This article was downloaded by: [Universite De Paris 1]On: 01 September 2013, At: 23:55Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Elder Abuse & NeglectPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/wean20

Geriatricians and Psychologists: EssentialIngredients in the Evaluation of ElderAbuse and NeglectErika Falk PsyD a , Elizabeth Landsverk MD a , Laura Mosqueda MD b ,Bonnie J. Olsen PhD b , Diana Cafaro Schneider MD c , Susan BernatzPhD c & Stacey Wood PhD ca San Francisco Elder Abuse Forensic Center, San Francisco,California, USAb University of California, Irvine, School of Medicine, Irvine,California, USAc Los Angeles County Elder Abuse Forensic Center, Los Angeles,California, USAPublished online: 12 Aug 2010.

To cite this article: Erika Falk PsyD , Elizabeth Landsverk MD , Laura Mosqueda MD , Bonnie J. OlsenPhD , Diana Cafaro Schneider MD , Susan Bernatz PhD & Stacey Wood PhD (2010) Geriatricians andPsychologists: Essential Ingredients in the Evaluation of Elder Abuse and Neglect, Journal of ElderAbuse & Neglect, 22:3-4, 281-290, DOI: 10.1080/08946566.2010.490142

To link to this article: http://dx.doi.org/10.1080/08946566.2010.490142

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

Journal of Elder Abuse & Neglect, 22:281–290, 2010Copyright © Taylor & Francis Group, LLCISSN: 0894-6566 print/1540-4129 onlineDOI: 10.1080/08946566.2010.490142

Geriatricians and Psychologists:Essential Ingredients in the Evaluation

of Elder Abuse and Neglect

ERIKA FALK, PsyD and ELIZABETH LANDSVERK, MDSan Francisco Elder Abuse Forensic Center, San Francisco, California, USA

LAURA MOSQUEDA, MD and BONNIE J. OLSEN, PhDUniversity of California, Irvine, School of Medicine, Irvine, California, USA

DIANA CAFARO SCHNEIDER, MD, SUSAN BERNATZ, PhD,and STACEY WOOD, PhD

Los Angeles County Elder Abuse Forensic Center, Los Angeles, California, USA

This article describes the clinical work that three sets of geria-tricians and psychologists provided in three elder abuse forensiccenters in California. After a brief history of how the clinicalservices in each program developed, the contributions of geriatri-cians and psychologists within these elder abuse teams are detailedthrough the use of several case anecdotes. Beyond providing physi-cal and psychological evaluations, geriatricians and psychologistsprovide consultations and education to other professionals andto elder abuse victims and their caregivers. These clinical teamsemphasize the importance of conducting home visits and func-tional assessments, working with interdisciplinary team members,and providing expert testimony.

KEYWORDS elder abuse forensic centers, elder abuse teams,expert testimony, geriatrician, home visits, psychologist

Mrs. Violet White, a 73-year-old widow, is cared for at home by heryoungest son, Mark. She has Parkinson’s disease, hypertension, diabetes,and a history of a stroke. She was admitted to the hospital after she fell

Address correspondence to Laura Mosqueda, UC Irvine Program in Geriatrics, 200 S.Manchester Avenue, Suite 835, Route 81, Orange, CA 92868, USA. E-mail: mosqueda@uci.edu

281

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

282 E. Falk et al.

and lay on the floor for 36 hours before being brought to the emergencyroom by her neighbor. The emergency room doctor noted that she wasdirty, had elongated toenails, and suffered from multiple pressure sores.

Unfortunately, this scenario is not uncommon. While it is clear thatsome interventions are necessary, it is not as clear what those interventionsshould be.

● Was this situation almost inevitable, or at least understandable, consideringher multiple medical problems?

● Should the police investigate for criminal neglect?● Should the doctor support her decision to go home with Mark after the

hospital stay?

