Effectiveness of Nurse-Led Case Management in Community Settings Among Older Adults: A Systematic Review and Meta-Analysis.

چکیده اصلی

INTRODUCTION: Integrated, people-centred care requires continuity and coordination across services, and nurses increasingly contribute to case management; however, evidence on its effectiveness for older adults living at home remains limited. This systematic review aimed to evaluate the effectiveness of nurse-led case management for community-dwelling older adults compared with usual care. METHODS: PubMed, CINAHL, Embase and the Cochrane Central Register of Controlled Trials were searched from inception to 13 August 2025, for randomised controlled trials comparing nurse-led case management with usual care among community-dwelling older adults with frailty or risk of functional impairment. Primary outcomes were institutionalisation, hospital admissions and mortality. Secondary outcomes included quality of life, emergency department visits, physical function, costs, client satisfaction and days living at home. This review was reported in accordance with PRISMA 2020. RESULTS: Fifteen trials involving 7995 participants were included. The evidence was of very low certainty for institutionalisation, mortality and hospital admissions, with pooled estimates indicating little to no difference. Nurse-led case management probably results in a slight improvement in the physical aspect of quality of life (SMD 0.08, 95% CI 0.00-0.15; moderate certainty). It probably also results in a slight improvement in the mental aspect of quality of life, although the confidence interval included no effect and probably results in little to no difference in physical function. Evidence regarding emergency department visits was of very low certainty. CONCLUSION: The evidence for the effects of nurse-led case management on institutionalisation, hospital admissions and mortality was of very low certainty. Nurse-led case management probably results in a slight improvement in the physical aspect of quality of life, although the clinical importance of this effect remains uncertain. Implementation and evaluation should align with the current uncertainty regarding healthcare utilisation outcomes and include patient-reported outcomes alongside utilisation outcomes. Future research and policy evaluation should use frameworks that assess long-term continuity and coordination of care and system-level impacts, in addition to individual health outcomes. IMPLICATIONS FOR PRACTICE: Nurse-led case management may yield a small improvement in physical quality of life for community-dwelling older adults, while effects on institutionalization, hospital admissions and mortality should be interpreted cautiously because the certainty of evidence is very low. Routine evaluation of nurse-led case management should include patient-reported outcomes, such as quality of life, alongside healthcare utilization outcomes. TRIAL REGISTRATION: PROSPERO: CRD420251114141.

ترجمه فارسی چکیده

مقدمه: مراقبت‌های یکپارچه و متمرکز بر افراد نیازمند پیوستگی و هماهنگی میان خدمات است و پرستاران به طور فزاینده‌ای در مدیریت موردی مشارکت دارند؛ با این حال، شواهد مربوط به اثربخشی آن برای سالمندان ساکن در منزل محدود است. این مرور سیستماتیک هدف ارزیابی اثربخشی مدیریت موردی توسط پرستار در مقایسه با مراقبت معمول برای سالمندان ساکن در جامعه را داشت. روش‌ها: از آغاز تا ۱۳ اوت ۲۰۲۵ در پایگاه‌های PubMed، CINAHL، Embase و Cochrane Central Register of Controlled Trials جستجو شد. نتایج: پانزده آزمایش شامل ۷۹۹۵ شرکت‌کننده وارد شد. شواهد برای سکونت در موسسات، مرگ‌ومیر و بستری در بیمارستان بسیار پایین‌سطح بود. مدیریت موردی توسط پرستار احتمالاً منجر به بهبود جزئی در جنبه فیزیکی کیفیت زندگی می‌شود. نتیجه‌گیری: شواهد برای اثرات بر سکونت در موسسات و مرگ‌ومیر بسیار پایین‌سطح است.

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