A randomised trial of occupational therapy led versus social work led assessment of frail older people in the community
Objectives: To compare the effectiveness of occupational therapist-led with social
worker-led assessments of older people, on dependency and service use and a
parallel health economic evaluation to compare additional benefits of intervention
with the change in costs.
Design: The clinical trial was a pragmatic community based randomised controlled
trial over 28 months. The economic evaluation compared costs and consequences
in a cost utility analysis.
Setting: Cambridgeshire, UK.
Participants: 321 older people aged 65 and over living in their own homes and 113
Intervention: Participantsw ere randomisedt o receive either occupationatlh erapistled
or social worker-led assessment.
Outcome measures: The primary outcome was dependency using the Community
Dependency Index. Secondary outcomes included quality of life scores using
EuroQol (EQ-5D) and psychological outlook using the Perceived Stress Scale
(PSS). Outcome measures for carers included Carer Assessment of Difficulty
(CADI), PSS and EQ-5D. Measures were collected at baseline, four and eight
months, and resource use data from health and social care records, participants and
carers at eight months.
Results: 264 (82%) of randomised participants completed the study. No betweengroup
statistically significant differences were found, except better scores for carers
in the OT arm for EQ-5D scores at eight month follow-up (thermometer pß. 03) and
in the SW arm, for CADI scores on Stress (p= 0.047) and Amount of Caring (p=
0.049). Mean total costs of care per participant were £3765 and £3113 for the OT
and SW arms respectively. Difference in mean cost per case was £652 with 95%CI
[-£282 to £1587] but not statistically significant.
Conclusions: There was no clear difference In patient-centred effec iveness
measures between occupational therapists and social workers in assessing frail
older people and their carers in the community, nor In care costs per patient. Delays
in OT assessments and in completing recommended housing adaptations perhaps
contributed to these negative findings.