Are occupational therapists more effective than social workers when assessing frail older people? Results of CAMELOT, a randomised controlled trial

Objectives: To compare the effectiveness of occupational therapist-led assessments of older people on dependency and service costs with that of social worker-led assessments. Design: Pragmatic community-based randomised controlled trial over 2 years 4 months. Setting: Cambridgeshire, UK. Participants: 321 older people aged 65 and over living in their own homes and 113 caters. Intervention: Participants were randomised to two groups, to receive either occupational therapist-led or social worker-led assessment. Outcome measures: Primary outcome was dependency (Community Dependency Index). Secondary outcomes included quality of life scores (EQ-5D) and psychological outlook (Perceived Stress Scale (PSS)). Outcome measures for caters included Carer Assessment of Difficulty Index (CADI), PSS and EQ-5D, collected at baseline, 4 and 8 months. Resource use data were collected from professional practice records, participants and carers at final follow-up. Results: 264 (82%) of the randomised participants completed the study. No between-group statistically significant differences were found, except that carers in the occupational therapist arm had significantly better EQ-5D scores at the 8 month follow-up (thermometer P=0.03) and in the social worker arm better CADI scores on stress (P=0.047) and amount of caring (P=0.049). Conclusions: There was no clear difference in patient-centred effectiveness measures between occupational therapists and social workers in assessing frail older people and their carers in the community. More extensive use of primary care health services by occupational therapists may have contributed to the differences in EQ-5D scores for carers. Delays in making occupational therapy assessments and in completing recommended housing adaptations may have contributed to these negative findings.