate the innate self-healing ability of the body, playing an important role in alleviating pain, anxiety, and stress, and making patients feel comfortable and safe [116]. IEQ plays a crucial role in improving the well-being and comfort of occupants throughout the life cycle, especially for the elderly population [117]. The physical factors, such as the quality of architectural features, furniture, decorations, lighting, and ventilation, as well as the degree of daylighting, color temperature, and material temperature, can all influence the psychological factors of patients and affect the overall indoor environmental quality [118]. IEQ elements not only have a concentrated impact on the psychology of patients but also influence the physiological and psychological health status of patients’ families [92]. The elderly population often requires the care and companionship of family members, and a sound healing environment can alleviate the stress of patient families and improve their quality of life. For example, comfortable seating, appropriate lighting, and good ventilation can create a relaxed and welcoming healthcare environment, enhancing patient families’ sense of belonging and security [96]. The environmental design of healing spaces needs to keep up with the times and continuously optimize and upgrade. With the development of technology, some intelligent environmental control systems, such as automatic temperature and humidity adjustment, as well as lighting control, can also be incorporated into the design to enhance IEQ further and create a more comfortable and safe healthcare experience for OA [119].

2.

Research Frontiers

Extensive patient-oriented research has demonstrated the close relationship between indoor environmental quality (IEQ) and the health and well-being of the healing population [120]. Ulrich proposed that the design of a healing environment should focus more on emotional and psychological responses, emphasizing that healing is based on the emotional feedback generated by the quality of the spatial environment [121]. There is a positive correlation between indoor environmental quality and the healing outcomes of the user group, which is influenced by sociological needs, psychological states, and individual differences. High-quality indoor environmental quality leads to favorable healing outcomes [122]. In recent years, research on the environmental quality of healing spaces has often been oriented towards high-energy-efficient buildings, where thermal optimization of insulation and airtight building envelopes, as well as high-efficiency heating, ventilation, and air conditioning (HVAC) systems, may lead to a deterioration of indoor environmental quality (IEQ) [123]. Most review studies have focused on the relationship between specific physical IEQ elements and patient psychological elements related to healing outcomes, lacking targeted research on the impact of staff activities on healing outcomes, such as the appearance, communication, and accessibility of healthcare professionals [124]. At the same time, the healing space’s environmental design should be focused on the intangible dimensions of sustainable design, such as the semantics and regenerative properties of the healing space [120,125].

• Cluster #5: mental health

• Research Basis

The design of healthcare environments has begun to be oriented towards rehabilitation and providing mental health services, including aesthetic enhancement, to alleviate stress and anxiety, improve patient satisfaction, and promote health and recovery [10,126]. In considering the psychological aspects of patients, the mainstream design approach for healing spaces has become to tailor the design based on the stage of the illness, considering factors such as the physical attributes of the space, the sensations evoked by the space, the familiarity of the space, the relationship with nature, and spiritual or religious meanings [94]. Users’ ability to establish a spiritual connection in the healing environment, provide positive distractions, and enhance a sense of control can, to some extent, reduce the perception of pain [45]. For example, based on the problem of functional decline faced by the elderly population, their spiritual perception of autonomy, independence, and self-well-being in the healing space is reduced, which requires more emotional support services provided by healthcare professionals to support the healing process of OA [96].

2.

Research Frontiers

With the intensification of population aging, mental health problems such as depression and anxiety are becoming increasingly prominent among the elderly population, which requires high attention [127]. The prevalence of depression among people aged 50 and above is 5.5–27.5%, and the prevalence of anxiety is 1.2–15%, far higher than other age groups [128]. In response to this issue, the specialized principle of rehabilitation-oriented mental healthcare, which includes therapeutic spaces, holistic care, and person-centered care, is considered a positive approach [126]. The patient-centered holistic care model can effectively improve OAs’ treatment adherence and subjective well-being [129]. At the same time, creating a comfortable and safe therapeutic space, such as incorporating natural elements and an artistic atmosphere, can also help alleviate patients’ anxiety and promote mental health [130]. This whole-person care based on the biopsychosocial model has become the mainstream direction of mental health services for OA [97]. Although the argument that the environmental elements within the healing space can positively impact the healing outcomes and the subjective well-being of patients has been established, this may be because these environmental elements can regulate the neuroendocrine system of patients, thereby producing positive psychological effects. However, the specific mechanisms of action still require further in-depth research, such as the impact of different sound characteristics on patients’ emotional states [131] and even the establishment of clear standards and regulations to ensure service quality [132].

