Older medical inpatients have complex biopsychosocial problems, which often lead to prolonged hospital stays. Proactive Integrated Consultation-Liaison Psychiatry was designed to help ward teams manage biopsychosocial complexity and thereby reduce the time that older medical inpatients spend in hospital.

To assess the experience, effectiveness and cost-effectiveness of enhancing medical care with Proactive Integrated Consultation-Liaison Psychiatry in The HOME Study.

A parallel-group, multicentre, individually randomised controlled trial with process and economic evaluations in 24 medical wards of three National Health Service hospitals.

Patients aged ≥ 65 years, admitted in an emergency and expected to remain in hospital for at least 2 days from the time of enrolment.

Proactive Integrated Consultation-Liaison Psychiatry clinicians (consultation-liaison psychiatrists supported by assisting clinicians) made proactive biopsychosocial assessments of patients' problems, then delivered discharge-focused care as integrated members of ward teams. Usual care was provided by ward teams.

Observations on training Proactive Integrated Consultation-Liaison Psychiatry clinicians and the care they provided; Proactive Integrated Consultation-Liaison Psychiatry clinicians' experiences of working in the new service model; patients' and ward staff members' experiences of Proactive Integrated Consultation-Liaison Psychiatry.

Time spent as an inpatient (during the index admission and any emergency re-admissions) in the 30 days post randomisation.

Rate of discharge for the total length of the index admission; discharge destination; length of the index admission post randomisation truncated at 30 days; number of emergency re-admissions, number of days in hospital and rate of death in the year post randomisation; the patient's experience of the hospital stay and view on its length; anxiety; depression; cognitive function; independent functioning; health-related quality of life; overall quality of life.

Cost-effectiveness of Proactive Integrated Consultation-Liaison Psychiatry over 1, 3 and 12 months from a hospital perspective.

Two thousand seven hundred and forty-four participants were enrolled (1399 male, 1345 female; mean age 82.3 years; 2565 White; 1373 Proactive Integrated Consultation-Liaison Psychiatry, 1371 usual care). Proactive Integrated Consultation-Liaison Psychiatry was experienced positively by patients (43 interviews) and ward staff (54 interviews). The mean time spent in hospital in the 30 days post randomisation was 11.37 days (standard deviation 8.74) with Proactive Integrated Consultation-Liaison Psychiatry and was 11.85 days (standard deviation 9.00) with usual care; adjusted mean difference -0.45 (95% confidence interval -1.11 to 0.21; p = 0.18). The only statistically and clinically significant difference in secondary outcomes was the rate of discharge, which was 8.5% higher [rate ratio 1.09 (95% confidence interval 1.00 to 1.17); p = 0.042] with Proactive Integrated Consultation-Liaison Psychiatry - a difference most apparent in patients who stayed for > 2 weeks. Compared with usual care, Proactive Integrated Consultation-Liaison Psychiatry was estimated to be modestly cost saving and cost-effective over 1 and 3, but not 12, months.

Uncertain generalisability to other populations, hospitals and healthcare systems.

This is the first randomised controlled trial of Proactive Integrated Consultation-Liaison Psychiatry. Proactive Integrated Consultation-Liaison Psychiatry is experienced by older medical inpatients and ward staff as enhancing medical care. It is also likely to be cost saving in the short term. Although the trial does not provide strong evidence that Proactive Integrated Consultation-Liaison Psychiatry reduces time in hospital, it does support and inform its future development and evaluation.

Effectiveness of different forms of Proactive Integrated Consultation-Liaison Psychiatry; predictors of long hospital stays; barriers to and facilitators of the implementation of biopsychosocial medical care.

This study is registered as Current Controlled Trials ISRCTN86120296.

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/11/16) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 41. See the NIHR Funding and Awards website for further award information.

There is a complex and interacting relationship between visual acuity, cognitive dysfunction, and frailty. It is suggested that frailty may mediate the relationship between visual acuity and cognitive impairment in older adults.

This study aimed to examine the mediating role of frailty in the relationship between visual acuity and cognitive function in older adults with visual impairment.

This cross-sectional correlational study was conducted with 116 participants with visual impairment at an ophthalmology clinic in Turkey between January and February 2025. Data were collected using an information form, the Standardized Mini-Mental Test, and the Edmonton Frailty Scale. Visual acuity was expressed as a logMAR score, ranging from 1.00 to -0.30.

The mean age of the participants was 70.92 ± 5.92. The logMAR score positively and significantly associated with frailty levels (p < 0.001). Frailty was found to have a significant negative effect on cognitive function (p < 0.001). In addition, a significant negative relationship was identified between cognitive function and the logMAR score (p < 0.01). Both the total and direct effects of the logMAR score on cognitive function were significant (p < 0.001). The indirect effect, tested using the bootstrap method, was also significant (Coeff = -5.304, BootSE = 1.079, 95% CI [-7.652, -3.462]).

