Are psychological disorders most prevalent among older adults? Examining the evidence.

A persistent popular and professional perception is the high rate of psychological disorders among older adults (age 65+), especially higher than among younger adults. To examine the perception's accuracy, data from all psychiatric epidemiology studies conducted since 1950 with random community samples were reviewed. The studies were divided into categories according to type of disorder and instrument used. Prevalence rates were recalculated to compare those under 65 and over with those aged 65 and over. The review reveals that in none of the impairment categories do the preponderance of studies document more disorders among older than younger adults. In contrast, studies indicate more disorders reported by younger than older adults for depressive symptoms, major depression (clinical), and clinical affective disorders. While several methodological caveats are warranted, available data do not support the prevailing perception that psychological disorders are most prevalent among older adults. Despite these findings, future policies should consider older adults a high priority for outpatient mental health services. Older persons use disproportionately fewer outpatient services than other adults; over-utilization of primary care services occurs among all age groups, including older persons; and finally, the co-occurrence of psychological and physical disorders often results in elders' mental disorders not being recognized or treated appropriately in the primary care sector.