Community Health Worker Interventions for Older Adults with Complex Health Needs: A Systematic Review

Details

• Alternative Title:
  J Am Geriatr Soc
• Personal Author:
  Kennedy, Meaghan A. ; Hatchell, Kayla E. ; DiMilia, Peter R. ; Kelly, Stephanie M. ; Blunt, Heather B. ; Bagley, Pamela J. ; LaMantia, Michael A. ; Reynolds, Charles F. ; Crow, Rebecca S. ; Maden, Tara N. ; Kelly, S. Logan ; Kihwele, Jacqueline M. ; Batsis, John A.
• Description:
  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:
  
  Older adults 60 years of age 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 5,671 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.
  
  
• Subjects:
  Aged Community Health Workers Frailty Humans Middle Aged Multimorbidity Multiple Chronic Conditions Physical Functional Performance Quality Of Life Social Support
• Keywords:
  Community Health Workers Complex Health Needs Older Adults
• Source:
  J Am Geriatr Soc. 69(6):1670-1682
• Pubmed ID:
  33738803
• Pubmed Central ID:
  PMC8263299
• Document Type:
  Journal Article
• Funding:
  T32HP30036/HRSA/HRSA HHSUnited States/ ; K23AG051681/AG/NIA NIH HHSUnited States/ ; VA/VAUnited States/ ; U48DP005018/CC/CDC HHSUnited States/ ; U48DP005018/ACL/ACL HHSUnited States/ ; K23AG043498/AG/NIA NIH HHSUnited States/ ; K23 AG051681/AG/NIA NIH HHSUnited States/ ; K23 AG043498/AG/NIA NIH HHSUnited States/
• Volume:
  69
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e0f979c19840b0b2bd86b145f11bcfe8c3f953ad78215ea39ff1dc20b06085d6
• Download URL:
  https://stacks.cdc.gov/view/cdc/107888/cdc_107888_DS1.pdf
• File Type:
  [PDF - 512.14 KB ]