A randomized clinical trial was conducted over 1 year to examine the combined effect of SS and TS on pain intensity, as well as the mental and physical health of older adults living in nursing homes. The study specifically targeted older adults residing in these settings. All participants were randomly assigned into 3 groups by the supervising researcher using a stratification strategy to ensure balanced groups (see the “Randomization” section). The executing researcher and research staff responsible for assessments were blinded to the randomization process.

Participants were recruited using a convenience sample from Ahuzat Hazafon Geriatric Nursing Hospital. Eligible participants were residents aged 65 years or older who had lived in the facility for at least three months and were capable of participating. Exclusion criteria included uncontrolled epilepsy and severe behavioral disturbances. Following eligibility screening, participants were assigned to 1 of 3 groups—SS, TS, or the combined SS+TS group—using stratified randomization. Stratification was based on age, sex, and cognitive level to ensure balanced groups. Randomization and allocation were overseen by an independent researcher who was not involved in the trial’s day-to-day activities. Additionally, research staff responsible for conducting baseline and postintervention assessments were blinded to group assignments to minimize assessment bias.

Patients, with the approval of their custodians, were invited to participate in the study. Each eligible participant attended 4 weekly therapeutic sessions based on their group assignment: SS (SS intervention using Snoezelen room therapy, involving gradual multi-SS without social interaction), TS (therapist’s social support intervention only, without SS), or SS+TS (a combined intervention of both SS and therapist’s social support). Each session lasted 20 minutes. Immediately before and after each session, we collected objective measures, including pain intensity, blood pressure, blood oxygen saturation, hand grip strength (HGS), and heart rate, from each participant. Additionally, eligible participants completed subjective assessments (Multimedia Appendix 1) to measure their satisfaction with life and anxiety levels at the beginning and end of the study.

A prestudy power analysis was conducted, and the sample size was calculated based on an effect size of Cohen d=0.40, with a power of 0.80 and a type I error rate of 0.05/6 (0.0083) to account for 6 primary outcomes [18]. This analysis resulted in an estimated sample size of 102 participants.

The objective measures included systolic and diastolic blood pressure, heart rate, blood oxygen saturation, and HGS. These metrics were assessed before and after each session. Patient-reported outcomes included life satisfaction, current pain, and general anxiety. Life satisfaction and general anxiety were assessed before the first session and after the last session, while pain was evaluated before and after each session.

The following tools and instruments were used in this study:

To minimize selection bias, participants were recruited through a convenience sample, and stratified random assignment was used to evenly distribute potential confounders among the study groups. Additionally, the researcher conducting the study was blinded to the group assignments to reduce bias in data collection and analysis.

To address confounding variables, statistical control was applied. Sex and age, known universal variables that can act as confounders, were included as control variables in the statistical analysis. This approach ensured that any observed group differences were not solely influenced by these variables.

Group differences were examined using the chi-square test for categorical variables and a 1-way analysis of variance for continuous variables. For session-level outcomes, including blood pressure, blood oxygen saturation, heart rate, HGS, and pain intensity, percentage changes from presession to postsession were calculated. These changes were then analyzed using mixed models to test the differences between treatments over time, defining an interaction between time and treatment. Tukey-corrected post hoc analysis was applied for significant interactions. Pairwise contrasts were used to compare group differences at each session, with participant-based random intercepts and session slopes defined. The analysis of anxiety and life satisfaction outcomes was conducted using mixed effect models to compare pre- and postintervention differences across groups. When significant differences were detected, intervention-specific slopes were further examined using Tukey correction to account for multiple comparisons.

Participants were recruited by an occupational therapist who contacted all eligible patients living in the nursing home. The researcher explained the purpose of the study, ensured voluntary participation, and clarified that nonparticipation would not affect the patients’ or therapist-patient relationship. Informed consent was obtained from participants or their custodians, particularly for those lacking sufficient cognitive capacity. The study was preregistered with ClinicalTrials.gov (registered ID NCT05394389) and received ethical approval from the Faculty of Social Welfare & Health Sciences Ethics Committee at the University of Haifa (approval number [112/21]).

The study was conducted at Ahuzat Hazafon Geriatric Nursing Hospital, which provides medical, nursing, and paramedical services to its residents in mentally ill and nursing wards. The Snoezelen room where the study was conducted was a white, furnished space equipped with various SS systems, including lighting, audio, odor distribution, and massage systems. The room already had visual, auditory, tactile, and aromatic SS systems in place, which were used during the study.

The mean age of participants was 82.2 (SD 7.92) years, with the majority being women (62/96, 65%; Table 1). Most participants exhibited some degree of cognitive decline (mean Mini-Mental State Examination [MMSE] score 15.4, SD 8.45). The analysis indicated no significant differences between the groups in MMSE scores (F_2,93=1.51; P=.32). Additionally, no significant differences were found among the 3 intervention groups for gender, age, cognitive state, or pain intensity (all Ps>.2). Complete statistical analysis is presented in Multimedia Appendix 2. Participant recruitment is detailed in Figure 2.

