The reasons for referral of elderly persons to a psychiatric hospital in Cape Town were investigated in respect of behavioural difficulties, impairment of function, psychiatric diagnosis and the attitudes and understanding of relatives and caring agents. Confused behaviour was the most common reason for admission, followed by depression, and anxiety symptoms were frequent. An impaired ability to manage their daily lives was a factor in 90% of cases. In general, referrals were appropriate and families showed a considerable ability to put up with disturbed behaviour. However, manifestations of anxiety and depression often went unrecognized and skill in handling difficult behaviour in old-age homes was often lacking. It was considered that a better level of general medical care would have obviated the need for admission in several cases. Response to a short period of hospitalization reduced the degree of impairment very considerably, even in patients with organic brain damage.