Effectiveness and experiences of quality improvement interventions in older care: a mixed-methods systematic review

Background: The growing global population of older adults presents significant challenges for health and social care systems, requiring effective quality improvement (QI) interventions to enhance care delivery and outcomes. While various QI strategies have been implemented across care settings, evidence regarding their effectiveness and implementation experiences remains fragmented.

Objective: This mixed-methods systematic review aims to examine both the effectiveness and experiences of QI interventions designed to improve care for older adults across diverse healthcare settings.

Methods: A comprehensive search was conducted across multiple bibliographic databases and supplementary sources for studies published from 1990 onward. Studies were included if they reported an explicit QI intervention with implementation and evaluation components. Both quantitative and qualitative studies were included, and findings were synthesized using a convergent integrated approach. Data extraction and critical appraisal were conducted using established methodological frameworks.

Results: A total of 23 studies were included, comprising nine qualitative, 12 quantitative, and two mixed-methods studies. QI interventions were categorized into key domains, including education and training, communication and collaboration, technology-based interventions, person-centered care, and health and well-being promotion. Quantitative findings demonstrated improvements in outcomes such as staff competence, patient safety, quality of life, and care coordination. Qualitative findings highlighted the importance of user engagement, contextual fit, communication, and organizational support in the successful implementation of QI interventions. Technology-based interventions showed potential benefits but were highly dependent on usability, training, and integration into care practices.

Conclusion: QI interventions can improve outcomes and care experiences for older adults when implemented within supportive and context-sensitive care systems. No single intervention type is sufficient in isolation; rather, effective improvement requires a combination of strategies tailored to user needs and care contexts. Future research should focus on strengthening implementation processes and evaluating long-term sustainability across diverse settings.

Systematic Review Registration: https://doi.org/10.2196/56346.