The Elderly and the Mentally-Ill

  • Matjaž Zwitter


Elderly and psychiatric patients share some common characteristics: limited autonomy, uncritical over-estimation of their physical and mental abilities, and need for assistance in daily activities. However, there are also some important differences: psychiatric disease often leads to stigmatisation and to a low social and economic position in society. When dealing with elderly, chronologic age is one important piece of information; yet, age alone should not be a decisive factor in choosing the preferred medical intervention. The main ethical problem is lack of knowledge concerning the elderly: they represent a small minority of patients in clinical trials and are seldom reported separately. In the absence of precise guidelines, we should consider slower metabolic, repair and adaptation processes in advanced age and exert all medical interventions with caution. Caution is also recommended in dealing with psychiatric diseases: every non-conforming behaviour and every minor complaint regarding emotional well-being should not be treated as a disease. Surrogate decision-making should respect the remaining patient’s autonomy and should be based on beneficence as the leading ethical principle. When clearly indicated, intervention against a patient’s will is ethically justified: effective treatment of the underlying disease will hopefully restore patient’s autonomy.


Treating elderly patients Diagnosis of a mental disease Loss of autonomy Surrogate decision-making Acting against the will Hunger strike Anorexia nervosa Stigmatization 

Suggested Reading

  1. Allen NG, Khan JS, Alzahri MS, Stolar AG. Ethical issues in emergency psychiatry. Emerg Med Clin North Am. 2015;33:863–74. Scholar
  2. Daher M. Ethical issues in the geriatric patient with advanced cancer ‘living to the end’. Ann Oncol. 2013;24(Suppl 7):vii55–8. Scholar
  3. Diekema DS. Involuntary sterilization of persons with mental retardation: an ethical analysis. Ment Retard Dev Disabil Res Rev. 2003;9:21–6.CrossRefGoogle Scholar
  4. Gauthier S, Leuzy A, Racine E, Rosa-Neto P. Diagnosis and management of Alzheimer’s disease: past, present and future ethical issues. Prog Neurobiol. 2013;110:102–13. Scholar
  5. Gopal AA. Physician-assisted suicide: considering the evidence, existential distress, and an emerging role for psychiatry. J Am Acad Psychiatry Law. 2015;43:183–90.PubMedGoogle Scholar
  6. Hébert PC, Weingarten MA. The ethics of forced feeding in anorexia nervosa. CMAJ. 1991;144:141–4.PubMedPubMedCentralGoogle Scholar
  7. Heinimaa M, Larsen TK. Psychosis: conceptual and ethical aspects of early diagnosis and intervention. Curr Opin Psychiatry. 2002;15:533–41.CrossRefGoogle Scholar
  8. Ho AO. Suicide: rationality and responsibility for life. Can J Psychiatr. 2014;59:141–7.CrossRefGoogle Scholar
  9. Hughes J, Common J. Ethical issues in caring for patients with dementia. Nurs Stand. 2015;29:42–7. Scholar
  10. Humphreys K, Blodgett JC, Roberts LW. The exclusion of people with psychiatric disorders from medical research. J Psychiatr Res. 2015;70:28–32. Scholar
  11. Irmak N. Professional ethics in extreme circumstances: responsibilities of attending physicians and healthcare providers in hunger strikes. Theor Med Bioeth. 2015;36:249–63. Scholar
  12. Kukreja D, Günther U, Popp J. Delirium in the elderly: current problems with increasing geriatric age. Indian J Med Res. 2015;142:655–62. Scholar
  13. Lazarus JA. Physicians’ ethical obligations to hunger strikers. BMJ. 2013;346:f3705. Scholar
  14. Silber TJ. Treatment of anorexia nervosa against the patient’s will: ethical considerations. Adolesc Med State Art Rev. 2011;22:283–8.PubMedGoogle Scholar
  15. Strand M, von Hausswolff-Juhlin Y. Patient-controlled hospital admission in psychiatry: a systematic review. Nord J Psychiatry. 2015;69:574–86. Scholar
  16. Svensson B, Hansson L. How mental health literacy and experience of mental illness relate to stigmatizing attitudes and social distance towards people with depression or psychosis: a cross-sectional study. Nord J Psychiatry. 2016;70:309–13. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Matjaž Zwitter
    • 1
    • 2
  1. 1.Faculty of MedicineUniversity of MariborMariborSlovenia
  2. 2.Institute of OncologyLjubljanaSlovenia

Personalised recommendations