BACKGROUND: Although assessment of geriatric syndromes is increasingly encouraged in older adults, little evidence exists to support its systematic use by general practitioners (GPs). The aim of this study was to determine whether a systematic geriatric evaluation performed by GPs can prevent functional decline.
METHODS: We conducted a controlled, open-label, pragmatic cluster-randomized trial in 42 general practices in Switzerland. Participating GPs were expected to enrol an average of 10 community-dwelling adults (aged = 75 yr) who understood French, and had visited their GP at least twice in the previous year. The intervention consisted of yearly assessment by the GP of 8 geriatric syndromes with an associated tailored management plan according to assessment results, compared with routine care. Our primary outcomes were the proportion of patients who lost at least 1 instrumental activity of daily living (ADL) and the proportion who lost at least 1 basic ADL, over 2 years. Our secondary outcomes were quality-of-life scores, measured using the older adult module of the World Health Organization Quality of Life Instrument, and health care use.
RESULTS: Forty-two GPs recruited 429 participants (63% women) with a mean age of 82.5 years (standard deviation 4.8 yr) at time of recruitment. Of these, we randomly assigned 217 participants to the intervention and 212 to the control arm. The proportion of patients who lost at least 1 instrumental ADL in the intervention and control arms during the course of the study was 43.6% and 47.6%, respectively (risk difference -4.0%, 95% confidence interval [CI] -14.9% to 6.7%, p = 0.5). The proportion of patients who lost at least 1 basic ADL was 12.4% in the intervention arm and 16.9% in the control arm (risk difference -5.1%, 95% CI -14.3% to 4.1%, p = 0.3).
INTERPRETATION: A yearly geriatric evaluation with an associated management plan, conducted systematically in GP practices, does not significantly lessen functional decline among community-dwelling, older adult patients, compared with routine care.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT02618291.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The idea of the study is interesting. It is a pragmatic study that measures the effect of screening by a GP for multiple diagnosis on preventing cognitive or functional decline among patients 75 years and older. The screening included questions about functionality, urinary incontinence, PHQ2, Mini COg, in addition to near vision pocket card and whisper test. The study did not show any benefit of the above-mentioned screening. I suppose it makes sense as the cognitive and functional decline could be more related to better control of chronic diseases that was were included in the intervention.
Physician rater
At least the authors acknowledge the weaknesses of the study and its biases. Where I work, neither the elderly population is comparable nor is the medical practice so focused on the GP. We work in multidisciplinary teams, which is a more modern way to practice medicine.
, McMaster University