Mrs. White’s case, like many others, is best addressed through strongcollaboration among Adult Protective Services (APS), law enforcement, andmedical and psychological clinicians with expertise in working with olderadults. This article describes the clinical work that three sets of geriatrician-and-psychologist teams provide in three elder abuse forensic centers inCalifornia.

HISTORY

There are several models that show how physicians (most com-monly geriatricians) and psychologists (usually neuropsychologists orgeropsychologists1) collaborate with APS to assist in the diagnosis andtreatment of victims of elder abuse and neglect. Three such models weredeveloped in California over the past ten years. The Program in Geriatricsat the University of California, Irvine, developed a medical response team,the Vulnerable Adult Specialist Team (VAST), which provided APS workersin Orange County with assistance from medical professionals (geriatri-cians and psychologists) on elder abuse cases. The University of SouthernCalifornia partnered with the Los Angeles County/University of SouthernCalifornia (LAC+USC) Medical Center to develop a medical response teamfor elder abuse victims throughout Los Angeles County. Known as the AdultProtection Team (APT), APT works in partnership with Los Angeles County’sAPS to provide medical evaluation and social services to victims of elderand dependent adult abuse. The services provided by both of these modelsinclude medical and neuropsychological assessment in the home or in thehospital setting, review of medical records, referrals for medical care, facili-tation of the conservatorship process, and access for APS social workers toobtain answers to medical questions.

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

Geriatricians and Psychologists 283

Existing partnerships may grow into more inclusive and consistentteams. In Los Angeles and Orange counties, the teams of medical and socialservices specialists described above provided the impetus for the devel-opment of elder abuse forensic centers, with a focus on bringing peopletogether from the social services, health care, and criminal justice systems.In San Francisco County, the Elder Abuse Forensic Center grew out of asocial service collaboration, called the Multidisciplinary Assessment Team(MAT), where a geriatrician, psychologist, assistant district attorney, andpolice representatives met every two months at APS headquarters to coor-dinate and consult on cases. MAT members soon realized that to makemore progress in difficult cases, relationships needed to be strengthenedand institutionalized through more consistent and frequent interactions aswell as through specific action plans like those fostered within an elderabuse forensic center.

WHAT CAN A GERIATRICIAN OFFER?

The geriatricians working in these centers learned about the forensic aspectsof medicine in a variety of ways: consulting with child abuse experts tolearn about documentation, examination, and testifying in court; spendingtime with colleagues, such as emergency room physicians and gynecologistswith expertise in family violence; and consulting with coroners and medicalexaminers. All of the clinicians (physicians and psychologists) spent timewith adult protective service workers and professionals in the criminal justicesystem (e.g., police investigators, detectives, and prosecutors) in order tolearn how the social services and criminal justice systems work on behalfof abused elders. The geriatricians also needed to learn how to be the mosthelpful to the older adults as well as to colleagues outside the healthcaresystem. In the end, much of the expertise acquired was through experienceand trial and error. Since inception ten years ago, these healthcare providershave collectively assessed over 1,000 elders who were thought to be victimsof mistreatment.

There are many ways that elder abuse teams utilize the geriatrician’sexpertise in caring for elders. Perhaps the most important contribution is themedical and cognitive assessment of the alleged victim of abuse. This assess-ment can be done in the hospital, clinic, or in the patient’s home. Whenundertaken in a hospital setting, this assessment is often used as a consul-tation to the medical team caring for the patient, and the geriatrician canprovide an expert assessment regarding the probability of abuse or neglect.A geriatrician also can ensure that proper documentation is completed, bothwithin the written medical record and also through medical photography,radiologic, and laboratory studies. This documentation could later provide

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

284 E. Falk et al.

crucial evidence in any criminal legal proceedings or in conservatorshipand/or guardianship matters. The geriatrician can ensure that the suspicionof abuse is reported to the proper agency (i.e., APS, California Long-TermCare Ombudsman, and law enforcement) and that the victim is protectedwithin the hospital setting (e.g., placing the patient in a secure location underan alias if necessary). Within a clinic setting, the geriatrician can provide acomplete physical and cognitive assessment, make necessary referrals, anddocument any signs of abuse or neglect. Home-based assessments, discussedbelow, offer both advantages and disadvantages to geriatricians assessingabuse and neglect.

