April 2016 | Earn one hour of MCLE Credit in Competence Issues (substance abuse)
By Richard Carlton
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Regardless of age, practicing legal
professionals must continue to serve the interests of their clients to the best
of their abilities, unimpaired by physical or mental disability. The goal of
this article is to increase understanding of depression, dementia and other
health problems that can impair cognitive skills and alter behavior in later
life. A variety of conditions, both physical and mental, can cause the symptoms
described herein; a diagnosis is well beyond the scope of this article. A
conclusive diagnosis can only be arrived at by a medical doctor or other health
All of us are vulnerable
to the health problems that come with age, both mental and physical. These
problems can affect our mental health, such as depression or grief. Aging can
also trigger a decline in our ability to think, changes in behavior or
personality, problems with mobility and function and other conditions that
affect our ability to work. It can show up as a noticeable decline in mental
abilities, including memory and thinking skills.
Lawyers should be aware of
how aging can bring about changes in their health. They also need to be able to
spot health problems in others and how to react when a lawyer is struggling
with mental or physical health problems. Spotting these problems will become
more important as the bar’s older members mature in coming years. A 2011
demographic survey conducted by the State Bar of California showed that 48
percent of practicing attorneys in California were over the age of 55, and 43
percent were over 60. These percentages are expected to escalate dramatically due
to the coming baby boomer “silver tsunami.” Furthermore, recent studies suggest
that large numbers of lawyers will continue practicing well past traditional
retirement age because they have insufficient savings and pensions to quit
working. Others will continue to work because they want to make positive
contributions to society. It is therefore inevitable that age-related mental
health problems and cognitive decline will become increasingly prevalent in the
population of practicing attorneys.
Mental health problems
Legal professionals tend to have a
preference for analytical thought versus emotional feelings and are trained to
be objective and solve problems. Many apply the same analytical approach to
their personal problems and are reluctant to focus on their inner emotional
lives. Some attorneys believe they should be able to handle personal problems
just as effectively as they handle their clients’ legal problems. These
factors, combined with high levels of work stress, often make legal
professionals more susceptible to anxiety and depression.
A study of 12,000 adults by a team
Johns Hopkins University research team indicated that among all the
occupational groups represented in that sample, attorneys showed the highest frequency
of symptoms of clinical
depression. In fact, among the attorneys studied, they were 3.6 times more
likely to show signs of depression than those in all other occupations studied.
Older attorneys are at an even greater
risk for experiencing depression than younger legal professionals, often as a
result of needing to cope with chronic health conditions. Depression is a
treatable medical condition, however, and not a normal part of aging.
Signs of depression
It’s normal to be blue every once in a
while. But depressed and potentially suicidal individuals often exhibit changes
in mood, appetite and energy level, and often these changes last for more than
a few days. For colleagues, friends and family members who notice these changes
over a long period of time, it should be a matter of concern.
Common symptoms of depression include:
If you or someone you know has these
symptoms, encourage them to see a doctor or health professional. There may be a
physiological reason for it, such as a disease or chronic health condition that
can spur depression.
A mental health professional may help
them get treatment. They may recommend psychotherapy, medication or a
combination of the two. People with depression often begin to see positive
results within a month of beginning treatment.
If you observe any of these symptoms
in yourself, a colleague or a family member, contact the State Bar Lawyer Assistance Program at 877-527-4435 or LAP@calbar.ca.gov. You will receive a free,
confidential assessment with a mental health professional.
Mild cognitive impairment (MCI)
It’s a normal part of aging to forget
things. But as some people grow older, they can develop more severe problems
with their memory or decision making. It may not be noticeable enough to affect
their daily life, but sometimes it’s significant enough to be noticed by the
person who experiences it, or by the people around them.
People with mild cognitive impairment
do not always develop dementia. But when it does occur, it can get worse. A
higher percentage of those with amnestic MCI can develop more serious forms of
dementia than people without these early memory problems.
Dementia is not a specific disease.
