Effects of advanced age and dementia on restoration of competence to stand trial

Int J Law Psychiatry. 2009 May-Jun;32(3):156-60. doi: 10.1016/j.ijlp.2009.02.009. Epub 2009 Mar 24.


Elderly defendants (age 65+) and defendants with dementia adjudicated incompetent to stand trial and hospitalized for restoration to competence (RTC) often present unique challenges to clinicians charged with their restoration. In this study, we attempted to better identify predictors of successful RTC by building upon previous research correlating increased age with decreased likelihood of RTC. We identified elderly non-demented defendants (n=31) and defendants diagnosed with dementia (n=47) from a state database of 1380 individuals hospitalized for competence restoration from 1988-2004. Using regression analysis and correcting for demographic variables and common admission psychiatric diagnoses, we studied the relationship of age at hospital admission and dementia diagnosis on the likelihood of successful RTC. Both advanced age and dementia diagnosis were associated with decreased RTC. After correcting for dementia diagnosis, increased age retained its negative correlation with restoration success. Both elderly non-demented defendants and defendants diagnosed with dementia were significantly less likely to be restored to competence than all other RTC admissions (n=1302). However, a substantial percentage of both demented and elderly non-demented defendants were successfully restored to competence, potentially justifying restoration attempts for both of these groups of defendants.

MeSH terms

  • Age Factors
  • Aged
  • Dementia / therapy*
  • Female
  • Humans
  • Male
  • Mental Competency / legislation & jurisprudence*
  • Mental Health Services / statistics & numerical data*
  • Treatment Outcome