Skip to main content

Advertisement

Log in

Ethical, Legal and Forensic Issues in Geriatric Psychiatry

  • Geriatric Disorders (W McDonald, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

To evaluate the ethical, legal and forensic issues that is faced by the older adult population.

Recent Findings

Many older individuals will face a host of ethical, medical and legal issues associated with their care. Most prominent among these issues are the maintenance of autonomy while ensuring their safety and the safety of individuals who care for them. Decisions regarding end of life including the formulation of advance directives add to the complexity of care for these older adults. A significant portion of individuals in the criminal justice system are aging and many of these individuals have psychiatric disorders. Their care is compromised due to the lack of appropriate services within criminal justice system for providing care for these individuals.

Conclusions

Ethical, legal and forensic issues among older are not uncommon and complicate the care of these vulnerable individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. C.F.D.C.A. Health, United States, 2009: With Special Feature on Medical Technology. Health, United States, 2009: with special feature on medical technology. Health, United States. Hyattsville (MD) 2010.

  2. Walaszek A. Clinical ethics issues in geriatric psychiatry. Psychiatr Clin N Am. 2009;32(2):343–59. https://doi.org/10.1016/j.psc.2009.02.004.

    Article  Google Scholar 

  3. Rabins PV, Black BS. Ethical issues in geriatric psychiatry. Int Rev Psychiatry. 2010;22(3):267–73.

    Article  PubMed  Google Scholar 

  4. Department of Health E, Welfare, National Commission for the Protection of Human Subjects of B, Behavioral R. The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research. J Am Coll Dent. 2014;81(3):4–13.

    Google Scholar 

  5. Medicine AFABoI, Medicine A-AFACoP-ASoI, European Federation of Internal M. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–6.

    Article  Google Scholar 

  6. • Roberts LW. Informed consent and the capacity for voluntarism. Am J Psychiatry. 2002;159(5):705–12. This is an excellent review paper on informed consent.

    Article  PubMed  Google Scholar 

  7. • Moye J, Marson DC. Assessment of decision-making capacity in older adults: an emerging area of practice and research. J Gerontol B Psychol Sci Soc Sci. 2007;62(1):P3–P11. This is an excellent review paper on decision-making capacity among older adults. https://doi.org/10.1093/geronb/62.1.P3.

    Article  PubMed  Google Scholar 

  8. Irwin SA, Zurhellen CH, Diamond LC, Dunn LB, Palmer BW, Jeste DV, et al. Unrecognised cognitive impairment in hospice patients: a pilot study. Palliat Med. 2008;22(7):842–7. https://doi.org/10.1177/0269216308096907.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Okonkwo OC, Griffith HR, Copeland JN, Belue K, Lanza S, Zamrini EY, et al. Medical decision-making capacity in mild cognitive impairment: a 3-year longitudinal study. Neurology. 2008;71(19):1474–80. https://doi.org/10.1212/01.wnl.0000334301.32358.48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Huthwaite JS, Martin RC, Griffith HR, Anderson B, Harrell LE, Marson DC. Declining medical decision-making capacity in mild AD: a two-year longitudinal study. Behav Sci Law. 2006;24(4):453–63. https://doi.org/10.1002/bsl.701.

    Article  PubMed  Google Scholar 

  11. Ganzini L, Lee MA, Heintz RT, Bloom JD, Fenn DS. The effect of depression treatment on elderly patients’ preferences for life-sustaining medical therapy. Am J Psychiatry. 1994;151(11):1631–6. https://doi.org/10.1176/ajp.151.11.1631.

    Article  CAS  PubMed  Google Scholar 

  12. Palmer BW, Dunn LB, Appelbaum PS, Jeste DV. Correlates of treatment-related decision-making capacity among middle-aged and older patients with schizophrenia. Arch Gen Psychiatry. 2004;61(3):230–6. https://doi.org/10.1001/archpsyc.61.3.230.

    Article  PubMed  Google Scholar 

  13. Blank K, Robison J, Doherty E, Prigerson H, Duffy J, Schwartz HI. Life-sustaining treatment and assisted death choices in depressed older patients. J Am Geriatr Soc. 2001;49(2):153–61. https://doi.org/10.1046/j.1532-5415.2001.49036.x.

