• Robert Baldwin, Helen Pratt, Hannah Goring, Alison Marriott, and Chris Roberts.
• Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK. Robert.Baldwin@man.ac.uk
• Age Ageing. 2004 Sep 1; 33 (5): 472-8.

ObjectiveTo determine the clinical effectiveness of a nurse-led mental health liaison service in managing mental health problems in older physically ill inpatients.DesignRandomised controlled trial.SettingFour general medical wards in a district general hospital in a northern UK town.Participants153 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.InterventionMulti-faceted intervention led by a mental health liaison nurse.Main Outcome MeasuresScores on the Health of the Nation Outcome Scale 65+, the geriatric depression scale, and the Standardised Mini-Mental State Examination.ResultsNo 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).ConclusionsNurse-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.

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