Multicomponent Interventions for Functional Outcomes in Hospitalized Older Patients: A Systematic Review and Meta-Analysis.

OBJECTIVES

Hospitalization-associated disability (HAD) is increasingly common among older patients, and multicomponent interventions have emerged as a key strategy to address this issue. This study aimed to assess the effects of multicomponent interventions on functional outcomes in hospitalized older patients and identify critical elements that may enhance the intervention efficacy.

DESIGN

Systematic review and meta-analysis.

SETTINGS AND

PARTICIPANTS

Older patients hospitalized for acute illnesses.

METHODS

A comprehensive search was conducted across Cochrane Library, Web of Science, Embase, PubMed, and CINAHL. Eligible interventions were defined as multicomponent programs addressing at least 2 modifiable HAD risk factors. Outcomes included activities of daily living (ADLs), instrumental activities of daily living (IADLs), the Short Physical Performance Battery (SPPB) score, gait speed, and grip strength. Meta-analyses employed random- or fixed-effects models based on observed heterogeneity.

RESULTS

Twelve randomized controlled trials with 2202 participants were reviewed. Seven core intervention components were identified, including physical activity, nutrition support, cognitive stimulation, delirium management, fall prevention, depression management, and social interaction. Notably, interventions initiated during hospitalization and continued for 3 months postdischarge demonstrated the most significant improvement in ADLs [standardized mean difference (SMD), 0.41; 95% CI, 0.08-0.74], whereas multidomain interventions delivered during hospitalization showed borderline significant improvement in ADLs (SMD, 0.55; 95% CI, -0.01 to 1.11). In addition, multicomponent interventions yielded benefits in IADLs (SMD, 0.36; 95% CI, 0.05-0.66) and gait speed (SMD, 0.33; 95% CI, 0.09-0.58). Patients undergoing fracture surgery experienced greater improvements in SPPB scores (SMD, 2.57; 95% CI, 2.28-2.86) and grip strength (SMD, 1.98; 95% CI, 1.62-2.34).

CONCLUSIONS AND IMPLICATIONS: Multicomponent interventions suggest potential functional benefits in hospitalized older patients and offer valuable insights for designing future HAD programs, particularly in optimizing intervention components and timelines. Given the limited certainty of current evidence, further rigorous studies are warranted.