    Article  CAS  PubMed  Google Scholar 

  14. Palmer BW, Jeste DV. Relationship of individual cognitive abilities to specific components of decisional capacity among middle-aged and older patients with schizophrenia. Schizophr Bull. 2006;32(1):98–106.

    Article  PubMed  Google Scholar 

  15. Moye J, Karel MJ, Azar AR, Gurrera RJ. Capacity to consent to treatment: empirical comparison of three instruments in older adults with and without dementia. Gerontologist. 2004;44(2):166–75. https://doi.org/10.1093/geront/44.2.166.

    Article  PubMed  PubMed Central  Google Scholar 

  16. •• Karlawish J. Measuring decision-making capacity in cognitively impaired individuals. Neurosignals. 2008;16(1):91–8. This is an outstanding review paper on decision-making capacity among cognitively impaired individuals.

    Article  CAS  PubMed  Google Scholar 

  17. Marson DC, McInturff B, Hawkins L, Bartolucci A, Harrell LE. Consistency of physician judgments of capacity to consent in mild Alzheimer’s disease. J Am Geriatr Soc. 1997;45(4):453–7. https://doi.org/10.1111/j.1532-5415.1997.tb05170.x.

    Article  CAS  PubMed  Google Scholar 

  18. Marson DC, Earnst KS, Jamil F, Bartolucci A, Harrell LE. Consistency of physicians’ legal standard and personal judgments of competency in patients with Alzheimer’s disease. J Am Geriatr Soc. 2000;48(8):911–8. https://doi.org/10.1111/j.1532-5415.2000.tb06887.x.

    Article  CAS  PubMed  Google Scholar 

  19. Karlawish J, Cary M, Moelter ST, Siderowf A, Sullo E, Xie S, et al. Cognitive impairment and PD patients’ capacity to consent to research. Neurology. 2013;81(9):801–7. https://doi.org/10.1212/WNL.0b013e3182a05ba5.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kim SY, Caine ED. Utility and limits of the mini mental state examination in evaluating consent capacity in Alzheimer’s disease. Psychiatr Serv. 2002;53(10):1322–4. https://doi.org/10.1176/appi.ps.53.10.1322.

    Article  PubMed  Google Scholar 

  21. Kim SY, Karlawish JH, Caine ED. Current state of research on decision-making competence of cognitively impaired elderly persons. Am J Geriatr Psychiatry. 2002;10(2):151–65. https://doi.org/10.1097/00019442-200203000-00006.

    Article  PubMed  Google Scholar 

  22. • Dunn LB, Nowrangi MA, Palmer BW, Jeste DV, Saks ER. Assessing decisional capacity for clinical research or treatment: a review of instruments. Am J Psychiatry. 2006;163(8):1323–34. This review evaluated the literature for the usefulness of structured assessments of adult’s capacity to consent to clinical treatment or research protocols.

    Article  PubMed  Google Scholar 

  23. Drane JF. Competency to give an informed consent. A model for making clinical assessments. JAMA. 1984;252(7):925–7.

    Article  CAS  PubMed  Google Scholar 

  24. Sprung CL, Winick BJ. Informed consent in theory and practice: legal and medical perspectives on the informed consent doctrine and a proposed reconceptualization. Crit Care Med. 1989;17(12):1346–54. https://doi.org/10.1097/00003246-198912000-00022.

    Article  CAS  PubMed  Google Scholar 

  25. Mittal D, Palmer BW, Dunn LB, Landes R, Ghormley C, Beck C, et al. Comparison of two enhanced consent procedures for patients with mild Alzheimer disease or mild cognitive impairment. Am J Geriatr Psychiatry. 2007;15(2):163–7. https://doi.org/10.1097/JGP.0b013e31802dd379.

    Article  PubMed  Google Scholar 

  26. Jeste DV, Dunn LB, Folsom DP, Zisook D. Multimedia educational aids for improving consumer knowledge about illness management and treatment decisions: a review of randomized controlled trials. J Psychiatr Res. 2008;42(1):1–21. https://doi.org/10.1016/j.jpsychires.2006.10.004.

    Article  PubMed  Google Scholar 

  27. Wu P, Lorenz KA, Chodosh J. Advance care planning among the oldest old. J Palliat Med. 2008;11(2):152–7. https://doi.org/10.1089/jpm.2007.0134.

    Article  CAS  PubMed  Google Scholar 

  28. High DM. Surrogate decision making. Who will make decisions for me when I can’t? Clin Geriatr Med. 1994;10(3):445–62.

