OLD AGE MENTAL DISORDERS IN NEWCASTLE UPON TYNE. II. A STUDY OF POSSIBLE SOCIAL AND MEDICAL CAUSES.
1. The association of various medical, domestic and social characteristics with psychiatric illness in old age was investigated by interviewing a random sample of 294 old people living at home in Newcastle upon Tyne. The subjects were allocated to one of three groups: ( i ) with organic mental illness; ( ii ) with functional disorders; and ( iii ) without psychiatric abnormality. 2. In the organic mental disorders, consisting mainly of cerebrovascular and senile degenerative disease, advanced age is the main aetiological factor. Extracerebral disease may be a primary cause of mental symptoms or aggravate symptoms due to other causes. Sensory defects, and inadequate diet due to poverty, isolation or the mental state itself, probably contribute on occasion to the deterioration. It is possible that some associations, with, for example, living alone or low socioeconomic status, may be obscured, owing to differential rates of removal by death, or by admission to institutions. 3. In the functional disorders, in which neurosis is the most frequent diagnosis, various factors, both constitutional and environmental, appear to interact with each other. A hypothesis is advanced, according to which personality defects and adversities in early and middle life tend to bring about a cumulative and progressive diminution of the possibilities of effective adjustment to the adversities of old age. The most important of these is physical disability. Loneliness and increasing social isolation are experienced; but to a considerable extent, these are related to long-standing maladjustment in social and interpersonal relationships. 4. It is concluded that measures designed to improve the domiciliary health and welfare services, and to integrate the aged into the community, would be of some prophylactic value. Local registers of all old people are recommended.