It’s a set of symptoms triggered by a loss of brain function that can affect memory, thinking,
language, judgment and behavior. A person may not be able to do normal
activities, such as getting dressed or eating. They may be quick to anger or
forget things they just learned. The American Academy of Neurology estimates
that 10 percent of persons over age 65 have some form of dementia and up to 50
percent over the age of 85 experience dementia.
A person with dementia can show signs
of confusion and personality changes. As it gets worse, they may become lost,
have difficulty doing basic tasks and see things that aren’t there.
If a person shows increasing signs of
confusion or changes in behavior, encourage them to see a doctor or other
health provider. A health care professional will perform a physical exam and
may order a series of tests to rule out other causes. They may also call in a
neurologist, neuropsychologist or other health specialist to run further tests.
The following is a list of symptoms
that have been identified as commonly observed in individuals with early stage
Alzheimer’s disease. (This information is adapted from “Know the 10 Signs:
Early Detection Matters” and is used here with the permission of the Alzheimer’s
How can I help
someone if I observe these problems?
If you or a
colleague, friend or loved one has experienced any of these symptoms, urge them
to contact a health professional, such as a personal physician or a neurologist,
and schedule a complete evaluation. You may want to help them schedule this or
contact the doctor yourself.
It’s important to get
an early diagnosis for many reasons. Many
conditions can reduce mental acuity for periods of time, and some of these
conditions are easily treated. Some cases of dementia are reversible, and early
diagnosis increases the chances of successful treatment.
medical diagnosis, the person will be better able to organize financial
matters, establish a durable power of attorney and advance health care
directives, deal with other legal issues, create a support network and even
consider joining a clinical trial or other research study.
legal professional with signs of cognitive impairment, early diagnosis affords
the attorney an opportunity to participate in decisions such as appointing a
successor attorney or closing the law practice, rather than waiting until such
arrangements become the responsibility of colleagues or family members.
lawyer with more severe forms of dementia may want to consider limiting or
ending his or her law practice while he or she is capable of doing so. For
guidance with this process, please consult the State Bar publication “Guidelines for
Closing or Selling a Law Practice.”
Solo attorneys may also want to appoint a successor attorney for
the practice through the use of a surrogacy agreement. The State Bar Attorney
Surrogacy program provides a model agreement for the designation of an attorney
to administer a lawyer’s law practice in the event that the lawyer becomes
disabled or incapacitated. The agreement details the typical responsibilities
of the lawyers involved in an "Agreement to Close a Law
Practice in the Future" and is intended to facilitate compliance with Business and
Professions Code Section 6185 and relevant provisions of the Probate Code.
It may help to seek advice from a professional
about how to address these concerns with your friend or family member. If you
have questions, you may contact the State Bar Lawyer Assistance Program at
877-527-4435 or LAP@calbar.ca.gov.
Carlton is the director of the State Bar’s Lawyer Assistance Program.
What is depression? National Institute
of Mental Health. http://www.nimh.nih.gov/health/publications/depression/what-is-depression.shtml
Mild Cognitive Impairment. National
Insitute on Aging. http://www.nia.nih.gov/alzheimers/topics/mild-cognitive-impairment
Dementia. PubMed Health. U.S. National
Library of Medicine. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001748/
Dementia. Medline Plus. U.S. National
Library of Medicine. http://www.nlm.nih.gov/medlineplus/dementia.html
Preparing for a doctor’s visit. Alzheimer’s Association. http://www.alz.org/africanamerican/documents/aa_ed_doc_checklist-030609.pdf
What is dementia? Alzheimer’s
10 Early Signs and Symptoms of Alzheimer’s.
Alzheimer’s Associaiton. http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp
Alzeimer’s Disease Fact Sheet.
National Institute on Aging. http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet
Closing a Law Practice. State Bar of
Agreement to Close a Law Practice in
the Future. http://ethics.calbar.ca.gov/Ethics/SeniorLawyersResources/ClosingaLawPractice.aspx