    CAS  PubMed  Google Scholar 

  29. Moye J, Naik AD. Preserving rights for individuals facing guardianship. JAMA. 2011;305(9):936–7. https://doi.org/10.1001/jama.2011.247.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Brown JB, Beck A, Boles M, Barrett P. Practical methods to increase use of advance medical directives. J Gen Intern Med. 1999;14(1):21–6. https://doi.org/10.1046/j.1525-1497.1999.00276.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Omnibus Budget Reconciliation Act of 1990 (Public Law 101-508). Health Care Financ Rev. 1991;13(2):115–34.

  32. Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362(13):1211–8. https://doi.org/10.1056/NEJMsa0907901.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Maxfield CL, Pohl JM, Colling K. Advance directives: a guide for patient discussions. Nurse Pract. 2003;28(5):38–47. https://doi.org/10.1097/00006205-200305000-00008.

    Article  PubMed  Google Scholar 

  34. Johnston SC, Pfeifer MP, McNutt R. The discussion about advance directives. Patient and physician opinions regarding when and how it should be conducted. End of Life Study Group. Arch Intern Med. 1995;155(10):1025–30. https://doi.org/10.1001/archinte.1995.00430100047005.

    Article  CAS  PubMed  Google Scholar 

  35. Ramsaroop SD, Reid MC, Adelman RD. Completing an advance directive in the primary care setting: what do we need for success? J Am Geriatr Soc. 2007;55(2):277–83. https://doi.org/10.1111/j.1532-5415.2007.01065.x.

    Article  PubMed  Google Scholar 

  36. Billing for Advance Care Planning (ACP) Claims [updated March 20, 2017]. Available from: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10000.pdf. Retrieved 25 Sept 2017.

  37. Williams BA, Goodwin JS, Baillargeon J, Ahalt C, Walter LC. Addressing the aging crisis in U.S. criminal justice health care. J Am Geriatr Soc. 2012;60(6):1150–6. https://doi.org/10.1111/j.1532-5415.2012.03962.x.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Aday R. Aging prisoners’ concerns toward dying in prison. OMEGA-J Death Dying. 2006;52(3):199–216. https://doi.org/10.2190/CHTD-YL7T-R1RR-LHMN.

    Article  Google Scholar 

  39. Ann Carson E, Sabol W. Aging of the state prison population, 1993-2013. Bureau of Justice Statistics; [updated May 19, 2016. Available from: https://www.bjs.gov/content/pub/pdf/aspp9313_Sum.pdf. Retrieved 25 Sept 2017.

  40. James D, Glaze L. Bureau of Justice Statistics Special Report: mental health problems of prison and jail inmates. 2006. [cited 2016 30 October]. Available from: https://www.bjs.gov/content/pub/pdf/mhppji.pdf. Retrieved 25 Sept 2017.

  41. Barry LC, Wakefield DB, Trestman RL, Conwell Y. Disability in prison activities of daily living and likelihood of depression and suicidal ideation in older prisoners. Int J Geriatr Psychiatry. 2017;32(10):1141–9. https://doi.org/10.1002/gps.4578.

  42. Paradis C, Broner N, Maher L-M, O’Rourke T. Mentally ill elderly jail detainees. J Offender Rehabil. 2000;31(1–2):77–86. https://doi.org/10.1300/J076v31n01_05.

    Article  Google Scholar 

  43. Caverley S. Older mentally ill inmates: a descriptive study. J Correct Health Care. 2006;12(4):262–8. https://doi.org/10.1177/1078345806295546.

    Article  Google Scholar 

  44. Fazel S, Hope T, O’Donnell I, Jacoby R. Hidden psychiatric morbidity in elderly prisoners. Br J Psychiatry. 2001;179:535–9.

    Article  CAS  PubMed  Google Scholar 

  45. •• Kingston P, Le Mesurier N, Yorston G, Wardle S, Heath L. Psychiatric morbidity in older prisoners: unrecognized and undertreated. Int Psychogeriatr. 2011;23(8):1354–60. This important paper examined the prevalence of psychiatric disorders and physical disorders, including dementia among prisoners aged 50 years and over prisons.

