Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0113aElderly OffendersJanet M. ParrottBracton Centre, Oxleas NHS Trust, UKEXTENT AND PATTERN OF CRIMINALBEHAVIOUR IN THE ELDERLYCriminal behaviour is most common during youth and declinessharply with increasing age. Older people are responsible for onlya small part of the total amount of recorded crime and it is likelythat they also make a limited contribution to the ‘‘dark figure’’ ofunrecorded offences. The lower proportion of males in the elderlypopulation, their retired status and the absence of the risk-takingattitudes of youth may be of relevance. A review of the criminalstatistics for England and Wales indicates that the elderly’s shareof most offence categories is less than 1% of the total for all ages.Shoplifting is the most common indictable offence to involve theelderly and this is the only offence category where older womenmake a significant contribution 1 . The elderly’s share of sexoffences (other than rape) is higher than for other indictableoffences, varying between 5% and 9% of each category inEngland and Wales. Schichor 2 notes a similar 5% figure for theelderly’s contribution to overall sex offences in the USA. Offencesinvolving children are most common. In Craissati and McClurg’sstudy of a consecutive series of 356 men from two Londonboroughs convicted of sex offences or released on parole (1993–2001), 22 men (6.1%) were aged 60 or over, 19 men wereconvicted of offences against children, two against adults and oneof possession of prohibited material involving children 3,4 . Theelderly contribute very little to the total number of those convictedof burglary, robbery and drug offences.Violent behaviour in the elderly leading to conviction isextremely rare. Essex Police District recorded reports of violentincidents in only three people aged 65+ during a 14-monthperiod 5 . In 1998–1999, 3.9% of homicides (19 cases) in Englandand Wales involved those aged 60+; six of these were convicted ofSection 2 manslaughter (diminished responsibility), comprising31.6% of the elderly group. In comparison, 6.8% of homicidecases where the perpetrators were under 60 resulted in a Section 2manslaughter verdict, supporting the more prominent role ofpsychiatric disorder in the older offenders 1 .Kratcoski and Walker 6 studied 82 cases of homicide committedby those aged 60+ in the USA and concluded that elderlyhomicides were more likely to involve a spouse or other relative asvictim than the non-elderly; 81% of the offenders were male, and15% of the elderly offenders committed suicide, the victim beingthe wife in each instance.Hucker and Ben Aron 7 compared 16 elderly violent offenderswith a group of young violent offenders and with another groupof non-violent elderly sex offenders, all selected by referral to apsychiatric clinic in a case note study; 69% of the elderly violentgroup were diagnosed as having either an organic brain syndromeor a functional psychosis, compared with only 19% of the nonviolentelderly and none of the younger group. Paranoidsymptoms were prominent in the elderly violent group, irrespectiveof diagnosis.MENTAL ABNORMALITY AND OFFENDING INOLD AGEThe most common associations of criminal behaviour in theelderly are alcohol abuse 8 , homelessness and psychiatric illness 9 .In an early paper on this topic, Norwood East 10 suggested, on thebasis of his clinical experience in prisons, that the possibility ofpsychiatric disorder should always be considered in those whooffended for the first time in old age. Particular attention has alsobeen drawn to first-offender shoplifters 11 , although the contributionthis disturbed group make to the whole is unknown.In a study of 153 referrals aged 60+ to the community servicesbranch of Essex police 12 , 97 had been apprehended for shoplifting.The prevalence of psychiatric disorder in the 50 people interviewedwas higher than in other community samples; 38% ofthose charged with shoplifting were identified as cases, with 9/11cases belonging to AGECAT organic and depressive syndromegroups 13 . In a study of men remanded in custody, Taylor andParrott 9 found that nearly 3% of men were aged 55+. Half ofthese men had active symptoms of psychiatric disorder and halfsome form of physical disorder—twice the rates of those under 55.The commonest psychiatric problems were alcoholism (27%) andmajor functional psychosis (37%). Less than a quarter of the over-65s had a permanent address, suggesting that homelessness was animportant determinant of custodial remand. Twenty-four of 1062restricted patients admitted to hospital in 1998 in England andWales were aged 60+; nine of these patients had been convictedof homicide, six of other violent offences and two of sexualoffences 14 .CLINICAL ASPECTS OF OFFENDING INTHE ELDERLYAffective DisorderRoth 15 noted that the rare violent acts committed by aged menoften arise in a setting of depressive illness with suicidal ideation.Depressive homicide most often involves a man killing his wife.The killing is generally viewed by the patient as at least partlyaltruistic, on account of thoughts that she would be unable tocope without him, although a dynamic formulation may indicateunacknowledged hostility. It is common for the act to be followedPrinciples and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd