Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial.
BACKGROUND
The benefit of multidimensional assessment and management of older people remains controversial. Most trials have been too small to produce adequate evidence to inform policy. We aimed to measure the effects of different approaches to assessment and management of older people.


METHODS
We undertook a cluster-randomised factorial trial in 106 general practices (43219 eligible patients aged 75 years and older, 78% participation), comparing (1) universal versus targeted assessment and (2) subsequent management by hospital outpatient geriatric team versus the primary-care team. All participants received a brief multidimensional assessment followed by a nurse-led in-depth assessment in the universal group, whereas in the targeted group the in-depth assessment was offered only to those with problems established at the brief assessment. Referrals to the randomised team (geriatric management or primary care), other medical or social services, health-care workers, or agencies, and emergency referrals to the general practitioner were based on a standard protocol at the in-depth assessment. The primary endpoints were mortality, admissions to hospital and institution, and quality of life. Analysis was by intention to treat and per protocol. This trial has been assigned the International Standardised Randomised Controlled Trial Number ISRCTN23494848.


RESULTS
Mortality and hospital or institutional admissions did not differ between groups. During 3 years' follow-up, significant improvements in quality of life resulted from universal versus targeted assessment in terms of homecare, and from management by geriatric team versus primary-care team, in terms of mobility, social interaction, and morale. However, only the result for social interaction was consistent with a small but important effect.


CONCLUSIONS
The different forms of multidimensional assessment offered almost no differences in patient outcome.
Fletcher
Astrid E
AE
Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London, UK. astrid.fletcher@lshtm.ac.uk
Price
Gill M
GM
Ng
Edmond S W
ES
Stirling
Susan L
SL
Bulpitt
Christopher J
CJ
Breeze
Elizabeth
E
Nunes
Maria
M
Jones
Dee A
DA
Latif
Amina
A
Fasey
Nicola M
NM
Vickers
Madge R
MR
Tulloch
Alistair J
AJ
D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D005194:Family Practice; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics; D006760:Hospitalization; D006801:Humans; D007326:Institutionalization; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D011320:Primary Health Care; D011788:Quality of Life; D012017:Referral and Consultation; D012947:Social Work; D006113:United Kingdom