Answer:
There appear to be possible benefits from multidimensional
assessment of elderly people, for example in mortality, reduced hospital
bed days, and measures of disability, the trials have not been consistent
in their findings, nor have they been large enough to produce results of
sufficient precision and certainty to inform policy decisions. There is
stronger evidence that multidimensional assessment can prevent falls but
the size of the benefit for serious falls is quite small.
Existing trials of multidimensional assessment demonstrate a range of
methodological problems. The studies conducted in general practice used
within-practice individual randomisation and this may have resulted in
'contamination' of the control group, with dilution of benefits. Most of
the European trials suffered from 'black box' effects: the intervention was
described in such general terms that it was not clear exactly what it
comprised. This was particularly problematic for the trial by Hendriksen
and colleagues which showed the greatest benefit. A detailed description
of the assessment protocol and follow-up was given in only one
European trial14
. The US trials of geriatric screening were conducted in
956 British Medical Bulletin.
