Patient Education
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BEHAVIORAL ALEX D. MICHELSON M.D., INC Clinical and Forensic Psychiatry
Phone
(949) 462-9114
24401 Calle De La Louisa,
Fax (949) 460-9114 E-mail:
michelson@doctor.com
ASSESSING GERIATRIC COMPETENCY
The following few decades are likely to bring increasing calls for consultation and expert testimony on geriatric competency. With advanced technology in medicine, the length of our life extends every year. It is not uncommon to see the aging group of seniors in their eighties and above. The ability to qualify the cognitive and behavioral changes of aging is still in dispute in many courts and legal debates. This article reviews some situations when assessment of geriatric competency might become an issue. Conservatorship Issues
At times, frustrated patients and family members cannot agree on treatment issues, on priority of actions and financial affairs. Power of attorney is not useful in cases of major disagreements within the family. While conservatorship sounds more frightening, it is sometimes a life-saving measure, which brings peace and important balance within the family. Family members are usually appointed as conservators. When the projected conservator refuses to perform the duty or is highly opposed by a proposed conservatee, other
“neutral” candidates can be selected from outside the family. Other legal specifics may influence the
choice of a conservator, but usually close family members would fulfill well
the role of a conservator for the person and his estate. Driving
Competency Special
concerns are related to competency of driving a vehicle. It is common to see
seniors complaining about a suspended or revoked driver’s license.
Statistically speaking, crash rates per miles driven are higher in the elderly
than in other age groups. Driving skills
tend to deteriorate with age and it is partially related to the normal
processes of aging. Visual fields and visual
acuity tend to diminish. Concentration and attention may slowly decrease,
reaction time increases. The combination
of these may substantially impair driving abilities. Furthermore, side effects of medications
represent a separate risk. No
definitive cognitive test or driving test is available to accurately measure
the risk of accidents. A combination of tests for attention, concentration,
reaction time and cognitive functioning give the most comprehensive
assessment. Dementing
processes such as Alzheimer’s disease bring an additional challenge for driving
habits. California Code of Regulations
and Section 510 of the Health and Safety Code require reporting of dementia to
the DMV. In response, the DMV will
examine driving competency at Driver Safety Offices located in It
is important to maintain the balance in the risk vs. the benefit of driving and
be concerned about possible consequences of any imbalances. The safety of our families and the joy of
driving should be thought of constantly when we sit behind the wheel. Will
Contests Another
very important type of assessment is usually related to mental competency to
sign a will or susceptibility to undue influence at the time the will was
signed. While there are many grounds upon which the validity of a will can be
challenged, the most common points for contest from a competency stand point
would be: 1)
Testator
(the person signing the will) lacked the testamentary capacity to sign the will
or codicil (amendment to an existing will). 2)
Testator
was not able to tolerate the challenge and was susceptible to undue influence. If
it is proven that the testator lacked testamentary capacity, the entire will is
invalidated. If undue influence is proven, the part of the will affected by the
influencing person is invalidated. Forensic
expertise may be needed at the time of signing a new will when there is doubt
about the proposed beneficiary or testator’s competency. This
issue can also be raised post-mortem, a few years after testator’s death. At times, the will is contested by an unhappy
potential beneficiary asking for a settlement or compensation. Many
legal terms have been applied in decisions regarding geriatric competency:
“testamentary capacity”, “lucid intervals”, and “undue influence”. It is still
the obligation of the medical field to clarify the understanding of aging
processes. Medicine has been directed
for generations toward finding the truth about illness or normal processes of
aging. It can serve us again with
objectivity and impartial expertise in many legal situations. SHOULD YOU HAVE ANY QUESTIONS PLEASE CALL: (949)
462-9114 Alex D. Michelson, M.D. Forensic Psychiatry at BEHAVIORAL ALEX D. MICHELSON M.D., INC Clinical and Forensic Psychiatry
Phone (949) 462-9114
24401 Calle De La Louisa,
Fax (949) 460-9114
E-mail: michelson@doctor.com
SUICIDE AS A PSYCHIATRIC EMERGENCY In our
lives, various situations may represent substantial crisis or emergency. Loss of marriage, bankruptcy, terminal
illnesses are on the list among the most difficult situations. For many centuries, suicide has been one of
the most sorrow and critical tragedies in human lives. Each year, suicide takes away approximately
30, 000 people in the Suicide is
ranked as the ninth overall cause of death in this country after heart disease,
cancer, cardiovascular disease, COPD, accidents, pneumonia/influenza, diabetes
mellitus, and HIV virus. State by state
analysis of suicide in the last decade among people between the ages of 15 and
44 revealed that Let’s review step by step factors associated with the risk of suicide.
