Policy, Ethical, and Legal Issues

  • Aarti Gupta
  • Meera Balasubramaniam


Physical and cognitive decline in old age often put the autonomy of older adults at risk. A comorbid mental illness is likely to further compound this problem, increasing their dependency on those around them. A key issue encountered in the clinical care of older adults is respecting their autonomy, while also ensuring their overall well-being. This chapter describes important ethical and medicolegal concepts relevant to the care of older adults. The first section of the chapter examines the role of a geriatric psychiatrist across health-care systems and models of care. The next section describes the commonly encountered task of assessing the decision-making capacity of older adults across domains of health care, finances, independent living, driving, and sexual relations. This is followed by a discussion of medicolegal issues germane to the older adult, which includes the concepts of advance care planning, surrogate decision-making, as well as the assessment and diagnosis of elder abuse. We will then review issues that relate to the elderly prisoner, namely, their care in the criminal justice system, as well as the assessment of criminal responsibility and competence to stand trial. The last section of the chapter is a description of treatment setting regulations in geriatric psychiatry, specifically the care of older adults in nursing homes.


Autonomy Decisional capacity Informed consent Advance care planning Living Will Surrogates Power of attorney Guardianship Conservatorship Elder abuse Competence to stand trial Nursing home regulations 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychiatryConnecticut Valley HospitalMiddletownUSA
  2. 2.Department of PsychiatryYale Univeristy School of MedicineNew HavenUSA
  3. 3.Department of PsychiatryNew York University School of MedicineNew YorkUSA

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