London School of Hygiene & Tropical Medicine

A major Medical Research Council (MRC) trial in general practice in the UK has found that in-depth comprehensive assessment of older people is of little benefit. The results of the study are published in full in today's Lancet.

The trial, co-ordinated by researchers from the London School of Hygiene & Tropical Medicine, Imperial College London, and the Universities of Wales and Oxford took place in 106 general practices from the MRC General Practice Research Framework and included over 40,000 patients aged 75 years and over. The in-depth assessment included screening for a wide range of health and social problems. The comparison group received only a minimal assessment. A further component of the trial included a comparison of clinical management by a geriatric outpatient team compared to usual care by general practitioners and practice nurses.

After 3 years of follow-up, there were no improvements in survival or reductions in admissions to hospital, nursing or residential homes with in-depth assessment or outpatient geriatric management. There was a small benefit in social functioning from hospital-based outpatient geriatric management.

Professor Astrid Fletcher, the principal investigator of the trial, from the London School of Hygiene and Tropical Medicine, said:

"Over the last twenty years the benefits of comprehensive assessment of older people has been an area of considerable controversy with inconsistent results from previous trials in Europe and North America. Despite the lack of clear evidence in this area, government policy has favoured introducing multidimensional assessment into the care of older people, first as the over 75s checks in 1990 and more recently as part of the National Service Frameworks for Older People. The largely negative findings from our trial on the benefit of the over 75s check reinforces the importance of rigorous evaluation of policies before they are introduced".