4.3. Keyword Analysis

In the keyword analysis, CiteSpace has clustered the keywords into 10 clusters closely related to the research topic, as shown in Table 11. In developing healing spaces for OA, the healing environment plays a crucial role, and appropriate environmental design can significantly impact OAs’ physiological, psychological, and social health [133]. This is reflected in healthcare facilities and healthcare design and in optimizing architectural layouts and interior designs to provide OA with a safe, comfortable, and easy-to-navigate environment [36]. Healing architecture further emphasizes the importance of design elements, such as natural lighting, soothing color tones, and open views, to enhance OAs’ well-being and recovery process. These design elements can effectively regulate the emotional states of OA, alleviating negative emotions such as anxiety and depression and thereby promoting their mental health. Particularly for OA who may face issues like heart disease or prostate health, the design needs to ensure that it can meet the specific health needs and psychological service needs of this population [134]. Moreover, the optimization of air quality is crucial for maintaining the health of the elderly, especially for those with respiratory system diseases [135]. Health services research provides scientific evidence for the effectiveness of healing spaces for OA, offering evidence on the impact of different elements on the health of OA [136]. Social change also plays a role in developing healing spaces for OA, as increasing attention is paid to the well-being of OA, and more resources are being invested in creating supportive and inclusive environments [137]. Research suggests that spiritual care can help create an environment that meets the spiritual needs of OA, assisting them in finding inner peace and a sense of meaning [138]. This holistic approach to the well-being of OA reflects the deepening recognition of the needs of an ageing society. The optimal healing environment is a design concept that comprehensively considers all the above factors, based on extensive health services research, providing a scientific basis for the best practices in space design [136]. This comprehensive and systematic design approach can improve the physical health of OA and meet their psychological, social, and spiritual needs, creating a truly healing environment for them. Developing healing spaces for OA is increasingly intertwined with perspectives such as healing architecture, healthcare design, health services research, spiritual care, and optimal healing environment, and they are mutually reinforcing [121]. This development trajectory reflects the deepening recognition of the aging society and its unique needs and the continuous pursuit of comprehensive and humanistic care in the healthcare field. As society pays increasing attention to the well-being of OA, more resources are being invested in creating supportive and inclusive environments. This is not only reflected in the optimization of hardware facilities but also requires efforts in soft power, such as enhancing healthcare professionals’ service awareness and communication skills so that OA can feel more human care [96]. In the early stages, the concept of healing spaces for OA was relatively vague, focusing more on primary medical care and functional needs [139]. However, with in-depth health services research, especially on the physical and mental health needs of OA, people have begun to recognize the impact of the environment on health recovery. This has promoted innovations in the fields of healing architecture and healthcare design. Over time, the importance of spiritual care has gradually been incorporated, reflecting a comprehensive concern for the overall well-being of OA, including their emotional and spiritual needs. The integration of this concept has further driven the development of the optimal healing environment concept, aiming to comprehensively and systematically address the needs. Similar to the specialized research on male, female, and disabled populations, studies on specific groups like OA have also emerged and become increasingly popular. The development of healing spaces for OA is a multi-disciplinary and cross-domain integration process, reflecting society’s increasing attention to the well-being of OA and the healthcare field’s pursuit of humanistic care.

5. Discussion

5.1. Discussion of the Main Results

This paper analyzed the research on the impact of healing spaces on the elderly population using the WoS core database and Scopus database to determine the number of documents, journal classifications, research scope, institutional and author collaboration distribution, and the changes in research hotspots in this field. Using CiteSpace for domain analysis, the study has plotted the evolution of research hotspots and predicted their development trends. This study has obtained co-occurrence maps and timeline visualizations of the key terms by analyzing the hotspots in the research on the impact of healing spaces on OA.

