ABSTRACT

The highest rates of consultation are at the extremes of life for both males and females. The rates of doctor contact rises sharply in men from 3.3 per 10,000 years at risk in middle-life to 4.2 (65-74) and 5.6 (over 75) compared to the equivalent for women, being 4.5, 4.6 and 6.3. After the age of 75, the proportion of consultations in the United Kingdom that require home visits by a general practitioner exceeds those in the surgery (OPCS, 1995). The rates of consultation for severe physical illness and severe mental illness is also seen to rise with age. The consultation rates for what are perceived as disorders of intermediate severity (presumably anxiety and depression) remain stable from middle-age onwards. Physicians in primary care are, therefore, likely to see large numbers of older patients consulting with complaints in which physical and psychiatric illness coexist. The doctors are faced with a complex, clinical problem to disentangle in brief contact(s). Comments by specialist colleagues from secondary care services that primary care physicians could do better in their detection of psychiatric disorders are unhelpful unless this context is taken into account.