Assessing Geriatric Competency | Psychiatric Evaluation
Comprehensive guide to geriatric competency assessment for legal and medical purposes in Orange County.
Accepted insurances:
Anthem Blue Cross, Aetna, and Health Net/MHN.
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 Fullerton, Laguna Hills and Westminster.
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.