The role of primary care physicians in enabling validation of a patient’s ability to make legal statements and express a last will

Abstract

A -study Design, B -Data Collection, C -statistical analysis, D -Data interpretation, E -Manuscript Preparation, F -Literature search, G -Funds Collection the expression of a last will is legally invalid when the will-maker was in a state preventing him or her from making a decision, or expressing will, in a conscious or independent way; this could occur due to psychiatric disorders, mental retardation, or any other mental activity disturbance, even temporary. there are many problems with medical opinions concerning the validity of last wills. Medical staff play an important and law-rooted role in providing valuable evidence in such cases. the forensic medical literature was searched for topics related to evaluations of last will and testament. Forensic opinions issued by the Forensic Medicine Department, wrocław Medical university, Poland, in years 2006-2016 were also examined for cases illustrating the role of physicians and medical files in the legal evaluation of contested wills. this allowed us to conclude that mental status alterations that prevent patients from making last wills in a legally valid way can result from psychiatric or somatic disorders that negatively influencing the level of consciousness. Medical files are a highly valuable and trustworthy source of evidence -especially in the parts authored by medical staff in frequent contact with patients, which includes primary and palliative care physicians or nurses. it is necessary that these files contain remarks on the patient's behavior and ability to function in a home environment, as well as information shared by the patient's relatives. it is crucial that any drugs prescribed and their doses are recorded, and that the actual drugs administered to the patient are also noted. Key words: forensic psychiatry, forensic medicine, medical records, family medicine, last will.

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

“…Safety of medication in polypharmacy is a serious and complex issue [24], as polypharmacy often leads to elevated risk of drug relative overdose or interactions that are sometimes difficult to foresee [25], especially in older patients already limited organ function reserve [26]; it can also cause lowered physical or mental capabilities [27], excessive or prolonged hospitalization [28], and even deaths [29], often presenting as preventable medication errors [30]. Potentially inappropriate medications (PiM) [31] and improper prescribing can be identified and judged using objective means, such as beer's criteria [32], the improved Prescribing in the Elderly Tool (iPET) [33], and their apparently more sensitive successors [34], the Screening Tool of older Persons' Potentially inappropriate Prescriptions (SToPP) [35] or the Screening Tool to Alert doctors to right Treatment (STArT) [36].…”

Systemic aspects of securing the health safety of the elderly

“…in a patient who needs geriatric care, old age translates into complicated set of deficiencies in physical and mental functions, resulting in multiple organ insufficiency -the so-called frailty syndrome -which typically coexists with several chronic diseases, requiring fine-tuned therapy using many drugs [15]. even from medicolegal point of view, care for the elderly often becomes formally complex, especially in cases patients become incapable of effectively expressing themselves [16], which may affect their giving or refusing consent to medical diagnostics and treatment, and cooperation of medical personnel with their legal guardians is needed [17].…”

Modern technologies for improving elderly patients’ compliance

“…Among the various impairments that may affect the elderly, psychomotor disorders (including dementia) are of special significance, as they make technology-based improvements difficult to introduce because of the patient's frequent failure to cooperate; this often progressing to the point of full dependency upon others and a need for permanent supervision [1]. Similar problems arise from the variety of psychiatric ailments that affect elderly people, including depression (commonly underdiagnosed) [5] and psychiatric representations of somatic disturbances [6,7], which can limit patients' capabilities to express their will [8], such as effectively giving consent to medical treatment [9]. Deterioration of the senses, especially visual impairment, play a similar role in limiting the level of the older people's ability to care for themselves; these can only be overcome to a limited extent, even with the use of the latest medical advances, at least outside of a few notable examples, such as highly efficient cataract treatment [10].…”