Effectiveness, Process, and Economic Outcomes of Integrated Care for Community‐Dwelling Frail Older Adults: A Systematic Review and Meta‐Analysis

ABSTRACT

Aims

To assess the effectiveness, process, and economic outcomes of integrated care for community-dwelling frail older adults.

Design

A systematic review and meta-analysis.

Data Sources

We searched nine databases, including PubMed, Web of Science, CINAHL, Embase, the Cochrane Library, CNKI, SinoMed, Wanfang, and VIP, three trial registers, grey literature, and reference lists up to April 2024, with an updated search in March 2025.

Review Methods

Randomised controlled trials and non-randomised studies of interventions involving integrated care for community-dwelling frail older adults were included. Data analysis was conducted using the Comprehensive Meta-Analysis software.

Results

This review included 12 studies involving 6819 community-dwelling frail older adults from high-income regions. The results indicated that integrated care had significantly positive effects on frailty and functional ability, but not on social function, hospitalisation, nursing home admission, quality of life, and mortality. Outcomes of caregivers and professionals were rarely reported. The cost-effectiveness of integrated care has not been confirmed by limited evidence. Few studies have adopted a systematic approach to designing and conducting comprehensive process evaluations guided by scientific frameworks.

Conclusion

Integrated care improves frailty and functional ability in community-dwelling frail older adults but lacks consistent benefits for other outcomes. The lack of evidence on cost-effectiveness and the caregiver and professional outcomes highlight critical gaps in current research. The absence of systematic process evaluations underscores the need for future studies to adopt rigorous frameworks to assess them.

Impact

This implicates that more research, particularly in underserved regions that lack a high standard of usual medical services, should emphasise the outcomes of caregivers and healthcare professionals, process evaluation, and health economics. Policymakers and practitioners must consider these gaps when implementing integrated care programmes to ensure equitable and sustainable healthcare solutions.

Reporting Method

PRISMA 2020 Checklist.

Patient or Public Contribution

No patient or public contribution.

PROSPERO Registration Number

CRD42024568811