Multicomponent nursing interventions and frailty-related outcomes in older adults: An integrative review of primary studies and evidence syntheses.

Background: Frailty is a prevalent, dynamic and potentially modifiable syndrome in older adults, and nurses are increasingly involved in leading, delivering and coordinating the multicomponent interventions studied for this population. However, the typology of these interventions, the changes in frailty-related outcomes they report, the specific contributions of nurses, and the representation of low- and middle-income country evidence have not been integrated across diverse study designs. Objective: To integrate quantitative, qualitative and review-level evidence on nurse-led, nurse-delivered or nurse-coordinated multicomponent interventions for frailty in adults aged 60 years or older, and to characterise the nurse's role and the reported changes in frailty-related outcomes. Design: Integrative review following the Whittemore and Knafl (2005) framework, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and prospectively registered (Open Science Framework). Methods: Scopus and PubMed were searched on 15 January 2026 (316 records). In response to peer review, the search strategy was redesigned to remove overly restrictive requirements, broaden frailty terminology and separate the exercise and nutrition concepts; the revised PubMed strategy was re-run on September 2026 (13,663 records, screened in full), and verification searches were executed in EBSCOhost and SpringerLink. Backward citation searching of retained evidence syntheses was performed. All previously included studies were re-adjudicated at the full-text level against revised operational criteria requiring a documented frailty, pre-frailty or validated frailty-risk criterion and a defined minimum level of nursing involvement. Full texts were obtained for all retained primary studies. Methodological quality was appraised with the Mixed Methods Appraisal Tool (2018) using design-specific criteria, and evidence syntheses were appraised separately. The 23 retained primary studies constitute the principal analytic corpus; the 12 evidence syntheses are reported in a separate contextual section. Results: Of 316 records identified in the original search (273 screened after duplicate removal), 32 reports previously judged eligible were re-adjudicated. The updated PubMed search identified 13,663 records; after automated removal of 252 ineligible publication types, 13,411 records were screened, 44 reports were sought for retrieval, 23 were not retrieved and 21 were assessed at full text, of which 12 were excluded and 9 met all eligibility criteria. Thirty-five studies were included: 23 primary studies (9 randomised trials, 7 quasi-experimental, 3 mixed-methods, 4 observational) and 12 evidence syntheses. Six reports were excluded at re-adjudication: four lacked a documented frailty or pre-frailty criterion and two could not be obtained as full texts. Across the primary corpus, one trial reported a significant between-group categorical transition from pre-frailty toward robust status, three reported significant between-group improvements in validated continuous frailty scores, two quasi-experimental studies reported significant between-group improvements in non-validated or composite frailty scores, one pilot trial found no significant between-group effect, and four studies reported within-group improvements without between-group testing. Ten studies did not assess frailty status as an outcome. Five themes were generated: (1) a typology of multicomponent nursing interventions; (2) frailty outcomes and reported changes in frailty status; (3) the nurse's role and competencies; (4) implementation barriers and facilitators; and (5) geographic distribution of the evidence. Conclusions: Nurse-led, nurse-delivered and nurse-coordinated multicomponent interventions show promising associations with improvements in some frailty-related outcomes in controlled studies, most consistently for pre-frail community-dwelling older adults. The available evidence does not yet establish that nursing interventions reverse frailty trajectories, and effect estimates have not been pooled. Evidence from low- and middle-income countries remains very limited.