Community health worker interventions for older adults with complex health needs: A systematic review

Abstract

Background/Objectives The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW‐delivered interventions in older adults. Design We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English‐language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. Setting Any U.S. or international setting, including clinical and community‐based settings. Participants Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high‐utilization. Interventions Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. Measurements Pre‐defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. Results Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi‐experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low‐to‐moderate methodological quality. Outcomes included mood, functional status and disability, social support, well‐being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high‐quality RCT, while others noted no significant intervention effects on outcomes. Conclusion CHW‐led interventions may have benefit for older adults with complex health needs, but additional high‐quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence‐based interventions and improve clinical outcomes in complex older adults.

Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions.

“…Thus HMrs contribute to the opening and continuity of health coverage rights, access to care, and the reception of persons by raising the awareness of medico-social professionals, and to developing tools for health professionals [15]. HMrs create links between patients and healthcare professionals, and participate in a change of representations between the health system and a population that, because of its di culties, does not manage to access the system [10,16,17]. To our knowledge, only few studies have reported experience with or evaluated this intervention mode in emergency departments (EDs), even though they are highly concerned by persons in precarious situations [18,19].…”

Examining the Delivery of a Tailored Chinese Mind-Body Exercise to Low-Income Community-Dwelling Older Latino Individuals for Healthy Aging: Feasibility and Acceptability Study

“…FITxOlder was based on lessons learned from a previous pilot study that used an iterative process to gather input from a work group of Latino older adults in developing and tailoring the delivery of the FITxOlder program as well as the Five Animal Frolics routines [ 38 ]. For example, participants were appreciative of the group format that offered opportunities for socialization and peer support in FITxOlder [ 58 , 59 ] and the program delivery by a bilingual CHW who provided linguistically and socially sensitive support to engage the participants [ 60 ]. The findings also reflect older adults’ interest in improving quality of life and independent living beyond health indexes [ 61 ].…”

Simulation Versus Written Fall Prevention Education in Older Hospitalized Adults: A Randomized Controlled Study

“…The rate of making sustainable changes to prevent future fall events was similar between groups and both groups had a similar number of post-discharge hospitalizations. In older adults, interventions used by community health workers to decrease fall risk varied by study, were more often multifactorial, and typically included education and environmental modifications (Kennedy et al, 2021; Lee & Yu, 2020). For community-living adults 65 years and older, environmental factors were consistently identified as a primary causal factor in fall events and injuries sustained from falls (Adams et al, 2020; Stamm et al, 2016; Verma et al, 2016).…”