The wills of older people: risk factors for undue influence.

BACKGROUND: As people live longer, there is increasing potential for mental disorders to interfere with testamentary distribution and render older people more vulnerable to "undue influence" when they are making a will. Accordingly, clinicians dealing with the mental disorders of older people will be called upon increasingly to advise the courts about a person's vulnerability to undue influence. METHOD: A Subcommittee of the IPA Task Force on Testamentary Capacity and Undue Influence undertook to establish consensus on the definition of undue influence and the provision of guidelines for expert assessment of risk factors for undue influence. RESULTS: International jurisdictions differ in their approach to the notion of undue influence. Despite differences in legal systems, from a clinical perspective, the subcommittee identified some common "red flags" which might alert the expert to risk of undue influence. These include: (i) social or environmental risk factors such as dependency, isolation, family conflict and recent bereavement; (ii) psychological and physical risk factors such as physical disability, deathbed wills, sexual bargaining, personality disorders, substance abuse and mental disorders including dementia, delirium, mood and paranoid disorders; and (iii) legal risk factors such as unnatural provisions in a will, or provisions not in keeping with previous wishes of the person making the will, and the instigation or procurement of a will by a beneficiary. CONCLUSION: This review provides some guidance for experts who are requested by the courts to provide an opinion on the risk of undue influence. Whilst international jurisdictions require different thresholds of proof for a finding of undue influence, there is good international consensus on the clinical indicators for the concept.

"The view from the bottom of the cliff." Old age psychiatry services in New Zealand: the patients and the resources.

AIM: Despite the continual restructuring of New Zealand's health services in recent years, the development of mental health services for older people has been neglected as a strategic planning issue. METHODS: In 1998/9, the New Zealand branch of the Faculty of Psychiatry of Old Age (FPOA) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) initiated a national survey to obtain an overview of patient needs and national resources, with the aim of providing information to assist planning. Data were collected from eleven Old Age Psychiatry services nationwide, covering a total catchment of 2,800,000 New Zealanders. RESULTS: Patients were mostly over 70 years of age, female and with high co-morbidity for both medical and psychiatric illnesses. New Zealand resources directed to meet the needs are low by international standards. CONCLUSIONS: The results clarify the range of patient problems that Old Age Psychiatry services manage and the resources available. Most New Zealand services conform to World Health Organization recommendations.

The use of intravenous lignocaine in the diagnosis and treatment of tinnitus.

The effect of intravenous lignocaine upon the symptom of tinnitus has been assessed in seventy-eight patients and the results correlated with associated hearing loss. Lignocaine appears to be highly effective in suppressing tinnitus in patients with presumed damage or degeneration of the Organ of Corti and is less effective in other groups. It is postulated that tinnitus in patients with Organ of Corti damage is the result of abnormal hyperactivity in the auditory pathway following deafferentation.