Roles and functions of social workers in long-term care for older adults in East and North-East Asia: a mixed-methods systematic review since 2000

Introduction: Population ageing is accelerating in East and North-East Asia (ENEA), driving growing demand for long-term care (LTC). Social workers play a pivotal role in older adults' LTC by bridging healthcare systems and everyday life through care coordination, psychosocial support, and rights- and ethics-informed decision support. However, empirical evidence on their roles and functions in ENEA LTC remains fragmented, and region-specific synthesis is lacking. Methods: We conducted a mixed-methods systematic review of peer-reviewed English-language studies published from 2000 onward to synthesize evidence on social workers' roles and functions in older adults' LTC across institutional LTC and home- and community-based services (HCBS). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we included 24 studies from five ENEA jurisdictions (Japan, the Republic of Korea, mainland China, Hong Kong SAR, and Taiwan region). Results: We identified five core role domains: care coordination and case management; psychosocial assessment and support; communication facilitation, decision support, and rights/ethical advocacy; education and practice innovation; and organizational and systemic change. Social workers were particularly visible in dementia care, end-of-life care, and restraint governance, supporting service quality by strengthening continuity of care and person-centered decision-making. Role enactment was constrained by blurred mandates and accountability, uneven guidance and skills training, heavy administrative and compliance workloads, workforce instability, and weak organizational backing. Evidence linking these roles to resident- or system-level outcomes (e.g., quality of life, hospitalization, restraint use, institutionalization-related outcomes, or care-continuity indicators) was limited and heterogeneous, precluding causal inference. Discussion: Strengthening social work contributions in ENEA LTC requires clearer role mandates, setting-specific competency pathways, stronger organizational support and safety governance, improved cross-sector care-transition infrastructure, and an outcome-oriented evidence base using longitudinal, quasi-experimental, or implementation designs to test role–outcome pathways. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251270020, identifier: CRD420251270020.