Multidimensional assessment has been advocated as the most appropriate typeof screening activity for elderly people. The emphasis has traditionally been onscreening for problems with function, disability and dependency in order toidentify service and treatment needs. Several randomised trials ofmultidimensional assessment have been conducted. The UK trials have beenconducted in the setting of general practice, while trials in other Europeancountries as well as the US have targeted elderly people living in thecommunity. Although there appear to be possible benefits frommultidimensional assessment, for example in reduced mortality, disability andhospital inpatient admissions, these trials have not been consistent in theirfindings, nor have they been large enough to produce results of sufficientprecision and certainty to inform policy. There is stronger evidence thatmultidimensional assessment can prevent falls but the size of the benefit forserious falls is quite small. The UK health policy of regular assessment of peopleaged 75 years and above to be carried out in general practice has beenimplemented haphazardly with little guidance on appropriate methods andlevels of assessment. A large randomised trial is currently underway in the UKwhich will provide evidence on the cost effectiveness of a range of differentstrategies for assessment.
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