Evaluating effectiveness and implementation of digital health interventions for older adults with cognitive frailty: A systematic review and meta-analysis

OBJECTIVE: To evaluate the effectiveness and implementation of digital health interventions compared with control group for older adults with cognitive frailty. METHODS: We conducted a systematic review of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs), searching ten electronic databases and grey literature sources from their inception to 17 March 2024, with an update performed on 15 March 2025. The standardized mean difference (SMD) with 95 % CIs was calculated. The methodological quality was assessed by the Cochrane RoB2 and ROBINS-I. RESULTS: Eleven RCTs and two NRSIs with a total of 1069 participants were included. The meta-analysis showed that the digital health intervention among older adults with cognitive frailty significantly increased global cognitive function (SMD = 0.58, 95 %CI = 0.32, 0.83, P < 0.001), executive function (SMD = -0.54, 95 %CI =-0.99, -0.09, P = 0.02) and physical domain of quality of life (PCS) (SMD = 0.30, 95 %CI = 0.06, 0.55, P = 0.01), and decreased frailty (SMD = -0.41, 95 %CI = -0.81, -0.01, P = 0.04), depressive symptom (SMD =-0.41, 95 %CI =-0.73, -0.08, P = 0.01). RoB2 assessment revealed that six RCTs were rated as high risk, four as low risk, and one as some concerns. Additionally, two NRSIs were assessed as moderate risk using the ROBINS-I tool. CONCLUSIONS: Digital health interventions targeting older adults with cognitive frailty have demonstrated effectiveness in improving cognitive function, mental health, and PCS, as well as reducing frailty. High-quality research is warranted to bolster the evidence in these fields in the future.