In addition to medical and cognitive assessments, geriatricians may beasked to review current and prior medical records for signs of elder neglector abuse. This guidance early in an investigation is an efficient way to guidethe team toward legal or other remedies. For example, medical records maycontain information that the older adult was diagnosed with moderatelyadvanced Alzheimer’s disease four years prior to signing the deed of his orher home to a caregiver and alleged perpetrator. While a police detectivemay struggle to understand the medical terms (and read the handwriting),the geriatrician may be able to ascertain key information quite quickly andeasily, thus helping the police and prosecutor decide whether or not topursue the case further.

Geriatricians may act as expert witnesses in criminal, civil, or probateproceedings. They also may be asked to intervene on behalf of APS withthe patient’s physician in an attempt to gather information or work collabo-ratively to protect an elder. The geriatrician often serves as educator to theolder adult and his or her caregivers, an important role in situations whereneglect may be occurring due to the lack of understanding on the part ofthe caregiver about the underlying disease process.

The case of Mrs. Green demonstrates this dilemma clearly. APS wasconcerned about Mrs. Green because she was at home on oxygen, bed-bound with a pressure ulcer, and appeared to be extremely thin andfrail. Her caretaker daughter refused to allow in-home care, and APSsuspected criminal neglect. When the geriatrician visited the mother-daughter pair at home, the daughter was defensive at first, fearing (shelater admitted) that her mother would be taken from her. Her motherwas alert and talkative, and although she had some loss of short-termmemory, she was very clear and consistent in stating that she wanted tostay home with her daughter even if it shortened her life. She did notwant to go to the hospital or be put in a nursing home.

A review of Mrs. Green’s medications found that she was taking medicinethat made her confused and decreased her appetite. She also was inpain, which made her irritable. After prolonged discussion about her

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

Geriatricians and Psychologists 285

options, Mrs. Green decided to accept hospice support since the nursecould be available night or day to help with urgent issues and could alsovisit at least once a month. An air mattress for the bed was purchased,Mrs. Green’s pressure ulcer was treated appropriately, and instructionswere left that she was to be turned every two hours. Not long afterthis evaluation and treatment, the pressure sore healed. The geriatriciansuggested medication adjustments to her primary doctor, who had notseen her in several months, and these adjustments made it easier for herdaughter to provide appropriate care. In this case, the family memberwas trying to do the right thing. She just needed more education andexternal support.

Geriatricians aid the elder victim of abuse and neglect by conductingmedical and cognitive assessments across multiple settings and document-ing signs of abuse and neglect. Geriatricians also assist by educating othermedical providers, caregivers, and team members about dangerous medi-cal conditions and how they may have occurred and how to enhance thevictim’s overall well being.

WHAT CAN A PSYCHOLOGIST OFFER?

Mr. Raymond Smith, an 85-year-old widower, recently became roman-tically involved with a younger woman. His family became concernedwhen he told them that he thought he may have “put Karen on thehouse” and updated his estate planning documents, such as his trust andwill. His family had noted that Ray’s memory had recently become worse,and were concerned that Karen was financially exploiting his resourcesand taking advantage of him. Elder abuse teams are often confrontedwith situations like Mr. Smith’s and must grapple with the question ofthe extent to which Mr. Smith knew what he was doing and whether hewas acting of his own accord.

Cognitive assessment is a key element in the investigation of crimesagainst older adults. The most common question asked of psychologistsregarding elder abuse cases is “Does this client have capacity?” The teammust first clarify the question as “Capacity to do what?”

