Nurse-led, community-based interventions for people with or at risk of frailty: A rapid review

Community-based interventions are designed to address the needs of individuals living in the community, and particularly those with or at risk of frailty. Their primary aim is to support individuals to live independently in their homes. The aim of this rapid review is to identify and assess evidence on the clinical effectiveness of community-based interventions, led by nurses, for individuals with or at risk of frailty. The review includes 23 eligible studies conducted in the UK and Europe, which were published between 1984 and 2023. These studies included 16 distinct nurse-led interventions. The interventions differed considerably in factors including the procedures they used, how they were delivered and how tailored this was to individual needs, and their duration/intensity. 17 studies reported changes in activities of daily living (ADLs). One study suggested that a nurse-led rehabilitation programme for people with frailty was more likely to improve independence in personal ADLs compared to usual care. In eight studies reporting falls incidence, one study found that a nurse-led health consultation programme reduced falls incidence compared to usual care, while seven studies of other interventions found no conclusive evidence for this outcome. 13 studies reported hospital admission rates in people receiving nurse-led interventions. One study found that a nurse-led consultation programme reduced the proportion of participants experiencing hospital admissions compared to usual care, and one study found that a nurse-led surveillance programme for people with frailty was associated with fewer individuals admitted to hospital compared to usual care. We found no conclusive evidence on how any nurse-led interventions affect frailty status or progression, instrumental activities of daily living, mortality, and long-term care needs. Whilst the evidence suggests some specific types of interventions may be beneficial, the evidence is insufficient to conclude that these interventions would offer benefit if deployed. The findings could be used to explore how these interventions fit into the wider context of community care. We found no evidence suggesting that the use of nurse-led community-based interventions was detrimental when compared with usual care. Therefore, such interventions may offer added value by reducing the demand for, and/or the costs associated with, care delivered by other health care professionals. This review only studied interventions led specifically by nurses. It may be helpful to consider our findings alongside new (or existing) research into interventions delivered by wider teams of healthcare professionals.