Multidimensional assessment of elderly people in the community

Multidimensional assessment has been advocated as the most appropriate type of screening activity for elderly people. The emphasis has traditionally been on screening for problems with function, disability and dependency in order to identify service and treatment needs. Several randomised trials of multidimensional assessment have been conducted. The UK trials have been conducted in the setting of general practice, while trials in other European countries as well as the US have targeted elderly people living in the community. Although there appear to be possible benefits from multidimensional assessment, for example in reduced mortality, disability and hospital inpatient admissions, these 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. There is stronger evidence that multidimensional assessment can prevent falls but the size of the benefit for serious falls is quite small. The UK health policy of regular assessment of people aged 75 years and above to be carried out in general practice has been implemented haphazardly with little guidance on appropriate methods and levels of assessment. A large randomised trial is currently underway in the UK which will provide evidence on the cost effectiveness of a range of different strategies for assessment.