10 benefits of a multidimensional assessment for older people with complex needs

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.