Tahitian Pearls 2015 Tahiti CME Cruise March 18 28, Legal aspects of geriatric psychiatry: MD s Obligations Dr.

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1 Legal Issues in the Elderly Kiran Rabheru MD, CCFP, FRCP Geriatric Psychiatrist Professor University of Ottawa 1

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5 % 700K 1.5 M % 200K 500K 6.9% 2.1% 9.7% Double 2 4 million 5.8% Triple!! 800K to 2.5 million 5

6 Baby Boomers Years Ages #People % of population K 1.5M % Then stable at 5% but by 2021 = 2 million : 6.9% to 9.7% over this 3.9 million by Aged > 85 yrs rapid growth , from 196,000 to 492,000: 0.8% 15% 1.5% , aged > 85 from 800,000, stable at 2% , aged > 85 : 800, million, 2.1% 5.8% (TRIPLE!!) 6

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14 Elder Abuse: Extent of Problem Affects 2% to 10%of elders; Worldwide problem Underreported National Center on Elder Abuse, only 1 of 14 domestic adult abuse cases is reported 1.5 to 2 million older adults are neglected or abused in the United States t annually Serious health problems, risk factor for nursing home placement, higher mortality 14

15 Elder Abuse: Types Neglect or abuse: physical, psychological, sexual, financial (commissions vs. omissions). Subtle signs of neglect / abuse Must have a high index of suspicion Infrequent / cancelled visits, pattern of injuries, use, poor hygiene, malnutrition, misuse or absence of medications, poorly controlled chronic medical problems 15

16 Elder Abuse: Contributing Factors Why does elder abuse go unreported? Don t believe police or other agencies can help Don t want to lose their independence Fear being placed in an institution or kicked out of one they may already be in Not aware of their rights Feel ashamed of their mistreatment by family 16

17 Elder Abuse: Legal Aspects Is abuse of the Elderly a Crime? No specific criminal offence of elderly abuse There are various criminal offences, however, that might apply to different forms of elder abuse Physical abuse could be a form of assault or sexual assault Financial abuse could be an offence such as theft, fraud, or extortion Neglect might be covered by the offence of criminal neglect 17

18 Elder Abuse: Risk Profile Build rapport, private interviews, get collateral l info, observe the caregiver. Abuser profile: Adult children (32.6%), other family members (21.5%), or spouse/intimate partners (11.3%). Financial need, substance abuse, poor relationship, stress is not correlated. 18

19 Elder Abuse: Risk Profile Involving home care resources and addressing stressful Incontinence and disruptive behavior help as do respite and adult daycare. Be aware of family violence Involve law enforcement when there is immediate danger Advocacy 19

20 Elder Abuse: Reporting Who reports: Family members (17.0%), social services (10.6%), friends/neighbors (8.0%), self (6.3%), long-term care staff (5.5%), law enforcement (5.3%), and nurses/aides (3.8%). MDs only 1.4%!! Awareness, training, i denial, reluctance, uncomfortable, time, safety, symptoms masked by other illness 20

21 Elder Abuse: Detection 1. Has anyone at home ever hurt or threatened you? 2. Has anyone made you feel guilty about asking for help? 3. Has anyone refused to give you food or needed medicine? 4. Have you ever been asked to sign papers you did not understand? 5. Has anyone taken something from you without asking? 6. Has anyone touched you without your permission? 21

22 Elder Abuse: Resources Know the laws & support services. Preventive strategies t screening for substance abuse and dementia, Educating and counseling caregivers, and referring to support groups, local Alzheimer s Association chapters, Area Agencies on Aging, financial counselors, legal aid, and elder law specialists. 22

23 Capacity Issues Most older adults are capable of making their own decisions Capacity can change from decision to decision, and from time to time There is not a single test t that t determines capacity for all times and all purposes Watch out for a Best Interests Test a Capable person has the right to risk Continuing Power of Attorney for Property and Power of Attorney for Personal Care 23

24 Capacity Issues Do not automatically assume that frail elderly l people are incapable Speak with the older person, not around him/her Recognize potential conflicts of interest & opportunities for elder abuse by a substitute decision-maker Help to empower the older person 24

25 Continuing Power of Attorney for Finances 25

26 Power of Attorney for Personal Care 26

27 Driving & Dementia Dementia: 8% > 65 yrs, 35% > 85 yrs CI: 8% :65 74 yrs, 42% >85 yrs Both: 12% : 65 to 74 & 72%: age > 85. Canadian Study on Health and Aging (1991) 27

28 At-fault crash rates > 3 times higher than controls. Comorbidity raises the risk! 28

29 Dementia: 8% > 65 yrs, 35% > 85 yrs. Cognitive Impairment: 8% :65 74 yrs, 42% over 85 yrs. Both: 12% : 65 to 74 & 72%: age > 85. Canadian Study on Health and Aging (1991) 29

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34 SIMARD-MD MD (Screen for the Identification of Medically At Risk Drivers A Modification of the Dem-Tect), a new tool for Health Care Practitioners to identify cognitively impaired patients whose driving skills may have declined to an unsafe level. Until use of the SIMARD-MD MD has been fully implemented, the OSMV will accept the MMSE or MoCA as cognitive screens for making driver fitness determinations." ti 34

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36 Determining Medical Fitness to Drive: full text t book, Canadian Medical Association ca/determining%20medica l%20fitness%20to%20drive:%20a%20guid e%20for%20physicians ww.drivesafe.com/ 36

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