An older client displaying signs of dementia appears in your office wanting to make changes to her will. She is accompanied by a neighbor and caregiver on whom she has depended since the death of her husband two years prior. Do you allow your client to make the changes to her will? How will you assess decision-making abilities that may indicate diminished capacity? Do you refer your client to a professional? How will you address this issue with your client? Do you understand the caregiver’s role in your client’s wish to make changes to her will?
Capacity concerns are increasingly commonplace among attorneys given the aging population. The U.S. Census Bureau reports that in the year 2000 35 million people were older than age 60 in the United States, with projections that by the year 2030 the number will double to 70 million. Most important, the group of those 85 years of age and older will more than double in size, increasing from 4.2 million in 2000 to 8.9 million in 2030. Cognitive impairment rates are exceptionally high in this group, according to the Alzheimer’s Association.
One challenge faced by older adults with cognitive decline is the ability to make quick, sound decisions and judgments. In a society that values independence and autonomy, the responsibility to make decisions falls directly on the individual. “Adult Age Differences in Dual Information Processes: Implications for the Role of Affective and Deliberative Processes in Older Adults’ Decision Making,” an article published in
Perspectives on Psychological Science, a journal of the Association for Psychological Science, states that understanding the effects of cognitive decline, and subsequent dementia, on decision-making capabilities can help in identifying areas that may leave individuals vulnerable as well as areas that can be maintained at a higher level of competency throughout old age.
In 2008, the American Psychological Association and the American Bar Association Commission on Law and Aging partnered to create a handbook of mental capacity and assessment recommendations for professionals in the legal, psychological, and judicial fields, Assessment of Older Adults with Diminished Capacity: A Handbook for Lawyers. The handbook guides lawyers through a model of assessment that meets legal standards in all states, including information about assessment resources, the assessment process, and the various tests of cognitive functioning that are typically used to evaluate diminished capacity in older clients. The handbook also highlights the importance of using an “appropriate diagnostician” (or clinician) who is able to offer more than a diagnosis but also able to describe an older adult’s cognitive and functional abilities that relate to decisional capacity, inclusive of both areas of strength and compromise.
A geropsychologist is one such clinician who is knowledgeable about facets specific to aging, assessment tools that most accurately examine cognitive functioning relative to issues of capacity, and interventions that can maximize capacity. Geropsychologists view the whole person using assessment information from health care providers, neuropsychologists, and other informants. This holistic approach involves an appreciation of cognitive functioning as it relates to aging with an understanding of situational and environmental stressors that likely contribute to changes in behavior.
Additionally, while typically not authorized to prescribe medications, a geropsychologist will review a patient’s complete medical history to check for potential medication interactions that might play a role in compromised cognitive functioning. A comprehensive evaluation from a geropsychologist equips attorneys to support or discourage financial transactions by older clients who present with questionable decision-making abilities that may add to their risk for financial exploitation and abuse. A geropsychologist also can help guide and educate clients and their families about what to expect in the future and possible signs of dementia and can offer advice on how to respect an aging loved one’s autonomy while being cognizant that decisions are processed differently as a person ages.
Regardless of your area of specialty, your clientele inevitably will reflect the fastest growing segment of the population—those 65 and older. Having the resources and knowledge to best serve this population will not only augment your practice but also will support the protection and enhancement of older adults and their families. For more information about the handbook for lawyers, please visit the ABA Commission on Law and Aging at www.abanet.org/aging. To locate a list of available geropsychologists in your area, contact your local Area Agency on Aging, call the Eldercare Locator at 800/677-1116, or go online to www.eldercare.gov.
Sheri C. Gibson is a graduate student in the PhD Clinical Psychology program with a curricular emphasis in Geropsychology at the University of Colorado at Colorado Springs. Her research, which includes elder financial abuse issues, undue influence, and intervention strategies for suspected cases of elder financial abuse, has been partially funded by grants from the Borchard Foundation Center on Law and Aging and the American Psychology-Law Society Grants-In-Aid Division.