Psychiatric Ethics in Late-Life Patients

1. Front Matter

   Pages i-xi

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2. Ethical Aspects of Geriatric Psychiatry

   1. Front Matter

      Pages 1-1

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   2. Aging: Balancing Autonomy and Beneficence

      • Reiko Emtman, Jason Strauss

      Pages 3-20

   3. The Capacity to Make Medical Decisions

      • Sarah A. Kleinfeld, Rohini Mehta, Edward J. Wicht

      Pages 21-35

   4. The Capacity to Live Independently

      • Mary E. Camp, Alexander Cole

      Pages 37-51

   5. The Capacity to Manage Finances

      • Oliver M. Glass, Larry Tune, Adriana P. Hermida

      Pages 53-66

   6. Capacity to Manage Critical Domains of Living: Driving, Voting, and Sexual Expression

      • Feyza Marouf

      Pages 67-88

   7. Ethical Challenges in Mild, Moderate, and Severe Stages of Dementia

      • Jananie Kumaran, Rakin Hoq, Romika Dhar, Meera Balasubramaniam

      Pages 89-107

   8. Research Ethics in Geriatric Psychiatry

      • Laura B. Dunn, Iuliana Predescu

      Pages 109-119

3. Medicolegal Aspects of Geriatric Psychiatry

   1. Front Matter

      Pages 121-121

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   2. Advance Healthcare Planning

      • Aarti Gupta, Romika Dhar

      Pages 123-140

   3. Surrogate Decision-Making

      • Romika Dhar, Aarti Gupta

      Pages 141-152

   4. Guardianship

      • Nery A. Diaz, Reema D. Mehta

      Pages 153-164

   5. Elder Abuse

      • Mary Ellen Trail Ross, Katharine L. Thomas, Sabrina Pickens, Jennifer Bryan, Ali Abbas Asghar-Ali

      Pages 165-181

4. Forensic Aspects of Geriatric Psychiatry

   1. Front Matter

      Pages 183-183

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   2. Social Determinants and Mental Health Among Older Adults in the Criminal Justice System

      • Tina Maschi, Dhweeja Dasarathy

      Pages 185-202

   3. Capacity to Stand Trial Evaluations for Geriatric Defendants

      • Monika Pietrzak, Jeremy Colley, Bipin Subedi

      Pages 203-217

   4. Responding to Crisis of Aging People in Prison: Global Promising Practices and Initiatives

      • Tina Maschi, Adriana Kaye

      Pages 219-237

5. Back Matter

   Pages 239-246

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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.

• Competency assessment
• Guardianship and eldercare
• Aging in prison
• Elder abuse
• Advance care planning

• New York University School of Medicine, New York, USA

  Meera Balasubramaniam

• Yale University School of Medicine, New Haven, USA

  Aarti Gupta

• Yale School of Medicine, New Haven, USA

  Rajesh R. Tampi

Meera Balasubramaniam, MD, MPH
Clinical Assistant Professor of Psychiatry, New York University School of Medicine
Director, Geriatric Psychiatry Fellowship, New York University School of Medicine
One Park Avenue, 8th Floor, New York, NY 10016

Aarti Gupta, M.D.
Assistant Professor of Clinical Psychiatry
Yale University School of Medicine
New Haven, CT
Yale Psychiatric Hospital
184 Liberty Street, New Haven
CT 06519

Rajesh R. Tampi, MD, MS, DFAPA

Chairman, Department of Psychiatry & Behavioral Sciences
Cleveland Clinic Akron General
Chief, Section for Geriatric Psychiatry, Cleveland Clinic
Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
0208 Rosalee Lane, Strongsville, Ohio 44136

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