The aging of population increases the cost of health care and therefore an active and healthy aging process is an important factor of social development. The aim of this study was to investigate the importance of self-rated health on the occurrence of depression and anxiety and the impact of modifying factors on health and the use of health care by older persons in the following counties: Koprivnica-Krizevci, Istria and Dubrovnik-Neretva county, along with proposing measures for preserving mental health and an active and independent life at an elder age. The study used data collected in a comparative cross-sectional study in the international project TTB Second Decennial Survey of the Health Needs and Health Care for Older People in Europe (Elderly study) conducted in Croatia in 2006. The study included 1496 respondents of both gender aged 70 years and over who lived alone or in the same household with permanent residence in the study area. The socio-demographic data (age, gender, "live alone") and data on the use of health care (visits to family physicians, specialists and hospitalization in the last 12 months and data on the treatment of anxiety or depression in the last 4 weeks) were collected. Self-rated health and level of anxiety and depression were assessed with the SF-36 questionnaire and the HAD scale. The results showed that there were significant differences in self-rated health, prevalence of anxiety and depression and the use of health care at both primary and secondary level between the three counties studied. Respondents in the Koprivnica-Krizevci County rated their health the worst in all eight dimensions of health and most of them were depressed and anxious, while respondents in the Dubrovnik-Neretva County assessed their health the best and the least of them were depressed and anxious. Self-rated health and prevalence of depression and anxiety in respondents of the Istria County were similar to respondents in the Dubrovnik-Neretva County. The physical dimensions of health are generally rated worse than the mental ones, while depression is generally more common than anxiety in the elderly. Men rate their health significantly better than women in all eight dimensions, and women are more anxious than men. Self-rated health deteriorates and depression is more common, while the prevalence of anxiety decreases with older age. Respondents who live alone do not differ in self-rated health, the prevalence of anxiety and depression nor in the use of health care than those who do not live alone. Poor self- rated health, particularly the dimensions of mental health, is associated with anxiety and especially depression in the elderly. Older people in the Koprivnica-Krizevci County use health care less often than their peers in the other two counties. Secondary (specialist) health care is used most often in Istria, while primary health care by general practitioners/family physicians is used most often in the Dubrovnik-Neretva County. Women significantly more often visit only their general practitioner/family physician while men visit specialists more often. Younger respondents (70-79) use health care more often, especially specialist-consultative care, while older (80 +) significantly more often visit only general practitioners/family physicians. Poor self-rated general health, bodily pain and better vitality are important predictors of the use of specialist health care in the elderly. The probable and the borderline depressed and the probable anxious have a significantly higher risk for hospitalization compared with respondents who are not depressed and anxious, while the probable and the borderline anxious are more likely to use specialist health care. A high prevalence of depression and anxiety was found in the elderly but general practitioners/family physicians rarely recognize and treat depression and anxiety. Planning of public health measures aimed at preserving and improving mental health and early diagnosis and adequate treatment of mental disorders should be implemented at the local level, taking into account the specificities of the region and socio-demographic characteristics of the population as well as the scientific knowledge about the mutual influence of self-rated health and mental health on the use of health care. Better coordination of health care professionals at all levels of health care and an intersectoral approach of the wider community is needed for enabling older people to maintain an active and independent life through as long a period as possible.