In terms of geographic distribution, the research on healing spaces for OA is primarily concentrated in developed countries. However, as population ageing has become an important issue in developing countries [140], both developing and developed countries are taking proactive measures and exploring the construction of healing spaces for the ageing population, such as geriatric wards and integrated elderly care communities [141]. These initiatives are being incorporated into the overall future planning. Still, the specific actions taken vary [142,143] and must be tailored to the local context. Yet, most of the existing healing and wellness spaces targeting the elderly population are still experimental in practice and theoretical research. Updating or designing entirely new spaces that cater to the current and post-pandemic realities is a long-term process. At the same time, healing spaces for the elderly population are a crucial lever for future research and development. The uneven distribution of research and practical efforts across developed and developing countries highlights the need for a more globally inclusive approach to addressing the challenges and opportunities presented by population ageing. Collaborative efforts, knowledge sharing, and adapting best practices to local contexts will be essential in creating healing environments that meet the diverse needs of the elderly population worldwide.

5.2. The Basis of Research and the Future Development of Research

From the perspective of the research foundation, the main research themes have been the physical environment of healing spaces, mainly indoor air quality (IAQ), which has been shown to impact healing outcomes. While the research on IAQ is essential, it should not overlook other aspects of the physical environment, such as indoor thermal comfort, acoustic environment, and lighting conditions [144,145]. The elderly population is a unique user group in indoor environments [146]. Still, the development of healing spaces has not paid sufficient attention to this particular demographic’s specific spatial environment requirements. This may be a promising direction for future research. This direction suggests that in future research on the health and well-being of the elderly population, the design and application of healing spaces will emphasize individualized needs, scientific evidence, and the interplay between the environment and patient well-being. Particularly for the elderly population, the development of these research directions will lead to the design and construction of healthcare facilities becoming more personalized and better able to meet their specific needs.

Furthermore, from the perspective of research hotspots, the focus has shifted more toward the psychological and spiritual aspects of the elderly user group, which is also a key area of in-depth development in current healing spaces [147]. Spiritual care is a subjective and dynamic concept, as it showcases the unique aspects of care and integrates all other elements [148]. However, the human spiritual healing effect is immeasurable by scientific means. Therefore, their exact effects and benefits are unpredictable [149]. More experimental research is needed to scientifically prove the spiritual healing effects that healing spaces can bring to OA. The subjective and intangible nature of spiritual well-being presents challenges in quantifying and validating its impact, which requires a nuanced, multi-faceted approach to research and evaluation.

Additionally, technological and equipment factors are important in improving the health and well-being of OA in healing spaces. The research focus has been on the technologically enhanced healing effects brought by the physical architectural environment and the improved healing effects on the psychological issues of the elderly population through changes in design elements. The elderly user group of healing spaces values the physical environmental context of the healing process and the changes in healing equipment during the healing process [10]. Most research exists within the theme of updating equipment comfort, as the increased ageing-friendliness of individual elements can lead to an overall increase in the healing effects of the environment, such as the updating of technologically advanced furniture, integrated ventilation systems, and safe coatings [19,150]. However, little attention has been paid to the psychological effects of equipment on the elderly user group [151]. In the 21st century, the rapid development of internet-connected devices has enabled the integration of consumer electronics and medical equipment, potentially allowing every space to become a healing space. However, some issues remain to be addressed, such as patient compliance, battery life, and concerns about safety and privacy [152]. Incorporating technology and equipment in healing spaces for OA represents an important frontier, as it can enhance the physical, psychological, and functional aspects of the healing experience. Future research should explore the optimal integration of these elements, balancing the technological capabilities with the unique needs and preferences of the elderly population to create healing spaces that are truly empowering and restorative.

As the global population continues to age, how to provide high-quality healthcare services and life security for the growing elderly population has become a significant challenge facing society. In this context, healing spaces, as an important platform connecting medical care, rehabilitation, and elderly care, play a crucial role in improving the health and well-being of OA and have become a hot research topic for the future. Future research on the impact of healing spaces on the health and well-being of OA should consider multiple aspects, including the physical, psychological, and social dimensions, to achieve a comprehensive improvement in the health and well-being of OA through integrated design. In the psychological and social domains, it is essential to pay attention to the loneliness faced by the elderly population, as social exclusion, lack of social connections, and weak ties with other users within the space can lead to a strong sense of rejection [153]. Current research tends to focus more on cognitively intact elderly individuals, overlooking the psychological issues faced by those with cognitive impairments and the lack of awareness among healing space staff regarding OAs’ feelings of isolation [154]. In the physical environment, future research on healing spaces should also focus on the characteristics of the elderly population, emphasizing the integration of design and technology to meet the physiological healing needs of OA and optimizing the safety and comfort of the healing environment. For example, establishing support services and physical environments based on the highly diverse needs and preferences of OA [155] and utilizing electronic computing technologies (such as DHL technology) to manage the health and well-being of the elderly population [156]. However, research should also consider the cognitive decline, mental fatigue, and functional decline caused by electronic information technology among OA. Therefore, the impact of future healing spaces on the health and well-being of the elderly population will be far-reaching. This will improve the quality of life for OA and drive the healthcare field towards a more comprehensive, humanistic, and scientific direction, ultimately achieving better health management and quality of life for the elderly population.