    Article  PubMed  Google Scholar 

  46. Maschi T, Morgen K, Zgoba K, Courtney D, Ristow J. Age, cumulative trauma and stressful life events, and post-traumatic stress symptoms among older adults in prison: do subjective impressions matter? Gerontologist. 2011;51(5):675–86. https://doi.org/10.1093/geront/gnr074.

    Article  PubMed  Google Scholar 

  47. Flatt JD, Williams BA, Barnes D, Goldenson J, Ahalt C. Post-traumatic stress disorder symptoms and associated health and social vulnerabilities in older jail inmates. Aging Ment Health. 2017;21(10):1106–12. https://doi.org/10.1080/13607863.2016.1201042.

    Article  PubMed  Google Scholar 

  48. Blitz CL, Wolff N, Shi J. Physical victimization in prison: the role of mental illness. Int J Law Psychiatry. 2008;31(5):385–93. https://doi.org/10.1016/j.ijlp.2008.08.005.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Stojkovic S. Elderly prisoners: a growing and forgotten group within correctional systems vulnerable to elder abuse. J Elder Abuse Negl. 2007;19(3–4):97–117. https://doi.org/10.1300/J084v19n03_06.

    Article  PubMed  Google Scholar 

  50. Struckman-Johnson C, Struckman-Johnson D, Rucker L, Bumby K, Donaldson S. Sexual coercion reported by men and women in prison. J Sex Res. 1996;33(1):67–76. https://doi.org/10.1080/00224499609551816.

    Article  Google Scholar 

  51. Maschi T, Dennis KS, Gibson S, MacMillan T, Sternberg S, Hom M. Trauma and stress among older adults in the criminal justice system: a review of the literature with implications for social work. J Gerontol Soc Work. 2011;54(4):390–424. https://doi.org/10.1080/01634372.2011.552099.

    Article  PubMed  Google Scholar 

  52. Maschi T, Kwak J, Ko E, Morrissey MB. Forget me not: dementia in prison. Gerontologist. 2012;52(4):441–51. https://doi.org/10.1093/geront/gnr131.

    Article  PubMed  Google Scholar 

  53. Williams BA, Lindquist K, Sudore RL, Strupp HM, Willmott DJ, Walter LC. Being old and doing time: functional impairment and adverse experiences of geriatric female prisoners. J Am Geriatr Soc. 2006;54(4):702–7. https://doi.org/10.1111/j.1532-5415.2006.00662.x.

    Article  PubMed  Google Scholar 

  54. Haney C. From prison to home: the effect of incarceration and reentry on children, families, and communities—the psychological impact of incarceration: implications for post-prison adjustment. 2001. Available from: https://aspe.hhs.gov/basic-report/psychological-impact-incarceration-implications-post-prison-adjustment#Abstract. Retrieved 25 Sept 2017.

  55. Mossman D, Noffsinger SG, Ash P, Frierson RL, Gerbasi J, Hackett M, et al. AAPL Practice Guideline for the forensic psychiatric evaluation of competence to stand trial. J Am Acad Psychiatry Law. 2007;35(4 Suppl):S3–72.

    PubMed  Google Scholar 

  56. Heinik J, Kimhi R, Hes JP. Dementia and crime: a forensic psychiatry unit study in israel. Int J Geriatr Psychiatry. 1994;9(6):491–4. https://doi.org/10.1002/gps.930090608.

    Article  Google Scholar 

  57. Frierson R, Shea S, Shea M. Competence-to-stand-trial evaluations of geriatric defendants. J Am Acad Psychiatry Law Online. 2002;30(2):252–6.

    Google Scholar 

  58. Morris DR, Parker GF. Effects of advanced age and dementia on restoration of competence to stand trial. Int J Law Psychiatry. 2009;32(3):156–60. https://doi.org/10.1016/j.ijlp.2009.02.009.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rajesh R. Tampi.

Ethics declarations

Conflict of Interest

Juan Young, Silpa Balachandran, Dhweeja Dasarathy and Deena Tampi declare that they have no conflict of interest.

Rajesh R. Tampi receives honorarium from Oakstone and royalties from Lippincott Williams & Wilkins and Oxford University Press.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Geriatric Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tampi, R.R., Young, J., Balachandran, S. et al. Ethical, Legal and Forensic Issues in Geriatric Psychiatry. Curr Psychiatry Rep 20, 1 (2018). https://doi.org/10.1007/s11920-018-0865-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-018-0865-3

Keywords

Navigation