Mental disorders among the elderly. True prevalence and use of medical services

295 subjects aged 65 and older, chosen at random from three small-town rural communities in Upper Bavaria were questioned by psychiatrically trained physicians. At 9.2% the rate of the refusal was relatively low. Case identification was reached with the aid of the German version of the Clinical Psychiatric Interview developed by Goldberg et al. (1970) at the Institute of Psychiatry in London. In classifying the psychiatric diagnosis we used the ICD (8th revision). The true prevalence of those over 65 was 23.1%, whereby 8.8% suffered from organic mental diseases, 3.4% from functional psychoses and 10.9% from neuroses and personality disorders. 21.5% of those aged 65-74 and 29.0% of those over 75 showed mental disorders requiring treatment. The psychiatric morbidity for women, single, widowed and divorced persons was higher than average. Members of the lower social classes were not overrepresented. Most of the interviewers were under the care of a family physician, usually a general practitioner. We were able to obtain additional information for 269 subjects (91.2%) from this source. The case rate as determined by the general practitioners was slightly lower than that of the interviewers. However, there is a large number of cases who were not detected by either the interviewer or the general practitioner. Due to the multimorbidity among the elderly, the average annual use of private physicians is very high in comparison to the younger age groups. It was demonstrated that out-patient psychiatric services are greatly under-utilized by those over 65. A major reason for the low consultation rate of private psychiatrists among the elderly is the distance from the patient's home to the out-patient treatment facility.