Consider the case of Mrs. Atwood, a frail 85 year-old woman who wasliving at home with her adult son. Neighbors phoned APS concernedabout the condition of the home and yard as well as Mrs. Atwood’s care.APS social workers found that her son was unemployed and appearedto be drinking excessively. The home was dirty and there was little food.Mrs. Atwood defended her son’s care saying that he was “doing the besthe could.” She could not say how long it had been since she last saw her

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

286 E. Falk et al.

physician, what his name was, or what medications she was prescribed,although medication bottles were visible in the kitchen. In addition, shewas unable to provide any meaningful information about her finances tothe social worker.

An assessment of Mrs. Atwood’s cognitive functioning was requestedalthough it was not immediately apparent what question the assessmentwould attempt to answer.

● Was her son acting in a caregiver role?● Did Mrs. Atwood have dementia?● Were her needs being adequately addressed?● Was her son intimidating her or taking her money?

Clarifying these issues with the team revealed that while many of thesequestions may be relevant, the underlying concern was whether or not Mrs.Atwood had the capacity to determine if her son was able to provide forher care.

Older crime victims are more likely as a group to evidence cognitiveimpairment, and the presence of cognitive impairment can manifest itself in anumber of critical ways during the course of an investigation. In an allegedcase of elder financial exploitation, the presence of significant cognitiveimpairment may mean that illegal or damaging financial transactions thatoccurred as a result of exploitation can be reversed in court. For example, ifa psychologist can testify that the alleged victim was unable to consent to achange in title on a home, then that transaction can be legally voided. Otherexamples include revoking wills and trusts, power of attorney documents,fraudulent automobile purchases, illegal transfers of assets, art and jewelrytheft, and misuse of debit and credit cards.

A psychologist also may be asked to assist in assessments for con-servatorship. In these cases, there is typically some evidence of cognitiveimpairment at the time of referral and some concern exists regarding thesafety of the client’s estate or person. A cognitive assessment in conjunc-tion with a functional assessment is completed as part of the evaluationand if deemed necessary, a form (Judicial Council form CG-335, known asa “Capacity Declaration” in California) is completed. A conservatorship maybe sought in a wide variety of cases including financial exploitation, physicalabuse, and self-neglect.

Often the psychologist will not have an opportunity to complete anassessment at the time the fraudulent transactions have taken place, as thesetransactions often occur in secrecy. In these circumstances, a retrospectivedetermination must be done. A complete cognitive assessment is performedalong with an extensive record review to document the impairment duringthe time frame at issue. In addition, videotapes of the client made when

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

Geriatricians and Psychologists 287

law enforcement became involved may capture the victim’s neurocogni-tive functioning closer to the time period in question. The success of theseevaluations depends upon the quality of the records, the available collat-eral information collected during the relevant time frame, and the degree ofcognitive impairment that the victim demonstrates when the assessment isconducted.

In general, the same principles that guide strong clinical assessmentsare used to guide a forensic assessment in the field—with some impor-tant caveats. A battery of tests is designed based upon the particulars ofthe referral (e.g., age, etiology, etc). The first step is to determine thedegree of impairment in each cognitive domain (e.g., attention, concen-tration, memory, etc.) so that the client’s relative strengths and weaknessesare understood. It is also crucial to determine what other factors may beaffecting the client’s ability to reason, including mood or psychiatric disor-ders, medication side effects, or delirium. In elder abuse forensic centers,the most common diagnoses are dementias of varying etiologies, mental ill-ness, developmental disorders, and traumatic brain injuries. Functional dataacross the domains of financial management and activities of daily livingare gathered through the use of specific tests, collateral reports, and obser-vations during home visits. Specific recommendations for batteries of testsare beyond the scope of this article, but The Assessment of Older Adults withDiminished Capacity: A Handbook for Psychologists2is an excellent resource.

A cognitive assessment often generates information that leads the teamto particular strategies to ensure the client’s safety and possibly to prosecutethe perpetrator. Cognitive assessment in this context varies from a clinicalassessment in that the chief aim of the cognitive field assessment is notnecessarily to arrive at a diagnosis but rather to offer an opinion about theclient’s ability to make particular decisions. Importantly, the results of theassessment are more closely tied to the individual’s daily functioning than inmany clinical settings.

