Geriatrics and the Legal System.

Correctional systems, already struggling to meet the basic and functional requirements of older prisoners, will be further challenged by the increasing medical and psychiatric needs of this population. Mental health and general medical care for older adults requires specific on-site or consultation expertise in geriatric medicine and psychiatry, as well as potential changes in infrastructure, both of which may be prohibitively expensive. However, compassionate and effective treatment of older prisoners requires that prison and legal systems facilitate this expert care. To address this situation, strategic revisions of the criminal justice system are needed to alleviate prison overcrowding and consequent inadequate medical care for inmates, especially the elder ones. The unique, age-related demands of this older population predict an increased need for forensic psychiatrists with a thorough knowledge and expertise in geriatrics, as more forensic psychiatric evaluations will be needed before trial in both civil and criminal cases, during incarceration, and at the time of parole. In this article, we review the current state of elder inmates in correctional institutions and advocate for increased geriatric training for forensic psychiatrists in anticipation of this growing need.

Cocaine Abuse in Later Life: A Case Series and Review of the Literature.

OBJECTIVE: To raise awareness about the growing trend of cocaine abuse in later years as an underdiagnosed, undertreated, and comorbid condition in older individuals. Three cases of cocaine use in patients over the age of 50 years in the Malcolm Randall Veterans Medical Center, Gainesville, Florida, within a 10-day span in 2013 are presented. DATA SOURCES: PubMed was searched using combinations of keywords, including cocaine, addiction, elderly, and aging, to find articles published between 1986 and 2013. STUDY SELECTION: In total, 37 articles were selected for inclusion on the basis of their relevance to the objective and importance to the representation of cocaine abuse, including international guidelines for addiction. DATA EXTRACTION: Each article was reviewed for eligibility. Final decisions were made following full-text review. RESULTS: Cocaine addiction remains a high-morbidity chronic-relapsing illness with few treatment options. A review of the literature shows that late-life cocaine use is sparsely recognized. Of particular interest are the clinical presentations in which a higher index for detection is warranted. The high rate of medical comorbidity associated with cocaine use, especially cerebrovascular deficits, presents special treatment and social challenges. CONCLUSIONS: As the number of older individuals admitted for substance use continues to climb, clinicians must adapt to the changing demographics by increasing screening, early detection, and treatment options for older persons.