PSYCHIATRIC MORBIDITY AMONG THE ELDERLY IN A PRIMARY-CARE SETTING - REPORT FROM A SURVEY IN SAO-PAULO, BRAZIL

Brazil has been experiencing a steady increase in the elderly populati on during the past few years, and as a result old age health-related p roblems are increasing continuously in number. Psychiatric symptoms ar e among the most prevalent health problems of the elderly and are an i mportant source of distress for patients and carers, being also associ ated with significant growth in the costs and demand for the provision of health care services. This study aimed to investigate the prevalen ce of mental health problems among the elderly attending a regional pr imary care unit in the city of Sao Paulo, Brazil. A total of 351 patie nts older than 60 were assessed during a 6-month period with the SRQ-2 0 (a scale for the detection of minor psychiatric problems), four ques tions on psychotic symptoms, AMTS (a scale for the assessment of cogni tive functioning) and CAGE (a scale for the assessment of alcoholism); demographic variables were also recorded. Subjects' mean age was 71.2 2 (CI = 70.51-71.92) and 83.5% were female. Thirty-two per cent of sub jects were considered 'cases' as they scored more than 7 on the SRQ-20 (26.8% of total), or more than 1 on the CAGE (1.4% of total), or at l east 1 on the questions assessing psychotic symptoms (12.2% of total). There was a significant excess of women among those found to suffer f rom psychiatric problems (90.1% vs 80.4%). Cases were also more likely to be illiterate (23.4% vs 12.1%) and to have a lower income (2.21 vs 4.01 minimum wages). Depressive symptoms and tension were highly prev alent (72.9% of subjects). Somatic complaints and signs of inefficient functioning were also common (50.4% and 45.9% respectively). Only fiv e patients answered affirmatively two or more CAGE questions and 12.2% scored at least 1 on the questions assessing psychotic symptoms. Cogn itive deficit, as determined by the AMTS, was observed in 13.4% of the sample and was associated with ageing, being illiterate and having hi gher total SRQ-20 scores. We suggest, that the organization of health care services should take into account the needs of this population, a nd should also emphasize professional training for the correct assessm ent and treatment of the most frequent mental health problems in old a ge. (C) 1997 by John Wiley & Sons, Ltd.