Objective: Primary care has traditionally served as the front line for the identification and treatment of mental health and alcohol problems in the elderly. Screening for these problems is the first step towards identifying effective service delivery models for this population. This study has sought to determine the nature and the extent of psychological distress and at-risk drinking problems in older people presenting to primary care.
Design: The present study is embedded in a larger multi-site national study that was designed to compare different types of care models that deliver mental health services to elderly people through primary care. In this report, the screening for mental distress and at-risk drinking in older adults was performed at 10 study sites that included over 30 primary care clinics across the United States.
Materials and Methods: Older adults aged 65 and above participated in the screening during their regular visits for primary care. The screening tools included General Health Questionnaire (12 items) for psychological distress, Quantity/Frequency Questions (3 items) for alcohol consumption, Suicidal Questions for suicidal thoughts (2 items), and the Short Orientation Memory Concentration Test (6 items) for assessing cognitive impairment. The cognitive impairment questions were asked first and the patients with severe cognitive impairment were excluded from further screening. The screening was administered by a trained interviewer and lasted about 10-15 minutes.
Results: Of 24,863 older adults who were screened, nearly 20% scored positive for psychological distress, 8% were positive for at-risk drinking, and 5% had some suicidal thoughts. Overall, more elderly people experienced psychological distress with age, but the problem drinking rates decreased as they got older. Slightly more females than males were screened positive for psychological distress and suicidal thoughts, whereas predominately more males than females showed the sign of risk drinking. Elderly people of ethnic minority backgrounds such as Chinese Americans and Hispanic Americans showed the highest rates of mental distress and suicidal thoughts, but lowest for risk drinking, as compared with whites. Those elders who were married or had partners at the time of the study tended to report less psychological distress and suicidal thoughts, as compared with those who were separated, divorced, widowed, or never married. Additionally, the widowed elderly people seemed to have the lowest rates of at-risk drinking.
Conclusion: The findings are generally consistent with existing literature that substantial numbers of elderly people experience significant levels of psychological distress, at-risk drinking behavior, and suicidal thoughts, indicating critical needs for screening at primary care settings for mental health and problem drinking in the elderly. This study also confirms the urgent need for more evidence to identify factors that determine effective ways of delivering mental health services to those elders who screen positive at primary care settings.
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