Background/Objectives The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW‐delivered interventions in older adults. Design We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English‐language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. Setting Any U.S. or international setting, including clinical and community‐based settings. Participants Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high‐utilization. Interventions Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. Measurements Pre‐defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. Results Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi‐experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low‐to‐moderate methodological quality. Outcomes included mood, functional status and disability, social support, well‐being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high‐quality RCT, while others noted no significant intervention effects on outcomes. Conclusion CHW‐led interventions may have benefit for older adults with complex health needs, but additional high‐quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence‐based interventions and improve clinical outcomes in complex older adults.

Objectives To investigate the relationships between depressive symptoms and opioid potency among adults aged 50 years and older reporting use of one or more prescription opioids in the past 30 days. Materials/Design Adjusted multiple linear regression models were conducted with 2005‐2013 files from a secondary cross‐sectional dataset, the National Health and Nutrition Examination Survey (NHANES). Respondents were community‐dwelling, noninstitutionalized adults 50 years or older (n = 1036). Predictor variables included a positive screen for minor depression symptoms (Patient Health Questionnaire [PHQ‐9] score greater than or equal to 5 and less than or equal to 9), moderate depression symptoms (PHQ‐9 greater than or equal to 10 and less than or equal to 14), and severe depression symptoms (PHQ‐9 greater than or equal to 15). Criterion variables included weaker‐than‐morphine analgesics (eg, codeine and tramadol) and morphine‐equivalent opioids (eg, morphine and hydrocodone), which served as the reference category, as well as stronger‐than‐morphine opioid analgesics (eg, fentanyl and oxycodone). Results Prevalence rates for symptoms of minor depression, moderate depression, and severe depression were n = 236 (22.8%), n = 135 (13.0%), and n = 122 (11.8%), respectively. Severe depression was significantly associated with high‐potency opioid use (odds ratio [OR]: 2.27; confidence interval [CI], 1.16‐4.46). In post hoc tests, severe depression remained significantly associated with high‐potency opioid use only among respondents without arthritis (OR: 5.80; CI, 1.59‐21.13). Conclusions Compared with older adults without depressive symptoms, older adults with severe depressive symptoms are more likely to be taking high‐potency opioid medications. Future prescription opioid medication research should prioritize investigations among older adults with pain‐related diagnoses, other than arthritis, reporting preexisting or new symptoms of severe depression.