Matching coordination to complexity: integrated care for older adults with multiple needs

Vollständiger Abstract

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Purpose This study aims to conduct a systematic review and meta-analysis of care coordination interventions for older adults with intersecting physical, cognitive and social needs, addressing a gap in the fragmented evidence base and the practical challenge of matching coordination to complexity. Design/methodology/approach Following PRISMA guidelines, ten controlled studies and three published syntheses (2015–2025) were identified; four randomised trials permitted back-calculation of standardised effect sizes for random-effects meta-analysis, sub-group analysis, leave-one-out sensitivity testing and triangulation against two independent syntheses. Findings The pooled effect (k = 4) was small and nonsignificant (Hedges’ g = 0.22, 95% confidence interval −0.13 to 0.58). Sub-group analysis revealed a significant divide between light-touch coordination overlays (g = −0.07) and intensive, multi-domain, technology-enabled interventions (g = 0.60; Q_between = 13.94, p < 0.001), corroborated by triangulation. Research limitations/implications The core meta-analytic sample (k = 4) is smaller than conventional standards, reported transparently rather than concealed; intensity classification was applied by the reviewers rather than a validated instrument. Practical implications Effectiveness depends on whether intervention intensity is proportionate to need complexity, with direct implications for how health systems, regional care authorities and supportive-housing providers allocate coordination resources. Social implications By showing that light-touch coordination may be insufficient for older people with intersecting physical, cognitive and social needs, this study highlights the risk of perpetuating care inequalities through under-resourced interventions. More intensive, multi-domain coordination can support independence, dignity and ageing in place while reducing burdens on carers. However, technology-enabled models must address digital exclusion among low-income, rural, cognitively impaired and homebound older adults. Equitable implementation therefore requires accessible technologies, workforce investment and coordination tailored to individual complexity. Originality/value To the best of the authors’ knowledge, this is the first quantitative synthesis to pool coordination-outcome effect sizes specifically for older adults with intersecting physical, cognitive and social needs, triangulating a small core sample against independently published evidence.