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Age and Ageing Advance Access originally published online on June 24, 2004
Age and Ageing 2004 33(5):472-478; doi:10.1093/ageing/afh154
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Age and Aging Vol. 33 No. 5 © British Geriatrics Society 2004; all rights reserved

Research Paper

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

Robert Baldwin1, Helen Pratt3, Hannah Goring2, Alison Marriott1 and Chris Roberts4

1 Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
2 Department of Psychology, 3 CNS Office, Ward 21b, Tameside General Hospital, Ashton-under-Lyne, UK
4 School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK

Address correspondence to: R. Baldwin, Manchester Mental Health and Social Care Trust, York House, Manchester Royal Infirmary, Oxford Road, Manchester M13 9BX, UK. Fax: (+44) 161 276 5303. Email: Robert.Baldwin{at}man.ac.uk

Abstract

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.

Keywords: acute medicine, elderly, mental health liaison, nurse led

Received November 20, 2003; accepted in revised form March 5, 2004.


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