Does a nurse-led mental health liaison service for older people reduce psychiatric morbidity in acute general medical wards? A randomised controlled trial.

OBJECTIVE

To determine the clinical effectiveness of a nurse-led mental health liaison service in managing mental health problems in older physically ill inpatients.

DESIGN

Randomised controlled trial.

SETTING

Four general medical wards in a district general hospital in a northern UK town.

PARTICIPANTS

153 medically ill older people (aged 65 or over) who scored above the threshold for depression and/or cognitive impairment on a brief screening instrument (4-item geriatric depression scale and 6-item orientation-memory-concentration test): 77 were randomised to a nurse-led intervention and 76 to usual care. Included in the analysis were 120 participants who completed 6-8 week follow-up assessments.

INTERVENTION

Multi-faceted intervention led by a mental health liaison nurse.

MAIN OUTCOME MEASURES

Scores on the Health of the Nation Outcome Scale 65+, the geriatric depression scale, and the Standardised Mini-Mental State Examination.

RESULTS

No significant differences were found between groups on the total Health of the Nation Outcome Scale 65+ scores (11.5 versus 11.5, adjusted mean difference -0.04, 95% CI-1.4 to 1.3, P = 0.96) nor on the Standardised Mini-Mental State Examination (20.3 versus 21.8, adjusted mean difference -0.4, 95% CI-2.1 to 1.3, P = 0.63). Subjects randomised to the intervention arm had significantly lower Geriatric Depression Scale scores at 6-8 week follow-up than those receiving usual care (12.2 versus 14.0, adjusted mean difference -2.0, 95% CI-4.0 to -0.1, P = 0.043).

CONCLUSIONS

Nurse-led mental health liaison services which accept all screened cases from acute medical wards are unlikely to be effective in reducing general psychiatric morbidity. Services which focus on the prevention of delirium and target particular patient groups or disorders such as depression are more likely to be effective.