The analysis revealed that the groups showed a similar pattern of improvement related to the intervention for heart rate (F_6,271=1.33; P=.23) and blood oxygen saturation (F_6,274=2.06; P=.06).

This pilot randomized clinical trial is the first to investigate the combined effects of multi-SS in a Snoezelen room and TS (SS+TS) on the health of older adults living in nursing homes. Our findings indicate that the SS+TS intervention significantly reduced pain levels, lowered systolic blood pressure, and improved HGS compared with the SS and TS interventions individually. Additionally, the SS+TS intervention enhanced life satisfaction and reduced anxiety, with these effects being more pronounced than those observed with SS or TS alone [12,15,22].

Our findings supported the primary hypothesis, showing that the combined intervention of SS in a Snoezelen room, along with TS, had a more profound effect on pain intensity and physical and mental health outcomes compared with each intervention component delivered in isolation. Specifically, the SS+TS intervention led to reduced pain levels, lower systolic blood pressure, and increased HGS during sessions 3 and 4, surpassing the effects of SS and TS alone. Additionally, the SS+TS intervention showed greater improvements in life satisfaction and anxiety compared with the other interventions.

The therapeutic impact of the combined SS+TS intervention notably improved pain experience during the latter half of the intervention. Previous research has highlighted the unique positive effects of SS and TS on pain perception [1,15]. Pharmacological interventions, particularly opioids and other pain medications, can have adverse effects on older adults, including falls, cognitive impairment, constipation, and addiction [23,35]. Nonpharmacological methods for pain management, such as the Snoezelen room integrated with enhanced TS, offer a safer alternative and are often more cost-effective in the long term compared with continuous pharmaceutical treatments [23,33,34].

Our findings, combined with existing literature on the Snoezelen room intervention, support the multidimensional effects of the SS+TS intervention on pain intensity. Alleviating pain is crucial, as the experience of pain can lead to decreased mobility, sleep disturbances, emotional distress, and, consequently, a reduced quality of life among older adults [23,35,36].

Interestingly, our results revealed that the therapeutic effects of the combined intervention were most pronounced during sessions 3 and 4. This observation aligns with prior research indicating that pain reduction following nonpharmacological interventions can be delayed [1,15,37-39]. For example, pain reduction resulting from physical exercise for low back pain is often gradual and occurs over time [40,41].

Additionally, social support–focused interventions have been associated with delayed pain relief [23,37]. This delay may be due to the gradual implementation and refinement of coping strategies. It can take time for participants, particularly older adults, to adjust to a new type of therapy that includes multiple elements. This adaptation period may delay the positive interpretation of bodily sensations [37,42-46]. Further investigation is warranted to explore the temporal dynamics and long-term effects of the intervention.

We observed an increased impact of the combined SS+TS intervention on systolic blood pressure and HGS. Previous studies have shown that SS, especially olfactory and visual stimulation, can effectively reduce blood pressure and enhance overall health [12,47,48]. Another study highlighted that TS can enhance physical health by providing a safe and nonjudgmental space for older adults to share their concerns, fears, and anxieties. Such support can help reduce stress, which is linked to various physical health issues, including hypertension, heart disease, and compromised immune function [17,23,38,49-52].

Our findings underscore the importance of interventions that address the mind-body connection. Recent studies have shed light on the physiological mechanisms through which mental processes impact the immune system and other bodily functions [47,53-55]. Moreover, some multisensory interventions include resistance training and muscle-strengthening exercises. Participating in these activities can help older adults maintain or even improve muscle strength and endurance, leading to better physical health and greater independence in daily activities [54,56].

Contrary to our initial hypothesis, we did not find that the combined SS+TS intervention provided greater benefits compared with SS and TS alone in terms of heart rate, blood oxygen saturation, and diastolic blood pressure. None of the interventions showed improvements in these metrics. It is plausible that the duration of our intervention (4 sessions lasting 17-20 minutes each) was insufficient to detect changes in these outcomes. Moreover, existing research supports the notion that similar interventions focusing on sensory processing and social support may not effectively improve heart rate and blood oxygen saturation in advanced age [8,21]. Additionally, stable diastolic blood pressure among older adults is often indicative of good health, and reducing diastolic blood pressure could even pose a risk factor for heart disease [57,58].

Our study yielded promising findings regarding the therapeutic benefits of a brief SS+TS intervention for enhancing mental health among older individuals residing in nursing homes. This intervention showed potential for improving life satisfaction and reducing anxiety, without exacerbating the common issue of polypharmacy in the geriatric field. It is well-established that better mental health in this population is closely linked to improvements in physical well-being [49]. Previous research has consistently highlighted that multi-SS, which often includes elements such as soothing music, aromatherapy, and tactile sensations, can reduce stress levels, alleviate anxiety, and promote a sense of calm. For individuals dealing with anxiety disorders, such as generalized anxiety disorder or posttraumatic stress disorder, multisensory interventions can serve as valuable coping mechanisms.

