Yarnell Stephanie C, Kirwin Paul D, Zonana Howard V
Dr. Yarnell is a Chief-Resident in psychiatry, Dr. Kirwin is Associate Professor of Psychiatry, and Dr. Zonana is Professor of Psychiatry, Department of Psychiatry, Yale University School of Medicine, New Haven, CT. Dr. Kirwin is also Program Director, Division of Aging and Geriatric Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, CT.
J Am Acad Psychiatry Law. 2017 Jun;45(2):208-217.
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.
惩教系统已然难以满足老年囚犯的基本和功能性需求，而这一人群日益增长的医疗和精神需求将使其面临更大挑战。老年人的心理健康和一般医疗护理需要老年医学和精神病学方面的特定现场或咨询专业知识，以及基础设施方面的潜在改变，而这两者的成本可能高得令人望而却步。然而，对老年囚犯进行富有同情心且有效的治疗需要监狱和法律系统为这种专家护理提供便利。为应对这种情况，需要对刑事司法系统进行战略修订，以缓解监狱过度拥挤以及随之而来的囚犯医疗护理不足的问题，尤其是老年囚犯。这一老年人群独特的、与年龄相关的需求预示着，对具备老年医学全面知识和专业技能的法医精神病学家的需求将会增加，因为在民事和刑事案件的审判前、监禁期间以及假释时，都将需要更多法医精神病学评估。在本文中，我们审视了惩教机构中老年囚犯的现状，并鉴于这种不断增长的需求，主张增加对法医精神病学家的老年医学培训。
