Enquiries into mental disorder in old age.

Statistical data from different parts of the world all tell a similar tale of a rapidly rising rate of admission of old people to mental hospitals.40 Although it has been often claimed that the stresses of modern life involve an all round increase in the incidence of mental illness, a careful investigation of the changes in first-admission rate to mental hospital in Massachusetts by Goldhamer and Marshall8 has failed to confirm that mental disorder has become any more common under the age of 50 during the past century. However, above this age, an unequivocal rise in the hazard of being admitted to a mental hospital was found. In fact, the rate of increase in some parts of the world has been so rapid among old people that, to some extent, the change must be attributed to a decreased viability of the aged in the community, rather than an actual increase in the amount of mental illness. It is well known that the rate of hospitalisation is higher among certain individuals, namely the economically under-privileged and less well educated sections of the community and those exposed to the effects of social isolation.28' 9 These difficulties of the aged are often attributed to decline in filial piety, but the studies of Townsend38 and others have revealed that in many working-class areas, strong and lasting bonds of affection and mutual support continue to survive between the aged and their children, and regular contacts are the general rule. But the increased mobility of families, both in a social and geographical sense, is probably serving to increase the size of the marginal group of old people whose survival in the community is a precarious and insecure one and who tend in case of illness or growing infirmity, to become the responsibility of the Health and Welfare Services.