Evaluating a mental health assessment for older people with depressive symptoms in general practice: a randomised controlled trial.
BACKGROUND
There is a lack of evidence on the most effective primary care management of older people with minor depression.


OBJECTIVE
To evaluate a follow-up assessment by the community mental health team (CMHT) for older people with depressive symptoms identified by practice nurses at a health check for people over the age of 75 years.


METHODS
A pragmatic randomised controlled trial.


METHODS
A single large general practice in Leicestershire.


METHODS
Patients receiving a health check administered by a practice nurse and scoring 5 or more on the 15-item Geriatric Depression Scale (GDS15) were randomised to either follow-up by the CMHT or routine general practitioner (GP) care. The GDS15 score was measured at the subsequent health check 18 months later.


RESULTS
Forty-seven patients were randomised to CMHT assessment and 46 to routine GP care. Uptake of the intervention was 72% (n = 34). At the follow-up health check a greater proportion of the control group had improved GDS15 scores (P = 0.08). Following assessment, the CMHT recommended their further involvement in the care of 12 patients and this was authorised by patients' GPs in six cases.


CONCLUSIONS
A follow-up mental health assessment by a member of the local CMHT was not effective in improving outcomes for mildly depressed older people. Other than random error possible reasons for this include the length of follow-up and a failure to meet raised expectations among the intervention group. If complex referral procedures do not improve outcomes for this group, then specialist community services should play a more prominent part in the training of practice staff to care for their depressed older patients.
Arthur
Antony J
AJ
School of Nursing, Faculty of Medicine and Health Sciences, University of Nottingham, Queens Medical Centre. tony.arthur@nottingham.ac.uk
Jagger
Carol
C
Lindesay
James
J
Matthews
Ruth J
RJ
D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D004739:England; D005194:Family Practice / Q000379:methods*; D005260:Female; D015577:Geriatric Assessment; D006302:Health Services Research; D006801:Humans; D008297:Male; D008603:Mental Health; D009722:Nurse Practitioners; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D015397:Program Evaluation; D011569:Psychiatric Status Rating Scales