Use of substitute decision makers by the mentally ill rural elderly: an issue of concern for mental health nurses.

In 1986, the Abbe Center for Community Mental Health implemented a nurse-led elderly outreach program (EOP) designed to identify and treat elderly rural residents in need of mental health care. Because some EOP clients evidenced a lack of or limited decision-making capacity, a record review was conducted to answer the following questions: Do any of the clients have a legal substitute decision maker? What are the forms of substitute decision making? Is there a familial relationship between the elderly client and the substitute decision maker? Is there evidence that any of the named legal substitute decision makers have abused the elder? Almost half the clients who had a substitute decision maker used a power of attorney. Adult children were the most frequent family members named as substitute decision makers. Four records indicated that an adult child had been given a power of attorney and that the child had potentially abused the parent. Implications for mental health nurses dealing with this vulnerable population are set forth.