Community-based interventions to support aging in place and functional independence in older adults: a systematic review of randomized controlled trials.

Background: As the global population ages, ensuring the autonomy and wellbeing of older adults living at home has become increasingly important. Supporting independence is central to aging in place, which requires access to appropriate health and social resources. In this context, community-based public health interventions may play an important role in addressing physical, cognitive, and psychosocial challenges associated with aging. Objective: This systematic review aimed to synthesize evidence from randomized controlled trials examining community-based public health interventions that promote independence among older adults and to identify key components associated with successful aging in place. Methods: A systematic review of randomized controlled trials was conducted, including 91 publications representing 85 independent randomized controlled trials, retrieved from MEDLINE/PubMed, Embase, Web of Science, CINAHL, and PsycINFO. Community-based public health interventions were defined as structured programs delivered in non-institutional settings to support health, functional ability, and autonomy among community-dwelling older adults. Data extraction included intervention characteristics, outcomes related to independence, and levels of community engagement. Outcomes were categorized as primary independence measures (e.g., ADL/IADL performance, disability status), functional capacity proxies (e.g., gait speed, balance), and psychosocial enablers of independence (e.g., self-efficacy, depressive symptoms) to support interpretive clarity. Methodological quality was assessed using the Joanna Briggs Institute checklist for randomized controlled trials. Findings were analyzed using thematic synthesis. Results: Across 91 publications representing 85 independent randomized controlled trials, 45% of publications were classified as low risk of bias, 31% as moderate, and 24% as high. 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 direct and indirect independence-related outcomes, including functional ability, mobility, cognitive performance, mental well-being, and social participation, although the magnitude and consistency of effects varied across intervention types and outcome domains. Interventions integrating multiple components and tailored delivery formats were frequently associated with improvements in functional outcomes and psychosocial enablers related to independence. Conclusion: Community-based public health interventions that address the multidimensional needs of older adults may support the maintenance of functional ability and independence in later life. Structured, scalable models that integrate physical, cognitive, and social components may strengthen aging-in-place strategies and inform future public health planning. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024596045. The study protocol was registered with PROSPERO (CRD42024596045).