5.3. Research Limitations

This study acknowledges several limitations in terms of data sources, analytical methods, and analytical perspectives that warrant further refinement and expansion. Regarding data sources, the study relied solely on the literature from the WoS and Scopus core databases, excluding other vital databases such as Google Scholar. This may restrict the representativeness and breadth of the research sample. Future research could consider integrating multiple databases to enhance the reliability of the findings. Additionally, the analysis was limited to English literature, overlooking publications in other languages, which could introduce bias. Regarding analytical methods, the study employed only the LLR algorithm for cluster analysis in constructing the scientific knowledge graph. Combining multiple association-analysis algorithms could potentially improve the accuracy of the analysis, an area for improvement in subsequent research. Furthermore, the analytical perspective of this study has spatial limitations, primarily focusing on the analysis and interpretation of core subject areas. In contrast, the exploration of non-core subject areas lacks depth and comprehensiveness. While bibliometric software analysis can aid in objectively identifying research frontiers and development trends, it still necessitates in-depth literature reading and meticulous examination to obtain more precise and comprehensive research conclusions. In summary, future research in this domain should consider the following refinements: (1) expanding data sources by integrating multiple databases, including non-English literature, (2) employing a combination of analytical methods to enhance the accuracy of the analysis, and (3) broadening the analytical perspective to include more comprehensive exploration of both core and non-core subject areas. These improvements will provide more reliable and nuanced insights into the research landscape and development trends.

6. Conclusions

This study systematically reviews the current status, knowledge base, and development trends of research on the role of healing spaces in promoting the health and well-being among the elderly population based on bibliometric analysis and visualization exploration. In summary, this study drew the following inferences:

• The temporal analysis reveals that research in this field has progressed through three stages: slow start, steady development, and continued growth. While developed countries initially dominated, relevant research has also recently emerged in developing countries. Different countries and regions should strengthen cooperative efforts and integrate global research to drive innovative progress.
• Analysis of highly cited literature and clustering shows that the research foundations cover multiple aspects of healing spaces, including physical and chemical environments (e.g., indoor air quality), biological factors, environmental design, and psychological health of OA. The research frontier is shifting towards a greater focus on addressing OAs’ overall physical, mental, and social needs.
• Keyword analysis reflects a transition from a singular focus on physical environments towards a more interdisciplinary and integrated approach, with greater emphasis on the holistic psychological, social, and spiritual needs of OA. This transition reflects deepening societal awareness of ageing-related issues and a trend towards more humanized, individualized healthcare.
• Currently, the research foundation primarily concentrates on physical environmental factors, particularly the impact of indoor air quality on physiological health. However, future efforts need to place greater emphasis on individualized needs. Research hotspots are shifting towards the psychological and spiritual needs of OA, but a scientific evaluation system for assessing spiritual healing effects remains an area requiring further exploration. Technologies and equipment play a crucial role in optimizing healing spaces and enhancing the health and well-being of OA. However, their usage experience in this age group must also be considered. The integration of emerging technologies should adhere to a user-centered design philosophy to comprehensively meet the diverse needs of OA.

Overall, research in this field is evolving toward an interdisciplinary, individualized, and systematic approach. Future efforts should further emphasize the spiritual needs of OA and establish a scientific evaluation system for spiritual healing. By integrating emerging technologies like the Internet of Things and artificial intelligence, personalized and intelligent therapeutic environments can be optimized to holistically address OA’ physiological, psychological, social, and spiritual health and well-being, driving sustainable innovation.