The Clinician’s Guide to Geriatric Forensic Evaluations occupies a niche that is underrepresented in the clinical literature and popular press. It is concise enough to be easily accessible to those with precious little free time, yet thorough enough to guide a novice’s approach to the assessment of an older individual. Reimers is respectful in her use of terminology and her explanations and approach to the subject of ageism. She discusses real-world examples of the potential for discrimination that a geriatric patient may face in a legal proceeding, or even from a forensic examiner.
I was struck by the useful outlines at the beginning of each chapter and found them a helpful tool to quickly navigate to specific concepts in each chapter. The text is organized into chapters addressing, in order, an introduction to geriatric forensic evaluations, ethics and legal concerns, evaluation of cognitive impairment, evaluation of decision-making capacity and guardianship, evaluation of elder abuse and financial exploitation, and geriatric forensic report writing and testimony. The preface of the book contains a discussion of the objectives of the work as a whole, as well as a chapter by chapter summary. The index at the end gives a more specific listing of key words, with page numbers and a distinguishing notation for figures and text boxes. Numerous text boxes throughout the book outline and highlight important concepts.
The first chapter introduces concepts and terminology that may be unique to a geriatric evaluation, or addressed in a geriatric setting in a different way than in other areas of forensic practice. Background information is provided on forensic evaluations in general, which may be unnecessary for an experienced examiner but useful to a trainee or early career psychiatrist. Psychiatric and general medical conditions affecting mental status and decision-making in older adults are reviewed. Finally, Reimers reviews the performance of a mental status exam in older adults along with unique aspects faced with an older subject.
Chapter 2 covers ethics and legal concerns. These concepts are treated broadly and, again, at a level easily understood by novice as well as expert. The less experienced expert will find this chapter more useful.
Chapter 3 describes the cognitive examination of the older adult and discusses the nuances of updates in nomenclature and diagnostic criteria of neurocognitive disorders within the DSM-5. I found this section particularly helpful as my practice does not primarily involve older adults and I imagine other nongeriatric practitioners may find it similarly useful. Reimers discusses a number of tools to assess cognitive functioning, with emphasis on screening tools easily accessed and used by the general forensic psychiatrist.
Chapter 4 discusses decision-making and guardianship. I found much of this chapter to be a review, but the less experienced expert, or one who wishes a quick refresher, should find it useful. I found the section on testamentary capacity to be very thorough for a text covering this range of topics.
Chapter 5 consists of an in-depth discussion on elder abuse and covers not only the all too frequent and news worthy fact of physical abuse, but the more subtle yet life-altering problems of financial abuse and undue influence. I particularly found interesting a discussion on “due” influence versus “undue” influence. I don’t believe I have ever seen the concept of “due” influence discussed previously.
Chapter 6 covers the important area of forensic report writing. The author rightly points out that testimony in court is quite infrequent in such cases compared with the volume of requests to communicate one’s opinions via a written report. This section I found to be a basic review for a well-trained forensic psychiatrist. Nevertheless, for an early career psychiatrist, or a general psychiatrist called upon in a forensic matter, it is a good outline of report writing and tips on testimony.
The final section includes sample reports written by the author. One addresses undue influence, the other competency to stand trial. The undue influence report was detailed and very realistic. I contacted the author and received assurance that the report, consistent with the disclaimer in the book, had been thoroughly de-identified. Also included is an Afterward briefly covering miscellaneous topics, such as cultural competence in the elderly, restoration of rights from under guardianship, and requirements of accrediting bodies for training in geriatric topics. Finally, a sample of the MOCA (Montreal Cognitive Assessment) and a nice outline of the geriatric forensic interview conclude the book.
I believe this guide will be most useful to the early career forensic practitioner or general psychiatrist inexperienced in forensic work. Being well outlined, it will also serve as a quick reference to areas in which a forensic psychiatrist may be out of practice. Sections on report writing and testifying are useful in and of themselves, not just in geriatric work. The author reinforces important concepts throughout the text, similar to the way the Pimsleur® learning system reinforces language.
There is one significant drawback to this book. My first edition contains numerous typographical errors. Most are minor and do not distract from the concepts being taught. A few, however, are significant and distracting. A few print editing mistakes also distract to a degree. Absent this drawback, I would give this book my unqualified endorsement. I encourage the author to explore a re-edited version to be published online or as an updated print edition.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2022 American Academy of Psychiatry and the Law