THE IMPORTANCE OF HOME VISITS

While the maxim to “expect the unexpected” pertains to the conduct ofhome visits, home visits are invaluable in understanding how a person isactually functioning. The condition of the home, cleanliness, danger, andpresence of persons in the home and their interactions with one anotherare very important information to consider when deciding if elders are ableto function on their own or if caregivers are able to provide proper care.Field work requires greater flexibility than when seeing patients in an officesetting. For example, upon arriving at a victim’s home, the interior of theresidence may be so cluttered that it is necessary to do the assessment on

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

288 E. Falk et al.

the outside patio or porch (note: always bring a towel) or, in one case, inan abandoned car on the front lawn. In one instance, a client had a petcrow living with her. Negotiating the interview among accumulated birddroppings, feathers, and the flying crow required a calm demeanor alongwith good clinical skills. After the clinical assessment determined that shewas gravely disabled and unable to care for herself, the highest concern wasfor her safety, and arrangements were made for the paramedics to transporther to a hospital.

Some clients may become agitated by the intrusion into their home.Others are extremely frail, so a shorter assessment may be necessary. Someclients may not have had medical assistance for years, and the clinical pre-sentation may be quite different than anticipated; for example, when arrivingto do a dementia assessment, one may encounter a person with aphasia sec-ondary to a stroke. Further, clinicians may also be surprised by the presenceof unexpected third parties, so home visits are best conducted in tandemwith law enforcement or APS in order to address personal safety issues.

With respect to physical assessments, the home setting limits the geria-trician’s ability to perform a complete exam. Realistically, the portions of thephysical examination that can be performed in this setting include vital signs,functional assessment for activities of daily living, gross evaluation of hearingand vision, limited skin examination (depending on the privacy of the loca-tion), limited head/eyes/ears/nose/throat (HEENT) examination (dependingupon light), limited cardiovascular and pulmonary evaluation, foot examina-tion, gait assessment, and limited cognitive assessment (depending upon theenvironment). This assessment must be tailored to the individual, dependingupon the reason for the evaluation. For instance, if there is concern aboutneglect by a caregiver, the evaluation may focus primarily upon the signs ofthat neglect and the vulnerability of the elder, as opposed to a home visitdone for the purposes of documenting the capacity (or lack thereof) of anelder failing in the home setting.

At its heart, a capacity assessment is about what a client can do inthe real world. A person may report that they prepare all of their meals athome, but then have an empty refrigerator and cupboards. It is one thing fora cognitive report to indicate that a person has “severe short-term memorydeficits and spatial disorientation” and quite another to describe how Mrs.Smith got lost returning from her bathroom to her living room. A judge, jury,law enforcement, and attorneys may not understand what the phrase “severeexecutive functioning deficits” means, but may well remember a descriptionof how a person could not operate their coffee maker after offering coffee orcould not tie a bow with their apron strings. It is more powerful to describehow Mrs. Jones invited you in for an unannounced visit without askingfor identification and proceeded to show you her jewelry collection, thanto state that the person may have “deficits in personal safety awareness.”Thus, the home assessment, although it may limit the physical and cognitive

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

Geriatricians and Psychologists 289

assessment that can be done, is the most valuable setting to gain meaningful,reliable, functional, and social information about the older adult.

