University Centre for Primary care and Public Health (Unisanté) (Mueller, Schwarz, Locatelli, Senn) and Service of Geriatric Medicine and Geriatric Rehabilitation (Monod), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
CMAJ. 2021 Aug 23;193(33):E1289-E1299. doi: 10.1503/cmaj.202887.
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.
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.
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%, = 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%, = 0.3).
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.
ClinicalTrials.gov, NCT02618291.
尽管评估老年综合征在老年人中越来越受到鼓励，但几乎没有证据支持全科医生（GP）系统地使用这种方法。本研究旨在确定 GP 进行系统的老年评估是否可以预防功能下降。
我们在瑞士的 42 家全科诊所进行了一项对照、开放标签、实用的集群随机试验。参与的全科医生预计将招募平均 10 名居住在社区的成年人（年龄≥75 岁），他们懂法语，并在过去一年中至少两次看过全科医生。干预措施包括 GP 每年评估 8 种老年综合征，并根据评估结果制定相应的个性化管理计划，与常规护理进行比较。我们的主要结局是 2 年内至少失去 1 项工具性日常生活活动（ADL）和至少失去 1 项基本 ADL 的患者比例。我们的次要结局是使用世界卫生组织生活质量工具的老年人模块测量的生活质量评分，以及医疗保健的使用。
42 名全科医生招募了 429 名参与者（63%为女性），招募时的平均年龄为 82.5 岁（标准差为 4.8 岁）。其中，我们随机将 217 名参与者分配到干预组，212 名参与者分配到对照组。在研究过程中，干预组和对照组至少失去 1 项工具性 ADL 的患者比例分别为 43.6%和 47.6%（风险差异-4.0%，95%置信区间[CI]为-14.9%至 6.7%，=0.5）。至少失去 1 项基本 ADL 的患者比例在干预组和对照组分别为 12.4%和 16.9%（风险差异-5.1%，95%CI 为-14.3%至 4.1%，=0.3）。
与常规护理相比，在全科医生诊所系统地进行每年一次的老年评估和相应的管理计划并不能显著减少社区居住的老年患者的功能下降。
ClinicalTrials.gov，NCT02618291。
