Standardised brief geriatric evaluation versus routine care for preventing functional decline in general practice: a pragmatic cluster-randomised trial, AGE3

Objective. To determine whether a systematic geriatric evaluation performed by general practitioners (GPs) that includes a brief assessment of geriatric syndromes and a management plan can prevent functional decline in older patients.
Design. Controlled, open-label, pragmatic cluster-randomised trial, randomising at the GP level.
Setting. 42 GP practices, western Switzerland.
Participants. Participating GPs had to work at least 20 hours per week as GPs in French-speaking Switzerland, and were expected to enroll ten community-dwelling adults at least 75-years-old, able to understand French, and having visited their GP at least twice in the prior year.
Intervention. Yearly assessment by the GP of eight geriatric syndromes associated with ad hoc management plans.
Main outcome measures. The primary outcome was, at individual participant level, the proportion of patients losing at least one instrumental activity of daily living (IADL) over two years, compared by a generalised 2-level mixed model with a logit regression. Secondary outcomes were losses in basic ADLs and quality-of-life (WHOQOL-OLD) scores. After complete case analysis, predefined sensitivity analyses were performed with last observation carried forward and considering patients who died or were institutionalized as having lost an IADL.
Randomization and masking. The randomisation unit was the GP, with GPs assigned on a 1:1 ratio to the intervention or usual care arm, based on a computer-based randomisation list, using uneven block sizes. GPs were allocated to their respective arm after patient enrolment. The study staff performing the main outcome measures (telephone interviews), study coordinator and study statistician were blinded to the allocation.
Results: 42 GPs recruited 429 participants of mean age 82·5 years (SD 4·8) at inclusion, 63% women, with 217 participants allocated to the intervention and 212 to the control arm. The proportion of patients losing at least one IADL during the course of the study was 43·6% and 47·6% in the intervention and control arms, respectively (p=0·476). Mean reduction in quality-of-life score was -0·12 and 0·74 (p=0·331). There was no difference between arms in any of the outcomes considered. Concerning adhesion to the intervention, 85·7% (186/217) of patients in the intervention arm had at least one assessment and GPs adhered to 43·4% of the recommendations in the management plans.
Conclusion. A yearly geriatric evaluation associated with a management plan conducted systematically among community-dwelling, ≥75-year-old patients in GP practices does not lessen functional decline.
Trial registration. The trial was registered in ClinicalTrials.gov with identifier NCT02618291.