An Overview Of Legal Issues In Geriatric Psychiatry

The process of aging is frequently associated with changes in the physical and mental functioning of older adults, challenging their autonomy and rendering them vulnerable to exploitation. Certain illnesses that are more common in older adults can affect their capacity to function independently. These include the capacity to make medical decisions, live independently, manage finances, to name a few. Healthcare professionals, especially psychiatrists are often entrusted with the responsibility of assessing an older adult’s capacity to perform one or more functions. This makes it imperative for them to be cognizant of these issues, understand the need for these evaluations, and be able to conduct them in a comprehensive manner. Another way of protecting an older person’s rights and facilitating a life based on their own decisions even after they lose decision making capacity is Advanced Health Care Planning (AHCP). Health care professionals are required to initiate a discussion about AHCP with their patients and their families and review it periodically. Lastly, the older adults incarcerated in prisons is a group that is growing in numbers. They have unique needs at the intersection of the geriatric and forensic services, but are often marginalized by both services. The combination of poor quality of life and increasing costs makes the care of older adults in the criminal justice system makes this topic an important public health concern. There is a pressing need for better training of prison staff in issues of geriatric psychiatry. Assessment of criminal responsibility and competence to stand trial in aging offenders are other complex but under-studied issues. This proposed book will provide a comprehensive view of ethical, medicolegal, and forensic issues that will be useful in clinical practice. There will be three sub-sections, each focusing on ethical, medicolegal and forensic issues respectively. The first section will focus on ethical issues. Its first chapters will provide an overview of the how age and the process of aging influence decision-making and introduce unique ethical dimensions to clinical care. This will be followed by a discussion of the concepts of informed consent and capacity evaluation. The next chapters will focus on common scenarios that arise in the care of elderly patients and offer a practical approach to understanding and managing them. These will include assessments of the capacity to make medical decisions, the capacity to live independently, manage finances, drive a vehicle, have sexual relations etc. A chapter on ethical issues specific to dementia will outline issues related to diagnostic disclosure and genetic testing. Research ethics issues in geriatric psychiatry will also be outlined. The next section of the book will focus on surrogate decision making in an older adult who has been deemed to lack the capacity to serve one or more functions independently. The first chapters in this sub-section will focus on patient directed advance health care planning tools, namely, living will and power of attorney. This will be followed by an overview of default surrogate making. Guardianship will subsequently be covered. A separate chapter will cover the issue of elder abuse and discuss an approach to assessing it. The last section of the book will cover forensic issues in geriatric psychiatry. The first chapter will discuss aging older adults in the criminal justice system from an epidemiological perspective. The growing numbers of incarcerated older adults, their illness burden, the challenges in the diagnosis and management of neurocognitive disorders in the prison setting will be elucidated. The following chapter will discuss competence to stand trial with reference to elderly offenders. This will be followed by a discussion of the concepts of medical reprieve, compassionate release as well as model programs and policies currently in the works for older incarcerated adults.

As President of the American Academy of Psychiatry and the Law (AAPL), it is my pleasure to provide this Foreword for the third volume of Critical Issues in American Psychiatry and the Law. Through Dr. Richard Rosner's creativity and effort, the first volume of the series was pub lished in 1982. It represented the first major publishing activity of the AAPL other than the Bulletin and the Newsletter. Dr. Rosner carefully nurtured the project and the second volume, once again addressing a broad range of forensic issues, was published in 1985. The appearance of the third volume brings two major changes to the series. Dr. Rosner shares editorship of this volume with Harold I. Schwartz, and this is the first of the series to be devoted entirely to one area in forensic psychiatry, the elderly. This is a priority subject. As the baby boom ages and technology for extending life increases, the profile of our population is maturing. The aging of the nation brings with it problems of chronic care, the dementias, the fear of prolonging dying rather than extending meaningful life, the social question of increasing health care costs, and the medical and human question of legal and ethical protection of the elderly patient. This volume could not be more timely. As Bernice Neugarten has pointed out, we must avoid stereotyping the elderly.l Many individuals bring to older age a rich repertoire of interests, abilities, and insights. Among the elderly are the young-old.

Geriatric Forensic Psychiatry: Principles and Practice is one of the first texts to provide a comprehensive review of important topics in the intersection of geriatric psychiatry, medicine, clinical neuroscience, forensic psychiatry, and law. It will speak to a broad audience among varied fields, including clinical and forensic psychiatry and mental health professionals, geriatricians and internists, attorneys and courts, regulators, and other professionals working with the older population. Topics addressed in this text, applied to the geriatric population, include clinical forensic evaluation, regulations and laws, civil commitment, different forms of capacity, guardianship, patient rights, medical-legal issues related to treatment, long term care and telemedicine, risk management, patient safety and error reduction, elder driving, sociopathy and aggression, offenders and the adjudication process, criminal evaluations, corrections, ethics, culture, cognitive impairment, substance abuse, trauma, older professionals, high risk behavior, and forensic mental health training and research. Understanding the relationship between clinical issues, laws and regulations, and managing risk and improving safety, will help to serve the growing older population.

I. OVERVIEW Legal Issues in Mental HeaIth Care is aimed at the mental health clinician who provides services on either an inpatient or an outpatient basis. It is written for psychiatrists, psychologists, social workers, nurses, and other therapists to help them understand and manage legal issues in their daily practice. The issues covered apply to therapists who work for an agency or hospital as weil as those who work independently. The book is meant to serve as a handbook, but it also provides a quick resource as legal questions arise which are related to the obligations of the therapist. It ad dresses the legal issues that confront the clinician. It is not aimed at the clinicianwho specializes in forensie mental health issues, because the information provided does not reach that level of detail or sophistication. Nor is it aimed at the scholar, because our goal is to provide practical information in a clear and concise format. Wehave not addressed the wide array of laws protecting the mentally disabled from discrirnina tion-most notably, the Americans with Disabilities Act (1990)and the Fair Housing Act. Most states also have laws that prohibit discrimination in employment, services, and housing. These issues are beyond the scope of this book because we are address ing the legal issues that arise in providing care, rather than the rights of mentally disabled persons. 11. ORGANIZATION OF THE BOOK The book consists of eleven chapters and a Glossary of Legal Terms.

This essential guide is designed for mental health practitioners and primary care providers without advanced training in geriatric psychiatry. Gary J. Kennedy sets forth a clear framework for understanding the interplay of medical, psychological, and social factors in frequently encountered problems among older adults. Clear guidelines are delineated for assessing and treating such conditions as depression and anxiety, dementia, psychosis and mania, sleep disturbances, personality and somatoform disorders, substance abuse, and suicidality. Throughout, the book focuses on ways to sustain seniors' independence and overall quality of life while enhancing their adaptive capacities. Winner--American Journal of Nursing Book of the Year Award (2000) See also the author's Geriatric Depression: A Clinical Guide, which distills the best available interventions for depression in older adults in a highly accessible format.

Written by noted authorities in geriatric psychiatry, this volume is a clinically oriented guide to the diagnostic workup and treatment of psychiatric and neuropsychiatric disorders in elderly patients. The book describes in detail the neurologic and neuropsychiatric patient assessment and the use of all treatment modalities, both psychotherapeutic and pharmacologic, in elderly patients. Chapters discuss the treatment of disorders in all clinical settings—inpatient, outpatient, emergency, primary care, assisted living, and long-term care. Algorithms for workup and treatment are included, as well as case studies and personal accounts by patients and care providers. Appendices provide drug information and additional resources.