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Evaluating a mental health assessment for older people with depressive symptoms in general practice: a randomised
Antony J Arthur1, Carol Jagger, James Lindesay
1School of Nursing, Faculty of Medicine and Health Sciences, University of Nottingham, Queens Medical Centre. tony.arthur@nottingham.ac.uk
Background:
There is a lack of evidence on the most effective primary care management of older people with minor depression.
Aim:
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.
Design Of Study:
A pragmatic randomised controlled trial.
Setting:
A single large general practice in Leicestershire.
Method:
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.