JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Copyright © 1980 by the American Geriatrics Society Vol. XXVIII, No.1 Printed in U.S.A. Impact of Mental Disorders upon Elderly American Indians as Reflected in Visits to Ambulatory Care Facilities' EVERETT R. RHOADES, MD**, MELODY MARSHALL, PhD, CAROLYN ATTNEAVE, PhD, MARLENE ECHOHAWK, PhD, JOHN BJORK, ACSW and MORTON BEISER, MD' Department of Medicine, University of Oklahoma Health Sciences Center, and the Veterans Administration Hospital, Oklahoma City, Oklahoma ABSTRACT: In order to assess the impact of mental health problems among elderly American Indians, a study was conducted on the utilization patterns of ambulatory care facilities by various age groups of Indians. Since most health care of Indians is rendered by the Indian Health Service (IHS), data obtained from IHS computer centers provided a reasonable index of disease patterns. Because the elderly have constituted such a small fraction of the Indian popu- lation, they have not heretofore received significant attention. However, their problems are rapidly increasing. By adjusting the frequency of visits according to population, an estimate of visit "rates" was made. These rates showed one visit for every 10 persons in the 0-44 age group, one for every 5 persons in the 45-54 age group, but only one visit for every 25 persons in the 65+ age group. Most of the visits by older Indians concerned "social" problems rather than "mental" disorders as such. These data provide information that should prove especially helpful in the design of social and health programs for elderly Indians. Only in very recent years has attention been directed specifically to the needs of elderly Amer- ican Indians. The chief reason for this in the past undoubtedly was the small number of Indian peo- ple who survived to old age. However, in the past 20 years there has been a fairly rapid increase in the life-expectancy of American Indians. Because of this, and probably to a large degree because of the rapidly deteriorating nature of Indian family • The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the Indian Health Service. •• Address for correspondence: Everett R. Rhoades, MD, Department of Medicine, University of Oklahoma Health Sci- ences Center, P.O. Box 26901, Oklahoma City, OK 73190. E.R.R., Professor of Medicine, School of Medicine, Univer- sity of Oklahoma, and Department of Medicine, Veterans Administration Hospital, Oklahoma City; M.M., Associate Pro- fessor, College of Nursing, University of South Carolina, Co- lumbia, SC; C.A., Professor of Psychology and Adjunct Profes- sor in Psychiatry and Behavioral Sciences, University of Wash- ington, Seattle; M.E., Clinical Psychologist, Association of American Indian Physicians, Oklahoma City; J.B., Chief, Area Human Services Branch, Oklahoma City Area Indian Health Service, Oklahoma City; M.B., Professor of Psychiatry, De- partment of Psychiatry, University of Vancouver, Vancouver, BC. 33 living, Indians and their health providers are giv- ing increasing attention to the problems of the Indian elderly. The absence of mental health data relating to elderly American Indians in the litera- ture led us to believe that a compilation of data in this area would be useful. MATERIAL AND METHODS The records of general medical facilities (hos- pitals, clinics, and health stations) at the service- unit level reflect any diagnoses related to mental health. For patients referred to the Mental Health and Social Services, however, problem-oriented records are used which involve a different set of descriptive terms. These two types of data provide complementary views of the mental health prob- lems of those served by the Indian Health Service (IHS). In the IHS, both the diagnosis entered on the patient's chart and the problems detected in the Mental Health and Social Services branches are entered into a computer system, along with certain other information. These data, compiled for the