The paper reports that the HQP model of community-based nurse care management appeared to reduce all-cause mortality in chronically ill older adults. In the randomized controlled trial, 86 of 867 intervention participants (9.9%) died versus 111 of 863 control participants (12.9%) during a mean follow-up of 4.2 years.

This review provides a history of CHW integration with health care in the United States; describes evidence of the impact of CHW programs on population health, experience, costs of care, and health equity; and identifies considerations for CHW program expansion. Several studies have demonstrated that CHWs can improve the management of chronic conditions, increase access to preventive care, improve patients’ experience of care, and reduce health care costs. The pooled analysis from three RCTs of a CHW intervention with low-income adults in Philadelphia demonstrated a 34% reduction in total hospital days and shorter mean length of stay, and a study of Hispanic adults in Texas with type 2 diabetes projected that CHW support led to gains in quality-adjusted life years at costs below typical cost-effectiveness thresholds.

Community-based prevention interventions focus on population health and, in addition, may address changes in the social and physical environment, involve intersectoral action, highlight community participation and empowerment, emphasize context, or include a systems approach.[7] Population health in the United States improved dramatically because of these community-based efforts.[7] As a result of these efforts as well as improvements in clinical prevention, chronic diseases and injuries have replaced communicable diseases as the leading causes of illness and mortality in the United States.[7]

In this randomized trial, the HQP model of community-based nurse care management appeared to reduce all-cause mortality in chronically ill older adults. The abstract reports a 25% lower relative risk of death (hazard ratio 0.75, 95% CI 0.57-1.00) and no suspected program-related adverse events.

In 20 randomized controlled trials with 9,455 participants, community-based complex interventions involving holistic assessment and care planning **reduced mortality in older adults** (risk ratio 0.86; 95% CI 0.77–0.96; p=0.007; I²=9%), rated as **high-quality evidence**.[2] The authors conclude that "complex interventions involving holistic assessment and care planning increased the chance of living at home, **reduced mortality** and improved cognitive function and some ADLs" for community-dwelling older adults.[2] These trials were conducted in community settings and target the general older adult population living at home rather than institutionalized patients.[2]

For example, the first line shows that under the Status Quo, persons in the Birth cohort who are healthy at birth average 67.87 healthy years and 9.51 sick years, summing to 77.38 years of life (life expectancy).[3] Table 3 shows that if λ = 1 and α = .10 (if all of the initially sick enrollees become healthy and the probability of becoming sick decreases by 10%), this would increase years of healthy life (YHL) by 1.041 years and increase years of life (YOL) by .544 years, while decreasing years of sick life (YSL) by .497 years.[3] Interventions aimed at keeping persons healthy increased longevity and years of healthy life, while decreasing morbidity and medical expenditures.[3]

The study investigated whether a community-based nursing intervention improves longevity and cardiovascular risk factors in chronically ill older adults. The trial enrolled about 2,000 participants, and the control group received usual care without a nurse care manager.

We found evidence for the benefits of working with CBHWs in chronic disease prevention and management among populations at risk for health disparities. Compared with no intervention or other alternatives, partnering with CBHWs tended to result in increasing screening tests for breast, cervical, and colorectal cancers; decreasing blood pressure, blood glucose, and weight; and promotion of exercise in study samples. In several studies reporting costs, CBHWs tended to save costs as well. Our findings support the benefits of working with CBHWs in promoting health among people who are at risk for health disparities, although most studies did not include long-term outcomes such as mortality or life expectancy.

This BMJ systematic review and meta-analysis assessed "community based complex interventions to sustain independence in older people" living in the community.[3] The authors report moderate-certainty evidence that “multifactorial action and review with medication review” **probably results in a slight increase in the odds of living at home** (odds ratio 1.22, 95% CI 0.93 to 1.59).[3] The review found mixed and mostly low- to very low-certainty evidence regarding service outcomes such as hospital admission and care home placement, and did not directly evaluate life expectancy or long-term survival for the general adult population.[3]

This brief surveys the evidence on successful interventions designed to address social determinants of health (SDOH) and the health-related social needs (HRSNs) of people at various points in the lifespan.[6] In a study that examined the contribution of clinical care, health behaviors, social and economic factors, and physical environmental factors to health burden and life expectancy, social and economic factors accounted for two of the three largest impacts on health and life expectancy.[6] Experiencing poverty or near poverty imposed the greatest burden and lowered quality-adjusted life expectancy more than any other risk factor, with 8.2 QALYs lost per person exposed over his or her lifetime.[6] The Health Impact in 5 Years (HI-5) initiative highlights non-clinical, community-wide approaches that have evidence for reporting positive health impacts within five years.[6]

Fourteen studies (41%) demonstrated a statistically significant decrease in ED visits, hospitalizations, or urgent care visits among patients who received a CHW intervention, relative to a randomized control, baseline measure, or observational cohort. An additional three studies reported positive results for these outcome measures, but did not calculate statistical significance. Of the studies that reported overall costs, the majority found that the CHW interventions were cost saving, and all studies that measured the per-patient annual cost indicated that interventions are low cost, less than $1500 per patient per year. Because of the variability in interventions, outcomes, and study quality, our findings do not allow us to draw firm conclusions about the effects of CHW interventions on costs or healthcare utilization.

