The cluster-randomized BRIGHT trial: Proactive case finding for community-dwelling older adults.
OBJECTIVE
People are now living longer, but disability may affect the quality of those additional years of life. We undertook a trial to assess whether case finding reduces disability among older primary care patients.


METHODS
We conducted a cluster-randomized trial of the Brief Risk Identification Geriatric Health Tool (BRIGHT) among 60 primary care practices in New Zealand, assigning them to an intervention or control group. Intervention practices sent a BRIGHT screening tool to older adults every birthday; those with a score of 3 or higher were referred to regional geriatric services for assessment and, if needed, service provision. Control practices provided usual care. Main outcomes, assessed in blinded fashion, were residential care placement and hospitalization, and secondary outcomes were disability, assessed with Nottingham Extended Activities of Daily Living Scale (NEADL), and quality of life, assessed with the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF).


RESULTS
All 8,308 community-dwelling patients aged 75 years and older were approached; 3,893 (47%) participated, of whom 3,010 (77%) completed the trial. Their mean age was 80.3 (SD 4.5) years, and 55% were women. Overall, 88% of the intervention group returned a BRIGHT tool; 549 patients were referred. After 36 months, patients in the intervention group were more likely than those in the control group to have been placed in residential care: 8.4% vs 6.2% (hazard ratio = 1.32; 95% CI, 1.04-1.68; P = .02). Intervention patients had smaller declines in mean scores for physical health-related quality of life (1.6 vs 2.9 points, P = .007) and psychological health-related quality of life (1.1 vs 2.4 points, P = .005). Hospitalization, disability, and use of services did not differ between groups, however.


CONCLUSIONS
Our case-finding strategy was effective in increasing identification of older adults with disability, but there was little evidence of improved outcomes. Further research could trial stronger primary care integration strategies.
School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand n.kerse@auckland.ac.nz.
Ngaire
N
Kerse
School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Interdisciplinary Trauma Research Centre, AUT University, Auckland, New Zealand.
Chris
C
McLean
School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Simon A
SA
Moyes
School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Kathy
K
Peri
School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Terence
T
Ng
School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Laura
L
Wilkinson-Meyers
School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Health Sciences Research Institute, University of California, Merced, California.
Paul
P
Brown
Health and Disability Research Institute, Boston University, Boston, Massachusetts.
Nancy
N
Latham
Freemason's Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Martin
M
Connolly
D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living; D007407:Interviews as Topic; D008297:Male; D011788:Quality of Life / Q000523:psychology
disability; early medical intervention; older adults; population screening; practice-based research; primary care