Is there a case for a specialist forensic psychiatry service for the elderly?

The number of elderly offenders in England and Wales is increasing. There is, therefore, a concern that their needs may not be met by existing forensic services. However, there is a paucity of information on elderly patients referred to existing forensic psychiatric units.

Data on patients over the age of 65 years referred to a large medium secure forensic psychiatric unit in London were collected for a 13-year period using a retrospective design. The sample was divided into those who had first offended before the age of 65 and those who had offended after the age of 65. Data was also collected on victims of the offences.

5477 referrals were made during the study period. Those aged over 65 years accounted for 78 (1.4%) of all referrals. These 78 referrals were for 55 patients. Forty-five of these had offended. Case notes of 42 patients from this group were screened. Sexual and violent offences accounted respectively for 20 (47%) and 15 (36%) of offences. 31% had no psychiatric disorder but organic disorders accounted for 21% of cases. Only eight (19%) required admission to the medium secure unit. Fourteen (33%) had first offended after the age of 65 while others were known to either the forensic services or criminal justice system before the age of 65. The two groups did not differ from each other.

The elderly accounted for very few referrals to the medium secure forensic service, yet there is a high prevalence of psychiatric morbidity in both remand and sentenced elderly prisoners. Therefore, elderly offenders with psychiatric morbidity may benefit from specialist old age psychiatric forensic services, perhaps at a supraregional level.