These results suggest that the deterioration of visual acuity strongly impacts cognitive function and that frailty may mediate this relationship. Protecting visual health and preventing frailty in older adults may play a critical role in reducing the risk of cognitive impairment. Regular eye examinations, early intervention for vision disorders, and frailty prevention strategies can contribute to maintaining cognitive health.

This study aimed to identify core shared competencies required for effective physician-nurse collaboration in primary care.

A three-round Delphi survey was conducted from November 2024 to February 2025 with 30 experts (12 physicians, 18 nurses), including family medicine professors, primary care physicians, nursing professors, and practicing nurses. Experts evaluated the importance and roles of interprofessional team approaches using online questionnaires. Quantitative analyses included mean, standard deviation, and content validity ratio (CVR).

The first round confirmed the necessity of interprofessional teamwork in cases such as chronic disease management, rehabilitation, elderly care, and mental health. Essential team members were physicians, nurses, and social workers, with additional professionals engaged as needed. Through iterative consensus, six shared competencies were derived: (1) patient-centered integrated care, (2) treatment plan development and implementation, (3) communication and collaboration, (4) professional development as a team member, (5) Evaluation and feedback on service outcomes, and (6) disease prevention and health promotion. All items met consensus criteria (CVR ≥0.34).

These findings clarify physician-nurse shared competencies in primary care and provide a foundation for developing competency-based interprofessional curricula and training programs to enhance collaborative care quality and patient outcomes.

Training in evidence-based psychotherapies (EBPs) in clinical programs is crucial for increasing their use in practice. Twenty years ago, the National Psychotherapy Training Survey-I (NPTS-I) examined whether U.S. training programs required didactic training and clinical supervision in EBPs. Almost all psychiatry (96%) programs, but only 56% of clinical psychology Ph.D., 33% of clinical psychology Psy.D., and 38% of social work (i.e., M.S.W.) programs, required EBP training. After years of dissemination efforts, the authors reexamined EBP training levels across those disciplines as well as counseling psychology and psychiatric-mental health nurse practitioner (PMHNP) programs by conducting the NPTS-II.

Half of accredited training programs in each discipline were randomly selected for an online survey of training requirements and electives, whether all trainees receive EBP training, and associated barriers and facilitators. Of 574 invited programs, 253 (44%) program directors completed responses: 48 psychiatry (37%), 44 clinical psychology Ph.D. (53%), 14 clinical psychology Psy.D. (36%), 34 counseling psychology (58%), 38 PMHNP (35%), and 75 M.S.W. (49%) programs.

At least 75% of programs across disciplines offered didactic and clinical supervision EBP training. Required training rates were higher in psychiatry (90%) and clinical psychology Ph.D. (81%) programs than in clinical psychology Psy.D. (59%), PMHNP (48%), counseling psychology (28%), and M.S.W. (27%) programs. A similar pattern emerged in estimations of all trainees receiving EBP training.

EBP training requirements held steady in psychiatry and increased in clinical psychology programs. Low EBP training rates persist in other disciplines, possibly contributing to the continuing gap between EBP research efficacy evidence and practice.

To highlight the recent advancements in understanding the influence of psychological factors on the causation and management of obesity, which holds significance for clinical practice.

This review explores developments in understanding psychological risk factors, sequelae, and treatments for obesity. Despite good evidence for psychological therapies in weight management, there are no standardized protocols for assessing patients requiring metabolic and bariatric surgery. Psychological therapies are synergistic with obesity medications.

Obesity is a complex health issue with psychological dimensions. Stress, emotional dysregulation, and cognitive factors contribute to obesity. Stress's physiological impact on adipose tissue distribution and metabolic function, mediated by cortisol, demonstrates this interaction. Obesity leads to psychological consequences, including depression, low self-esteem, and reduced quality of life. The relationship between depression and obesity is modulated by demographic factors and biological mechanisms. Body composition reflects interactions between habits and cultural ideals, and medical models may increase stigma. Psychological interventions like cognitive-behavioral therapy and motivational interviewing effectively maintain weight loss. Psychological assessments before bariatric surgery are crucial for identifying mental health issues. This review highlights psychological dimensions in obesity prevention and treatment strategies.

Alzheimer disease is the most common cause of dementia and a major global health concern with a significant impact on elderly individuals and society. Gantenerumab, a monoclonal antibody that targets aggregated amyloid beta and removes Aβ plaques, could potentially treat Alzheimer disease.

To systematically evaluate the safety of gantenerumab in patients with Alzheimer disease through a meta-analysis of available clinical studies.

A comprehensive literature search was conducted, and six studies were included. Extracted data included study year, location, sample size, age, gender, gantenerumab dosage, APOE4 status, cognitive scores, CSF biomarkers, PET-SUVr, Changes in mental function, hippocampal volume, PET-SUVr, adverse effects, and mortality. Analysis was done using the R software.

ADAS scores increased less in the gantenerumab group than in the placebo group (MD=-1.25, 95% CI:-1.40 to -1.10, P<0.00001, I²=88%). The increase in the FAQ score was also smaller (MD=-0.82, 95% CI: -0.92 to -0.72, P<0.00001, I²=87%). Hippocampal volumes significantly improved (right: MD=11.93, P=0.01; left: MD=12.24, P=0.008). However, gantenerumab was linked to higher rates of ARIA-E (OR=25.62, P<0.00001) and ARIA-H (OR=1.80, P<0.00001).

