Geriatric Forensic Psychiatry

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.

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.

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.

The Clinician's Guide to Geriatric Forensic Evaluations provides practical guidance to clinicians performing forensic evaluations on older adults. The book begins with how geriatric forensic evaluations differ from those done on non-geriatric adults. DSM-5 criteria for neurocognitive disorders are discussed and differentiated from the previous criteria in DSM-IV. Coverage includes assessing decision-making capacity/competence and evaluating undue influence, elder abuse, and financial exploitation. Each chapter opens with a case study and then highlights specific assessment techniques, best practices, and common pitfalls to avoid. The book additionally covers forensic report writing, court testimony, and when to refer to an outside independent expert. Samples of geriatric forensic reports are provided. Provides practical information on performing geriatric forensic evaluations Identifies DSM-5 criteria for neurocognitive disorders Includes assessing decision-making capacity/competence, undue influence, elder abuse, and financial exploitation Features assessment strategies, case studies, best practices, and pitfalls to avoid Advises on report writing and court testimony

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.

In the course of the study, we have used the methodological approach to the scientific substantiation of the comprehensiveness of expert assessments of the mental state of patients-offenders suffering from cerebral-organic pathology. As a result, we have formulated the following general points: The forensic-psychiatric expert procedure is comprehensive in nature due to the participation of medical doctors, medical psychiatrists, and medical psychologists. Medical-social examination, which is carried out for the purposes of determining the social status of patients (disabled or not disabled) and their need for social protection, is a processthat is comprehensive due to participation of medical doctors, medical clinicians, and medical psychologists. The comprehensiveness of expert assessmentsthe forensic psychiatric and the medical social onesis made more complex due to the comprehensiveness of each one of these expert assessments. The methodological approach to the comprehensiveness of expert assessments is based on taking into account the following three principles: the principle of continuity, the principle of cooperation, and the principle of psychological support for patients-offenders, provided to them over the entire length of their medical-social route.

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.