WORKING WITH OTHER PROVIDERS ON THE TEAM

Cross-consultation among geriatricians, psychologists, law enforcement, andsocial workers enhances both content knowledge and team skills and alsocreates considerable work efficiencies; for example, law enforcement mayinterview an alleged abuser during a home visit, freeing the clinician andsocial worker to interview the victim privately. Conducting joint interviewsmay reduce the number of times a victim must tell her story. In addition,cross-consultation may offer clinicians the opportunity to learn how lawenforcement approaches safety and legal questions, and law enforcementthe opportunity to learn how to ask pertinent mental status questions. Whengeriatricians and psychologists work together, it is important to determinewhich provider would best serve the victim in the evaluation. When physi-cal abuse or neglect is suspected, the geriatrician is most needed. When thevictim is a developmentally delayed adult and there is a question of capac-ity, the neuropsychologist is more capable of completing an assessment thatincludes Intelligence Quotient testing. When there are questions of capacityassessment in financial abuse cases, there may be situations that are suit-able to either a psychologist or a geriatrician. In general, if the cognitiveimpairment is thought to be mild, the psychologist may be able to deter-mine more subtle impairment. There are certainly times when it is suitablefor both providers (geriatrician and psychologist) to evaluate the client, forexample, in the case of an 89 year-old female who was financially abused.She had mild impairment according to the APS worker, but also thoughther caregiver might be poisoning her. In this case, both the geriatrician andpsychologist were needed.

PROVIDING EXPERT TESTIMONY

Providing expert testimony in a civil, probate, or criminal court proceedingis an important role geriatricians and geropsychologists play. It is an oppor-tunity to present the facts and offer a well-informed opinion based uponthese facts. Geriatricians and geropsychologists also might provide a voicefor the alleged victim when they are no longer able to speak for themselves.Many of these cases are prosecuted in the criminal arena, but then spill intothe probate and civil courts. While some health care providers avoid tak-ing on a role as an expert witness, the rewards can be great. Medical andpsychological testimony is a compelling way to educate judges, juries, andattorneys about how medical and psychological conditions correlate with

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013

290 E. Falk et al.

day-to-day activities. Medical and psychological testimony may be weightedheavily in the decisions that judges and juries make.

A helpful strategy is to assume from the outset that each case has thepotential to go to trial. As such, preparation for testimony begins from themoment the referral is received. This awareness guides how issues of con-sent and permission, as well as the collection of data, are handled. It is alsoimportant to understand the myriad of potential uses of clinical findings; thefollowing case provides an example.

A 45 year-old dependent adult, who was living with his 83 year-old fatherwho had moderate dementia of the Alzheimer’s type and was a victimof financial abuse, required that the psychologist wear several hats andunderstand both criminal and probate proceedings. Both the father andson were evaluated by the psychologist, and additionally, school recordswere necessary to verify that the son had a previous diagnosis of mildmental retardation. The father was conserved through the Office of thePublic Guardian’s Office, and the son was conserved by his ex-wife.The case also was filed by the District Attorney’s Elder Abuse Unit forfinancial abuse and eventually resulted in a jury trial.

SUMMARY

The medical and psychological services provided to victims of elder abusethrough the Elder Abuse Forensic Centers in Orange, Los Angeles, andSan Francisco Counties go far beyond clinical, physical, and cognitiveassessments. Special considerations for geriatricians and geropsychologistsworking in the field of elder abuse and neglect include documenting signs ofabuse and neglect (with the awareness that it is evidence that could be usedin court, educating other partners about how medical and psychologicalconditions affect decision-making) and focusing on functional capabilities.It is hoped that these dispatches will encourage more clinicians to do homevisits and to create innovative ways to partner with others caring for eldervictims of abuse.

NOTES1. A clinical neuropsychologist is a professional within the field of psychology with special

expertise in the applied science of brain-behavior relationships. Professional geropsychologists are psy-chologists with knowledge, skill, training, and experience related to the aging process who specializein assessment and intervention with older persons. In this article, the more general term “psychologist”will be used with the understanding that the psychologists providing services within these projects haveexpertise as neuropsychologists or geropsychologists and have specialized training in providing the typesof assessments described. Not all neuropsychologists have expertise in working with older adults andnot all geropsychologists have extensive training in neuropsychology.

2. The handbook can be accessed online: http://www.apa.org/pi/aging/capacity_psychologist_handbook.pdf

Dow

nloa

ded

by [

Uni

vers

ite D

e Pa

ris

1] a

t 23:

55 0

1 Se

ptem

ber

2013