The different risk factors described in this article are based on a substantial amount of statistical information. These factors though should not be utilized alone in suicide risk assessment. Taking into consideration the individual characteristics of a person gives a comprehensive approach to this issue. Most of the time, mental health professionals assess suicide risk. You may contact Dr. Michelson’s office at (949) 462-9114 to discuss your concerns or questions. The majority of suicide committers
tend to suffer from depressive disorders and substance abuse. By reducing the
rate of depression and substance abuse in the community we decrease the
incidence of suicide and subsequently frustration, guilt and despair among
surviving friends, family and significant others. Alex D. Michelson, M.D. Clinical Psychiatry Offices In
BEHAVIORAL ALEX D. MICHELSON M.D., INC Clinical and Forensic Psychiatry
Phone (949) 462-9114
24401 Calle De La Louisa,
Fax (949) 460-9114
E-mail: michelson@doctor.com
“Life Comfort versus Depression”
Historically, mood disorders have occupied a prominent part in medicine and numerous scholars have written about depression over the years. It is not surprising that people are very much aware of depression as a phenomenon. Quite a few people have asked me about specifics of depression with respect to age, gender and suicide potential. Those inquiries triggered interest in writing this article and summarizing some important aspects of clinical depression. Let me focus first on the causes of depression, which indeed can be very different and complex. The most common life situations that account for depression are loss of a spouse, multiple physical illnesses, social isolation, and low socio-economic status. It is interesting that 50% of my patients deny depressive feelings and are referred for treatment due to social withdrawal and decreased activity. Depressed people tend to have a good understanding of their problems. At times, they overemphasize symptoms, their disorder, and their life problems. On one hand, it makes some facilitation for treatment because of good compliance with medications and therapy. On the other hand, it is difficult at times to convince such patients that improvement is possible. Patience and compliance with therapy usually give positive results in over 90% of cases. Nevertheless, we are aware that the risk for depression is 15% in a lifetime. Up to 65% of depressed individuals contemplate suicide, and 10%-15% commit suicide. Therapists are encouraged to ask depressed patients about suicidal thinking. This practice does not increase the risk for suicide. Depressed mood and loss of interest in hobbies or
pleasurable activities would be the key symptoms for depression. Other symptoms such as decreased appetite,
insomnia, poor concentration and indecisiveness may also be part of the
picture. Anxiety is present in 90% of all cases. Cognitive decline in
depression has a sudden onset as opposed to dementing
processes. In dementia, deterioration of
cognitive functioning is more gradual. Dynamically, it is common to see pain of “loss” directed
toward oneself among depressed patients. Many of them live for somebody else
and in those situations tend to experience multiple setbacks in relationships
by not receiving empathy and compassion.
Disappointments in life generate desperate sadness, and depressive
feelings. Biological predispositions have also been described in literature. Lately, in clinical practice, we have noticed a tendency of stopping estrogen / progesterone replacement medications among female patients. Discontinuation of this therapy exacerbates depressive symptoms. Although we are aware of increased incidence of mood disorders in post-partum and perimenopausal periods, future evaluation of sex steroids with respect to mood stabilization is warranted. Many therapies and medications are currently available to
improve our life and target depression. Yet, some people are still suffering
from depressive symptoms and delay treatment. We believe that life comfort
should be considered in every individual of either gender and in all age groups
regardless of cultural backgrounds and socioeconomic status. Alex Michelson, M.D. Clinical and Medical-Legal Psychiatry Offices in Phone: (949) 462-9114 |
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