CHWs can improve the management of chronic conditions, increase access to preventive care, improve patients’ experience of care, and reduce health care costs. In the United States, most CHW interventions have focused on people with chronic health conditions, and there is strong evidence for CHW effectiveness in improving both health behaviors and health outcomes related to chronic disease. A pooled analysis from three RCTs of a CHW intervention with low-income adults in Philadelphia demonstrated a 34% reduction in total hospital days and shorter mean length of stay. A study of Hispanic adults in Texas with type 2 diabetes projected that CHW support led to gains in quality-adjusted life years for costs lower than the typical cost-effectiveness threshold of $50,000.

This scoping review examined "the impact of community-based food interventions on older adults’ health, well-being, and social connectedness" and included 40 studies.[4] The review concludes that community-based food interventions "successfully improved **dietary quality, social connections, and overall mental and physical well-being** of older adults," with more significant benefits when interventions promote social bonding and a sense of belonging.[4] While the review documents improvements in multiple health-related domains, it does **not report direct evidence of increased life expectancy or reduced mortality** as outcomes of these community-based interventions.[4]

Across 91 publications representing 85 independent randomized controlled trials, community-based interventions such as physical activity programs, cognitive and psychological support, multidomain models, nutrition interventions, social engagement initiatives, and rehabilitation strategies were generally associated with improvements in functional ability, mobility, cognitive performance, mental well-being, and social participation. The review emphasizes independence-related outcomes, not a demonstrated increase in life expectancy for the general adult population.

This systematic review of 61 studies on community-based palliative care (CBPC) programs found that, overall, quantitative articles indicate CBPC programs are associated with "fewer hospitalizations, fewer emergency department visits, decreased hospital length of stays, improved quality of life, and lower health care costs" for seriously ill patients in the community.[5] The review notes that CBPC "increase the likelihood that seriously ill patients in their community have their place of death as home" and often improve patient-centered outcomes, but the included studies rarely measure **life expectancy** directly, and some programs were unsuccessful in improving stated outcomes.[5] These findings show that certain community-based health models can affect end-of-life care patterns and health service use, yet the evidence base is not designed to estimate changes in overall population life expectancy.[5]

This systematic review and meta-analysis of older adults living alone found that community-based interventions had substantial effects on health behavior and mental health, with the strongest results for nutrition and combined approaches. The paper does not report a clear life-expectancy or all-cause mortality benefit for the general adult population.

Field research has now demonstrated that the programs using CHWs can make important contributions to improving health- and nutrition-related behaviors, increasing utilization of key preventive and curative health services, and diagnosing and treating serious illnesses at the community level, all with beneficial effects on population health. When CHWs provide various combinations of these interventions together, often along with other types of primary health care services, reductions in under-five mortality have been achieved. Using a technique called the Lives Saved Tool (LiST) and assuming that the mortality impact of interventions that CHWs can provide is maintained as interventions are scaled up, we have estimated that if CHW interventions are scaled up to universal coverage in high-mortality settings, substantial reductions in child mortality would occur, though most studies have focused on maternal and child outcomes rather than adult life expectancy.

Community engagement was found to improve outcomes across various dimensions within public health interventions.[1] The meta-analysis revealed a statistically significant positive impact on health-related behavior, health outcomes, sense of self-efficacy among participants, and broader community and social determinants of health.[1] Interventions involving community members in the delivery process demonstrated greater outcomes compared to those involving community members in the design or evaluation phases.[1] This meta-analysis offers robust statistical evidence supporting the positive impact of incorporating community engagement activities within health interventions.[1]

This systematic review evaluates whether and how different types of interventions within community-based settings could benefit specific aspects of older adults' health. The accessible summary indicates a focus on healthy aging outcomes rather than a direct mortality or life-expectancy endpoint.

Programs involving community health workers (CHWs) in the United States have increased the proportion of patients with controlled blood pressure. This study highlights the potential benefits of involving CHWs in improving hypertension management in a developing country (Indonesia), supporting the findings of previous studies focusing on the role of CHWs in hypertension management. Members of the elderly program reported various benefits, such as a healthier feeling overall, peer support, and access to affordable health care. The life expectancy of Indonesians has increased by more than 20 years from 49.2 years in 1960 to 70.6 years in 2012, although this ecological observation cannot be attributed solely to CHW programs.

