•The presence of increased loudness and roughness in the soundscape of nursing homes may lead to elevated heart rate and an increased risk of cardiovascular health issues among the elderly population.•The moderate elevation of LAeq levels in the outdoor dynamic scenes within nursing homes may have a positively stimulating effect on the physiological function of older individuals.•Preference for different sound source types may have a significant effect on physiological indicators in older adults. This research explores the impact of outdoor soundscapes at nursing homes on the physiological health of older adults. Using virtual reality, the study recreated the outdoor environments at nursing homes for 57 seniors in a lab setting, continuously monitoring physiological indicators such as skin conductance level, heart rate, low to high-frequency heart rate variability ratio, respiratory frequency, blink frequency, and pupil diameter. The comparison of these indicators with corresponding soundscapes revealed the diverse effects of different nursing home outdoor scenarios on the physiological health of older adults. Furthermore, analysis of the temporal marginal effects of these indicators highlighted the significant influence of time on the physiological responses of seniors in various soundscapes, showing fluctuations in each indicator at different times. Finally, to understand the channels of impact, the study examined how acoustic features at nursing homes affect seniors' physiological indicators. The findings suggest that increased loudness and roughness in soundscapes elevate seniors' heart rates and cardiovascular risks, while a moderate increase in LAeq and fluctuation strength in dynamic scenarios might have positive stimulative effects on the physiological functions of the older adults.