Multisensory experiences can trigger the release of endorphins and other feel-good neurotransmitters, leading to improved mood and emotional well-being. Furthermore, chronic pain has been associated with an increased aversiveness to unpleasant multi-SSs, suggesting shared mechanisms between pain intensity and multisensory processing [15,59]. For older individuals who may struggle with depression or mood disorders, regular participation in multisensory activities can offer a natural, nonpharmacological approach to improving their mood. Additionally, multisensory activities that encourage social engagement can help mitigate feelings of isolation and loneliness, providing residents with a sense of belonging and companionship [19,21,32,60]. Moreover, these improvements have been shown to contribute to an enhanced sense of well-being and increased social engagement [60]. An extensive body of research has demonstrated the significant role of TS in improving various markers of mental health [17,18,20,61]. TS is widely regarded as a valuable component for addressing emotional and social needs, which are often critical for older adults facing mental health challenges. Emotional support and empathy can significantly enhance treatment outcomes for older adults experiencing depression, anxiety, and reduced life satisfaction [18,20,62,63].

An intriguing question arises from our study: What makes the combined SS+TS intervention particularly effective? We propose that the therapeutic state of mind fostered by the relaxing environment created through SS plays a crucial role. This environment prepares the groundwork for the TS to have a greater impact by reducing patient resistance. Supporting this notion, previous research has demonstrated that SS creates a more conducive analgesic environment compared with standard settings [15,64]. This shift in environment may be particularly therapeutic for older individuals living in nursing homes, where the atmosphere often mirrors that of a hospital, characterized by medications and medical procedures that can heighten feelings of discomfort and anxiety.

The observed effects of the SS+TS intervention may result from an interactive synergy between SS and TS. Rather than being merely additive, these interventions appear to enhance each other, leading to greater therapeutic outcomes. The soothing environment created by SS likely amplifies the effectiveness of TS, enabling a more profound impact on participants’ health. This combined effect underscores the potential of the SS+TS intervention to be particularly effective in settings such as nursing homes, where establishing a calming, supportive environment is crucial.

In exploring the nature of the combined effects of SS and TS, a critical question arises: Do these interventions provide additive or interactive benefits when applied together? An additive effect would suggest that the benefits of the combined SS+TS intervention are simply the sum of the individual impacts of SS and TS when applied separately. By contrast, an interactive effect would indicate a synergistic relationship, where the combined SS+TS intervention produces outcomes that surpass the sum of its individual components. Although a no-treatment control group would offer a more definitive basis for distinguishing between these possibilities, our current analysis, based on a visual examination of pre-to-post intervention changes, suggests the presence of an interactive effect. This observation suggests that the combination of SS and TS may activate mechanisms that go beyond their individual contributions, leading to enhanced therapeutic outcomes. This synergy could stem from how SS prepares individuals mentally and physically for more effective engagement with therapeutic support, or vice versa. Future research with a more comprehensive experimental design, including a control group and separate groups for each intervention, would be invaluable for confirming and further elucidating these effects.

Although our study has provided valuable insights, it is important to acknowledge its limitations. Conducted in a single nursing home, our findings may not fully represent the broader population.

First, the use of a convenience sample from a single nursing home may introduce selection bias, as participants may not fully represent the broader population of older adults in similar care settings. For instance, participants with behavioral issues were excluded, which limits the generalizability of the findings to this wider population. Additionally, the voluntary nature of participation may introduce selection bias, as participants who chose to join the study may have been more motivated or in better health, potentially influencing the outcomes. Future studies should aim to replicate our findings across multiple settings, explore additional measures of physical and mental health, and extend the intervention period to assess long-term effects.

Second, the sustainability of the observed effects was not assessed, as follow-up data were not collected. Consequently, while our findings suggest potential benefits of the combined SS+TS intervention, the duration of these effects remains unknown.

Third, the study’s modest sample size may limit the power to detect small effect sizes. Further research with larger sample sizes and extended follow-up periods is needed to validate these preliminary findings. Furthermore, exploring the impact of the SS+TS intervention on medication use, particularly for mental health conditions, as well as on sleep quality among nursing home residents, would provide additional valuable insights into the intervention’s effectiveness.

Our study highlights the therapeutic potential of the combined SS+TS intervention for managing pain and enhancing the physical and mental well-being of older adults in nursing homes. The results indicate that this intervention not only improves key health outcomes but also has the potential to reduce reliance on medications, addressing concerns related to polypharmacy. The scalability and ease of implementation make SS+TS a valuable nonpharmacological option for nursing homes, potentially enhancing patient care and resource efficiency. Future research should focus on larger-scale studies and long-term follow-up to confirm these findings and explore the broader applicability of the intervention.