Effectiveness of community-based nursing care frameworks inenhancing quality of life and functional independence amongloneliness-prone older adults: A systematic review

Abstract

Population ageing has emerged as one of the most significant demographic and public health challenges of the twenty-first century. Although increased longevity represents a major achievement, many older adults experience chronic illness, functional decline, social isolation, and persistent loneliness. Loneliness is increasingly recognized as an important determinant of physical, psychological, cognitive, and functional health rather than merely an emotional consequence of ageing. Conventional hospital-centred models are often insufficient to address the multidimensional needs of community-dwelling older adults. Community-based nursing care offers a preventive and person-centred approach through home visits, comprehensive geriatric assessment, case management, health education, social prescribing, and coordinated multidisciplinary support. To systematically review the effectiveness of community-based nursing care frameworks in improving quality of life, reducing loneliness, and preserving functional independence among loneliness-prone community-dwelling older adults. A systematic review approach was used to identify and synthesize contemporary evidence on nurse-led and nurse-coordinated community-based interventions for adults aged 65 years and above who were experiencing loneliness, social isolation, or an increased risk of functional decline. Eligible interventions included preventive home visits, comprehensive geriatric assessment, nurse-led case management, social prescribing, psychosocial support, health education, transitional care, and integrated community care programmes. The principal outcomes were loneliness, health- related quality of life, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), healthcare utilization, and maintenance of independent community living. The reviewed evidence indicated that multi-component community nursing frameworks were more effective than isolated or short-term interventions. Programmes combining structured home visits, individualized assessment, case management, social engagement, and continued follow-up produced meaningful reductions in loneliness and supported improvements or stabilization in quality of life. Across the reviewed evidence, reductions of approximately 4.2–6.8 points on the UCLA Loneliness Scale were reported following comprehensive community-based interventions. Nurse-led preventive case management and comprehensive geriatric assessment were also associated with slower deterioration in ADL and IADL functioning, improved chronic disease monitoring, and reduced avoidable emergency department attendance and hospital readmission. Interventions were particularly effective when they were individualized, sustained over time, and integrated with family, primary healthcare, and community resources. Community-based nursing care represents an effective strategy for addressing the interconnected problems of loneliness, declining quality of life, and loss of functional independence among older adults. The strongest outcomes are achieved through comprehensive, multi-component frameworks that combine clinical monitoring with psychosocial and social support. Greater investment in preventive community nursing, standardized loneliness assessment, continuity of care, and integration of digital and community resources may strengthen healthy ageing and enable older adults to remain safely and independently within their communities.