Psychosocial and rehabilitation interventions and health gains in older persons in long-term care: A systematic review

Abstract

Background: Global aging and the rising global prevalence of multimorbidity contribute to increasingly complex and substantial long-term healthcare needs. Person-centred psychosocial and rehabilitation interventions targeting older adults are essential in addressing these challenges effectively. Objective: To identify person-centred psychosocial and rehabilitation interventions targeting older adults in long-term care and the health gains associated with these interventions. Study design: Systematic literature review of randomized controlled trials with narrative synthesis. Methods: Included studies were: (1) those with older adults (65+) in long term care with multimorbidity; (2) studies comparing person-centred rehabilitation and/or psychosocial interventions with usual care; and (3) those reporting outcomes indicating a positive change or stabilization of health trajectories, including improved mental health, maintained or slowed decline in functioning, and enhanced well-being. The risk of bias was assessed using the Cochrane RoB 2 tool. Data sources: Database searches (Pubmed, CINAHL ultimate, MedicLatina, SPORTDiscus, MedLine Ultimate, Psychology and Behavioral Sciences Collection, CENTRAL, LILACS, ClinicalTrials.gov and Google Scholar) and manual searches were conducted, with the final search performed in June 2025. Results: Eighteen studies involving 9132 participants were included, identifying and normalizing 51 person-centred interventions using the International Classification for Nursing Practice taxonomy, categorized as psychosocial (15), rehabilitation (15), and complementary (21). Psychosocial interventions demonstrated consistent effectiveness across diverse long term care contexts, notably in improving symptom management in palliative care and health-related quality of life. Rehabilitation interventions, particularly when integrated with psychosocial components, showed robust improvements in health-related quality of life among participants with clear potential for functional stabilization or improvement. Significant heterogeneity was observed among the included interventions, populations, and care settings, limiting direct comparisons and quantitative synthesis. The strongest and most methodologically robust evidence was specifically observed in interventions implemented among frail and complex multimorbid older adults. Conclusions: The identified person-centred interventions effectively address complex health needs in older adults with multimorbidity. Psychosocial approaches demonstrated broad effectiveness, while rehabilitation interventions were most beneficial for participants with clear potential for functional improvement. These findings highlight the importance of integrating these approaches within multidisciplinary long term care models. Key limitations include the inability to conduct a quantitative synthesis due to heterogeneity and a focus on high-income countries. Future research should assess the cost-effectiveness, sustainability, and applicability of these interventions across diverse settings to inform clinical practice and policy development in long term care. Registration: PROSPERO, CRD42022363860, registered in October 2022.