The impact of integrated care on quality of life in community-dwelling older adults with frailty: A systematic review and mixed method synthesis

Background Frailty among older adults is an escalating public health challenge, often associated with poorer quality of life (QoL) and increased pressure on healthcare systems. Integrated care is proposed as a strategy to meet the complex needs of this population, though evidence of its effectiveness remains inconclusive. Objectives To determine the impact of integrated care on the quality of life of frail, community-dwelling older adults. Design Systematic review and mixed-methods synthesis, including meta-analysis and narrative synthesis. Setting Community-based healthcare systems across six international studies. Participants A total of 5498 frail, community-dwelling older adults across six studies: four randomised controlled trials and two quasi-experimental designs. Intervention Integrated care interventions tailored to frailty, including person-centred, multidisciplinary, and value-based models. Measurements Quality of Life was the primary outcome. Secondary outcomes included social functioning and healthcare costs. Standardised tools such as SF-12, SF-36, ICECAP-O, and EQ-5D were used across studies. Results The meta-analysis showed a small, non-significant improvement in QoL (SMD = 0.13, 95 % CI: -0.09 to 0.35, p = 0.24) with high heterogeneity (I² = 91 %). Tailored, multidimensional models showed greater effects, particularly in preserving social functioning. Findings on cost-effectiveness were inconsistent; some studies reported reduced hospital use, while others found increased primary care visits without cost savings. Conclusions . Integrated care may support social functioning but does not demonstrate a consistent improvement in overall QoL. Future trials should standardise QoL measurement, report intervention components clearly, include economic evaluations, and assess longer-term outcomes.