Existing studies on CHWs focus on assessing their effectiveness in improving health outcomes, reducing healthcare costs, and bridging the gap in health disparities. Interventions by CHWs appear more effective when compared with alternatives and are cost-effective for certain health conditions, particularly among underserved communities. Reported outcomes include increased likelihood of obtaining primary care, increased mental health improvements, reduced likelihood of multiple 30-day readmissions, improved disease self-management, and lower hospitalization rates. However, most of these studies measure intermediate outcomes such as utilization, disease control, or quality of life, rather than direct changes in all-cause mortality or life expectancy in the general adult population.

This U.S. Preventive Services Task Force/AHRQ article describes how "major improvements in health have occurred as a result of effective health care and **clinical and community-based preventive interventions**" targeting conditions such as tobacco use and obesity.[6] The authors state that "improvements can be made through effective prevention strategies" and advocate integrating evidence-based clinical services with community-level interventions to address the burden of preventable disease and injury.[6] Although the paper argues that community-level strategies are important contributors to population health, it does **not quantify their independent impact on life expectancy in the general adult population**.[6]

Below are examples of successful community-based interventions that these and other primarily publicly-funded programs have supported.[2] One statewide tobacco control program was projected to result in almost 8,000 fewer tobacco-related deaths and $300 million in averted medical costs.[2] In a diabetes management program, improvements in blood sugar control were predicted to result in an 8% reduction in diabetes deaths, a 6% reduction in heart attacks, a 5% reduction in stroke, a 17% reduction in amputations, and a 10% reduction in renal failure.[2] Another community cardiovascular risk reduction program reported a 5.4% reduction in 10-year estimated chronic heart disease risk and a 7.5% reduction in five-year estimated cardiovascular disease risk.[2]

In two separate randomized trials, the IMPaCT community health worker model has been shown to improve outcomes. In the first study of 450 hospitalized patients, the intervention improved discharge communication, access to primary care, and mental health, and reduced 30-day readmissions. In a second randomized trial, the intervention reduced hospitalization and improved outcomes in uninsured or publicly insured patients with multiple chronic conditions. Based on the reduction in hospitalizations, the researchers estimate a return on investment of $2 for every $1 spent on IMPaCT, indicating potential long-term benefits, though the trials did not directly measure life expectancy.

The findings of this study reveal that community-based interventions had a substantial impact on health behavior, with a large effect size, along with a moderate effect size on mental health and perceived health.[4] Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 and 0.43, respectively, and the overall effect size for interventions was 0.38.[4] These results suggest that the interventions were successful in promoting healthy lifestyles among older adults residing alone within their communities, implying potential long-term benefits for health and functional status, although direct impacts on mortality or life expectancy were not measured.[4]

The LIFE Study was a multicenter randomized controlled trial comparing a moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older adults. Its listed secondary outcomes included major mobility disability or death, showing that mortality was examined only as part of a composite outcome.

A 2014 systematic review investigated the impact of CHW interventions on health outcomes in older adults from ethnic minorities, noting improvements in health behaviors, disease management, and healthcare utilization. Community health worker interventions for older adults with complex health needs have been associated with better chronic disease control, reduced hospitalizations, and improved quality of life. However, the review highlighted that evidence linking CHW interventions to hard endpoints such as mortality or extended life expectancy in older adults is limited and further research is needed.

This study evaluated a community-based health intervention (CBHI) for older adults in Singapore, assessing changes in health knowledge, lifestyle goal attainment, and practices over time.[9] Participants in the CBHI demonstrated significant improvements in health knowledge and adherence to lifestyle goals (such as physical activity and diet), and reported better self-rated health after the intervention.[9] The study did not track mortality or long-term survival; thus, while it documents positive changes in proximal health outcomes in a community setting, it does **not provide evidence of increased life expectancy**.[9]

This record mirrors the PLOS Medicine randomized trial and states that community-based nurse care management was associated with lower all-cause mortality in chronically ill older adults, with an adjusted hazard ratio of 0.73 (95% CI 0.55-0.98).

IMPaCT Care describes itself as a proven approach to community health worker programs and a national center of excellence. Their published research section summarizes randomized trials showing that the IMPaCT CHW model improves patient-centered outcomes and reduces hospitalizations among high-risk adults. These studies collectively suggest that CHW interventions can influence morbidity and healthcare utilization, though they do not directly quantify changes in life expectancy.

Multiple systematic reviews and meta-analyses up to the mid-2020s consistently find that community-based health worker and related interventions improve intermediate outcomes such as chronic disease control, healthcare utilization, and quality of life in adult populations. However, very few studies are designed to measure all-cause mortality or changes in life expectancy directly, especially at the level of the general adult population; most mortality evidence relates to maternal and child health in low- and middle-income countries. As of 2026, there is no widely cited meta-analysis demonstrating a quantified increase in overall adult life expectancy attributable specifically to community health worker programs, although improved risk factor control and reduced hospitalizations are plausibly linked to longer survival.