Meaghan A Kennedy1,2, Kayla E Hatchell2, Peter R DiMilia2, Stephanie M Kelly3, Heather B Blunt4, Pamela J Bagley4, Michael A LaMantia5, Charles F Reynolds6, Rebecca S Crow7,8, Tara N Maden9, S Logan Kelly10, Jacqueline M Kihwele11, John A Batsis12. 1. New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA. 2. Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. 3. Health Unit, Mathematica, Cambridge, Massachusetts, USA. 4. Biomedical Libraries, Dartmouth College, Hanover, New Hampshire, USA. 5. Division of Geriatric Medicine, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA. 6. Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 7. Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. 8. Geriatrics and Extended Care, Veterans Affairs Medical Center, White River Junction, White River Junction, Vermont, USA. 9. Analytics Institute, Dartmouth-Hitchcock Clinic, Lebanon, New Hampshire, USA. 10. Center for Health Care Strategies, Inc., Hamilton, New Jersey, USA. 11. Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. 12. Division of Geriatric Medicine and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
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.
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.
Authors: Maria Panagioti; David Reeves; Rachel Meacock; Beth Parkinson; Karina Lovell; Mark Hann; Kelly Howells; Amy Blakemore; Lisa Riste; Peter Coventry; Thomas Blakeman; Mark Sidaway; Peter Bower Journal: BMC Med Date: 2018-05-30 Impact factor: 8.775
Authors: Jennifer C Davis; Chun Liang Hsu; Cheyenne Ghag; Samantha Y Starkey; Patrizio Jacova; Larry Dian; Naaz Parmar; Kenneth Madden; Teresa Liu-Ambrose Journal: Qual Life Res Date: 2022-07-07 Impact factor: 3.440
Authors: Yan Du; Neela Patel; Arthur Hernandez; Maria Zamudio-Samano; Shiyu Li; Tianou Zhang; Roman Fernandez; Byeong Yeob Choi; William M Land; Sarah Ullevig; Vanessa Estrada Coats; Jessh Mondesir Mavoungou Moussavou; Deborah Parra-Medina; Zenong Yin Journal: JMIR Form Res Date: 2022-09-13