In conclusion, patients with Alzheimer disease treated with gantenerumab showed significant improvement in the ADAS score, FAQ score, hippocampal volume, and CSF biomarkers compared with those treated with placebo. However, the use of gantenerumab is associated with a higher incidence of ARIA-E and ARIA-H.

Geriatric depression is an important mental health concern that generalist behavioral health clinicians are increasingly likely to encounter, yet the field lacks an adequate tool to assess providers' knowledge. This study evaluated the validity, reliability, and factor structure of the Later Life Depression Knowledge Questionnaire (LLD-KQ) as part of an ongoing effort to assess the psychometric properties of the scale.

Psychologists (N = 800) from the southwestern United States were randomly selected to complete a survey that could be returned via postal service or online. Responses were used to examine the internal consistency, construct validity, divergent validity, and factor structure of the 25-item scale.

Analysis of the returned surveys (n = 250) revealed that the LLD-KQ demonstrated adequate reliability and validity. Confirmatory factor analyses (CFA) supported a three-factor model with constructs of psychopathology, assessment/diagnosis, and treatment, although the differences between the three-factor and single-factor models were minimal.

The LLD-KQ demonstrates adequate psychometric properties and can be used in dissemination and implementation efforts, as well as in professional trainings, to assess clinical knowledge about later-life depression.

Effective management of mental health crises is a growing global concern, significantly impacting emergency services. In New Zealand the New Zealand Police have begun reducing their involvement in mental health emergencies. This shift positions paramedics as primary responders in pre-hospital mental health crisis management. This current study conducts a comparative analysis of mental health legislation in New Zealand, Australian jurisdictions and the United Kingdom to assess how laws empower paramedics in mental health crises.

A structured framework was employed to evaluate 12 key domains relevant to pre-hospital mental health interventions. These domains include criteria for involuntary detention, emergency detention and transportation powers, integration of services and legal protections for paramedics.

The analysis reveals that New Zealand's Mental Health Bill (as introduced in 2024) emphasises reducing coercion and promoting culturally appropriate care but lacks provisions granting paramedics the authority to manage crises in isolation. In contrast, jurisdictions like the Northern Territory, Western Australia and Queensland empower paramedics with greater legal authority and more integrated roles in mental health emergencies.

The absence of health-based legal tools and insufficient integration with mental health services in New Zealand may limit paramedics' effectiveness in crisis management, potentially increasing reliance on police and delaying interventions. Recommendations include expanding paramedic authority in line with other jurisdictions and improving integration with mental health services. By adopting models from leading Australian jurisdictions, New Zealand paramedics will be better placed to manage mental health responses and support a reduction in police involvement.

As the prevalence of dementia continues to rise globally, ensuring that individuals living with the condition are supported in making decisions about their lives is increasingly important. This article explores the legal, ethical and practical dimensions of decision-making capacity in dementia, with a focus on the application of the Mental Capacity Act 2006 in England and Wales. It outlines the principles and processes for assessing capacity, making best-interest decisions and the role of legal instruments such as lasting power of attorney and deprivation of liberty safeguards. The discussion highlights the importance of shared decision making and the need for community nurses to actively involve family, carers and individuals with dementia in conversations about their care and future. Two fictionalised case studies illustrate the complexities of real-life decision-making scenarios, offering insights into how legal frameworks and person-centred approaches can be integrated in practice. The article also considers the potential of decision aids to enhance autonomy and participation for people with dementia. This article aims to support community nurses in delivering compassionate, lawful and inclusive care.

Previous meta-analyses have shown that loneliness is associated with poor health (r = -.35) and sleep challenges (r = .29). However, that work is confounded by the inclusion of unhealthy populations, with chronic conditions, such as HIV, Alzheimer's disease, diabetes, and severe mental illness. This pre-registered meta-analysis (PROSPERO CRD42019119135) examined whether loneliness is linked to poorer health in healthy populations.

Meta-analysis.

PsycINFO, ERIC, PubMed, and Web of Science were searched for articles before January 2024 to examine the association between loneliness and health outcomes (categorized as general health, physical health [functional disability], sleep function, sensory acuity, and health service use) for healthy samples.

A total of 167 articles (303,643 participants; 334 effect sizes; 158 independent samples) from 36 countries were included in the meta-analysis. Loneliness is associated with worse health for healthy populations (r = -.22), with the largest effect (r = -.23) for general health. Loneliness was not related to health service use for healthy populations. Heterogeneity was substantial, with only 7.2% of the total variance attributable to sampling error, indicating that over 92% of the variability in effect sizes reflected true differences across studies.

Higher loneliness was associated with poorer health for healthy people. There are limited studies using (1) objective measurements of health outcomes in relation to loneliness, and (2) studies exploring the association among young people, highlighting a need for more work in those areas.