Use of psychiatric services by the elderly in Canada.

There is increasing emphasis on identifying mental disorders in the elderly and developing appropriate mental health services. However, there are few quantitative studies on service use by the elderly. This paper gives a national perspective on the use of psychiatric services by the aged in Canada, and details two of the health care studies used to assess their mental health needs in southern New Brunswick. The elderly now make up a higher proportion of the long-term mental hospital population than they did 20 years ago. Despite the increase in number of short-stay general hospital psychiatric units, there are still marked differences in their use by the elderly. There is a marked decrease in short-term psychiatric in-patient care after the sixth decade. As well there are marked regional variations. The results of a Level of Care Survey in a New Brunswick mental hospital shows the discrepancies between the needs for care and the level of care actually received. In comparison with other patient sub-groups, elderly long-stay mental hospital patients had the highest proportion (79%) deemed suitable for care in alternative settings outside the hospital. The anonymized merged statistical file revealed that the elderly mentally ill were more likely to be identified and cared for within non-specialized wards of general hospitals, and least likely to have contact with mental health clinics. Instead of adding new services to the existing system, reallocation and redirection of existing resources are crucial strategies in improving the mental health services for the elderly. The general hospital is an important area for psychiatric consultation and back-up to primary care services.