[Medical and social aspects of the psychological health of the elderly].

As a consequence of falling birth-rates and increasing life expectancy, the absolute and relative number of the elderly has been considerably growing in all industrial countries during the last hundred years. According to the findings of a field study carried out among inhabitants of the City of Mannheim, well in concordance with the results of comparable investigations undertaken in rural and urban areas of other countries, about a quarter of the individuals aged over 65 are mentally ill. Under the assumption of unchanged age-related morbidity rates, the absolute number of elderly persons suffering from mental illness more than doubled in the Federal Republic of Germany between 1950 and 1980, due to demographical changes only. The quantitatively most important risk factor for psychiatric morbidity in old age, especially for psycho-organic syndromes, seem to be physical illness and handicaps. Environmental factors determining the microsocial milieu of the elderly seem to influence the frequency of depressive syndromes, as was shown by a study carried out in homes for the elderly in New York, Mannheim and London. Also in old age, belonging to the lower socioeconomic stratum - as a macrosocial factor - correlates with increased rates for psychiatric morbidity as a whole, as it does with poor physical health and increased mortality. However, this correlation is significant only for the group of psycho-organic syndromes. In functional syndromes it is hardly marked. It can be assumed that to a large part, unfavourable socioeconomic conditions mainly have an indirect impact on psychiatric morbidity by way of higher rates of those somatic diseases leading to psychiatric sequelae, e.g. cardiovascular diseases. Events of losses and social isolation in a sense of experienced loneliness accompanied by a lack of contact enlarge the risk of developing psychiatric disturbances, in particular depressive syndromes, and also the risk of somatic diseases and suicides. Since coping resources of the individual also often decrease in old age, this phase of life shows specific mental health risks which should be counteracted as long as possible by medical and social care on the levels discussed before.