An exploration of the determinants of risk formulation, care plan and disposition among older adults in the Ontario forensic psychiatry system: implication for practice

BACKGROUND: Advances in medicine have led to an improvement in life expectancy, thus increasing the population of older individuals within the criminal justice system. This study investigates the determinants of risk formulation, care plan, and disposition among older adult forensic patients (OAFP) in Ontario, Canada. METHODS: This retrospective analysis utilized the Ontario Review Board database, focusing on 161 OAFP, aged 55 years and older. Hierarchical regression was used to analyze the relationship between changes in risk and six blocks of variables: sociodemographic characteristics (Block 1), circumstances during the index offense (Block 2), current clinical profile (Block 3), past psychiatric history and behavioral patterns (Block 4), criminal history and legal status (Block 5), and recent violent events (Block 6). RESULTS: The median age of patients was 61 years (IQR 58-67), with 83.4% being male. Schizophrenia was the most common diagnosis (68.3%), and 9.3% had neurocognitive disorders. The model with six blocks of factors explained 92% of the variability in risk change. Models 2 (blocks 1 and 2) and 4 (blocks 1-4) were statistically significant, explaining 34% (p = 0.010) and 22% (p = 0.018) of the variance in the change in risk of threat to public safety, respectively. OAFP with a significant risk to public safety were more likely to be inpatients and less likely intoxicated during their index offense. CONCLUSION: Resources, policies, and a supervised model of care to curtail behavioral risks are relevant to the care of OAFP. Innovative risk management models for OAFP are indicated.