[Filters in mental health care for the elderly. A literature study of the prevalence of psychiatric problems and the utilization of care by the elderly].

This article reports on the number of older people with functional psychological problems who receive mental health care. It uses a filtermodel, that shows which filters have to be passed to receive mental health care. The model describes five levels of morbidity. Based on literature the prevalence of functional psychiatric disorders in the community (level I) is estimated between 170 and 330 per 1.000 persons older than 65 a year. This range doesn't differ from the prevalence range of younger adults. One Dutch representative study is used to estimate the prevalence of psychological and/or social problems that elderly present to their general practitioner (GP) (level III). It is estimated at 189 per 1.000 persons. Based on registration data the prevalence of psychiatric care use by persons with a functional disorder (level IV) is estimated at 27 per 1.000 older persons a year. This implies that only a small percentage (8 to 16%) of the people with functional psychological problems receive mental health care. We conclude that compared to younger adults the accessibility of mental health care is worse for elderly adults. Elderly persons probably seek less help than younger people. But there is also some evidence of age discrimination by professional staff. Furthermore, psychogeriatric clinical syndromes are difficult to diagnose. The elderly cross the threshold to the fifth level more easily than younger adults; they are relatively often referred to institutional mental health care.