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Consultations for older adults can present difficult ethical dilemmas for psychiatrists. Often there are no adequate social or legal structures to address them. Healthcare reform will bring about specific changes that will impact these issues. Some versions of these changes have been tried in the past. We present three important aspects of older adult consultations with a view towards how the particular bioethical issues may be impacted by the proposed changes. We will provide a background on prior projects for older adult care improvement to set the stage for understanding the current proposed changes. We will then give an overview of the proposed changes in current healthcare reform and their potential impact on older adults.
Case-based presentations will illustrate the potential impact of healthcare reform on bioethical issues in the care of older adults. These include decisional capacity determinations and transfers between general acute care facilities and chronic care facilities such as nursing homes. Probate conservatorship and the gaps in coverage for certain subsets of elderly patients will be discussed. Concerns about polypharmacy, fragmented care by multiple clinicians, and polypharmacy and substance abuse will be explored along with recommendations for improvements in drug formularies and care coordination for older adults. We will present new resources available for older adults including educational grants for psychiatrists and increased funding for Adult Protective Services. These resources as well as team and consensus building will help prepare us for the changes ahead and lead to improvement in the quality of our care of older adults.
Overview of Healthcare Reforms for Older Adults - Talin Dadoyan, MD Department of Mental Health Los Angeles, Los Angeles, CA
Bioethics of Capacity Evaluations for Older Adults - Jaroslava Salman, MD, University of Southern California, Los Angeles, CA
Probate conservatorship and Placement Issues - Saba Syed, MD, University of California Los Angeles, Los Angeles, CA
Comorbidities in Older Adults - Sarah Gelberd, MD, Department of Mental Health Los Angeles, Los Angeles, CA
Chairs: Mary Ann Cohen, MD, FAPM, Mount Sinai School of Medicine, New York, NY and Talin Dadoyan, MD, Department of Mental Health Los Angeles, Los Angeles, CA
Discussant: Rabbi Bennett Blum, MD, private practice, Tucson, Arizona, and Director, Forensic Geropsychiatry Division of Park Dietz and Associates, Newport Beach, California.
