The MRC trial of assessment and management of older people in the community: objectives, design and interventions [ISRCTN23494848]

AE Fletcher¹ , DA Jones² , CJ Bulpitt³ and AJ Tulloch⁴

¹Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK

²University Department of Geriatric Medicine, Llandough Hospital, Penlan Rd, Penarth, Cardiff, CF64 2XX, UK

³Section of Care of the Elderly, Faculty of Medicine, Imperial College, Hammersmith Campus, Du Cane Road, London W12 ONN, UK

⁴Unit of Health Care Epidemiology, Institute of Health Sciences, University of Oxford, OX3 7LF, UK

author email corresponding author email

BMC Health Services Research 2002, 2:21doi:10.1186/1472-6963-2-21


Published:	25 October 2002

Abstract

Background

The benefit of regular multidimensional assessment of older people remains controversial. The majority of trials have been too small to produce adequate evidence to inform policy. Despite the lack of a firm evidence base, UK primary care practitioners (general practitioners) are required to offer an annual health check to patients aged 75 years and over.

Design

Cluster-randomised factorial trial in primary care comparing a package of assessments (i) universal versus targeted assessment and (ii) management by the primary care team (PC) or a multidisciplinary geriatric assessment team (GM). The unit of randomization is the general practice.

Methods

Older people aged 75 and over eligible for the over 75s health check and excluding those in nursing homes or terminally ill were invited to participate. All participants receive a brief assessment covering all areas of the over 75s check. In the universal arm all participants also receive a detailed health and social assessment by a study nurse while in the targeted arm only participants with a pre-determined number and range of problems at the brief assessment go on to have the detailed assessment. The study nurse follows a standard protocol based on results and responses in the detailed assessment to make referrals to (i) the randomised management team (PC or GM) (ii) other medical services, health care workers or agencies (iii) emergency referrals to the GP. The main outcomes are mortality, hospital and institutional admissions and quality of life. 106 practices and 33,000 older people have been recruited to the trial.