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Am J Psychiatry 1956;112:627-636.
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The number and percentage of aged persons in the population is increasing and will continue to increase for many years. The percentage of such persons admitted to public mental hospitals is increasing much more rapidly than their percentage in the population; and their admission rate to mental hospitals is increasing much more rapidly than that of younger persons. Although the incidence of mental disease increases with age, there is no evidence that a unilateral increase of mental disease among the aged in recent years has anything to do with these differential increases. Sociologic factors are mainly responsible.In order of increasing numerical importance, delirious and other dying persons, non-psychotic feeble persons, nonpsychotic old persons with chronic illness, and tractable old persons who technically may be called psychotic are being sent to our mental hospitals because there is no other place for them to go. No question about their mental condition would be raised if there were other facilities.The increase of admissions of the aged to mental hospitals has been greater in the United States than in certain European countries with similar cultures. This is due to a relatively greater development abroad of other outlets for the infirm aged, and to drifting in this country toward the area of least resistance which is the state hospital.Existing abuses at the institutional level should be corrected by:1. Increased subsidies by the states and local government agencies to private general hospitals for the care of chronically ill, medically indigent aged persons.2. Building by the states and local government agencies of hospitals for chronically ill, medically indigent persons.3. Building by the states and local government agencies of homes for the aged designed for comfort rather than for mass herding and operated with rehabilitation programs. They should have adequate medical services.4. There should be liaison between mental hospitals and public homes for the aged so that the aged who become troublesomely psychotic at the homes could be quickly transferred to a hospital and tractable old patients at the hospitals could, on request, be transferred to homes.Intensified social programs and aid to the aged at the preinstitutional level tend to prevent or retard mental and physical deterioration and make institutionalization unnecessary in many cases.

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