A Wellness Guide for Senior Lawyers and their Families, Friends and Colleagues

Introduction
Stress and Mental Health
What is mild cognitive impairment (MCI)?
What is dementia?
What are the warning signs of dementia that are associated with Alzheimer’s disease?
How can I help someone if I observe these problems?
Further Resources

Introduction


Senior Attorney

Health Problems That Come With Age

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, grief, emotional trauma or substance abuse. 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. You may forget someone’s name or where you put the car keys.

Although some changes are a natural result of aging, it differs for each individual. It may not be severe enough to interfere with daily life, but people who have mild cognitive impairment are sometimes at greater risk of developing more severe forms of dementia.

At advanced stages, dementia can interfere with long-term memory, the ability to make a decision or judge an issue. A person can forget the names of loved ones or become so confused they can’t make up their minds. But it’s important not to confuse age-related conditions with other health issues that produce similar symptoms.

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.

Aging Lawyer Population (“Silver Tsunami”)

The State Bar’s 2011 demographic survey 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 in coming years as a “silver tsunami” of baby boomer lawyers reach retirement age.

However, research indicates that large numbers of lawyers who are eligible for retirement will continue practicing because they have insufficient savings and pensions to quit working. Others will continue to work because they want to make positive contributions to society. (NOBC & APRL Joint Committee on Aging Lawyers Final Report, 2007)

Purpose of this Guide

Because of those trends, the State Bar of California has produced “A Wellness Guide for Senior Lawyers and their Families, Friends and Colleagues.” This guide is intended to protect the public and bar members by helping legal professionals take the necessary steps to address health problems that may impact their work. We hope that they will do so before their clients are harmed and their professional reputations suffer.

This guide is designed to increase your understanding of the signs of dementia and other health problems that can impair cognitive skills and alter behavior. But diagnosing the medical condition causing these symptoms is well beyond its scope. You may want to do more research and consult additional resources. You also may want to consult a medical doctor or other health professional to arrive at a conclusive diagnosis, and this may require medical tests.

It is critical that legal professionals serve the interests of their clients unimpaired by physical or mental disability, whether or not it is age-related. We hope that the information in this guide will better prepare you to address these sensitive matters for yourself or for colleagues, friends and family members.

If you or an attorney you know — a law partner, colleague, friend, spouse or other family member — is or may be impaired because of an age-related condition, it is important to seek help. Reading this material is a good first step in the right direction.

The Wellness Guide

Stress and Mental Health

Studies have confirmed it: Attorneys are less likely to take care of themselves than medical doctors and other professionals. That inattention can often lead to emotional distress, and if not managed or treated, it can harm an attorney’s professional practice, clients, colleagues and even personal life.

People under extended periods of stress may be unable to concentrate, to make decisions or even to think clearly. They may be constantly active, yet accomplish little. Chronic stress can also show up as inappropriate anger or impatience, overreaction to minor problems, anxiety, fear, irritability or resentment.

Stress may also contribute to the onset of clinical depression, especially for individuals whose brain chemistry makes them more susceptible. 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.

As a group, legal professionals also have a preference for analytical thought (believed to come from the left side of the brain) versus emotional feelings (right side of the brain), are trained to be objective and solve problems.

Attorneys often 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. Concerned colleagues, friends and family members, therefore, need to encourage a depressed attorney to seek help from a doctor or mental health professional.

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:

  • feelings of hopelessness and pessimism
  • restlessness and irritability
  • fatigue. lethargy or weakness
  • inability to concentrate or make decisions
  • lack of appetite
  • loss of interest in activities such as eating, sex and other activities that used to be pleasurable
  • suicidal thoughts or thinking about death
  • overwhelming sadness or anxiety
  • feeling guilty, worthless, or helpless
  • changes in sleep patterns, such as insomnia or oversleeping
  • noticeable weight gain or loss
  • chronic symptoms, such as headaches or stomach pain that doesn't go away with treatment

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, we recommend that you 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.

What is 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 lives, but sometimes it's significant enough to be noticed by the person who experiences it, or by the people around them.

  • When it affects memory, it is known as "amnestic MCI." A person may forget important information that he or she would previously have recalled easily, such as appointments, conversations or recent events.
  • MCI that affects decision making or organizing skills is known as "nonamnestic MCI." It includes the ability to make sound decisions, judge time or the sequence of steps needed to complete a complex task. It may affect visual perception.

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.

What is dementia?

Dementia is not a specific disease. It is 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.

Dementia is caused by changes in the brain that happen over time. There are many health conditions that can lead to a similar drop in mental acuity, including:

  • Certain medications, or a change in medications
  • Low vitamin B12 levels
  • Certain metabolic conditions that can cause changes in blood sugar, sodium and calcium levels 
  • Chronic alcohol abuse
  • Brain tumors or brain injury
  • Infections that affect the brain, such as HIV/AIDS and Lyme disease
  • Conditions such as Alzheimer’s, Huntington’s and Parkinson’s disease
  • A blockage in the brain or spinal fluid

A person with dementia may 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 this 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.

What are the warning signs of dementia that are associated with Alzheimer’s disease?

A person in the early stages of dementia or Alzheimer’s may seem healthy, but is actually having more and more trouble making sense of the world around him or her. Family members are often the first to sense that something is wrong. They may notice that the person has problems paying bills, gets lost often or repeats questions during conversation.

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 Association.):

  • Memory loss that disrupts daily life
  • Forgetting recent information or asking for the same information over and over
  • Trouble understanding visual images and spatial relationships
  • Getting lost in what was once a familiar setting
  • Misplacing things and losing the ability to retrace steps to find the object again
  • Confusion with time or place
  • Forgetting where one is or how one got there
  • Challenges planning or solving problems
  • Changes in one’s ability to develop and follow a plan, work with numbers, or follow a familiar recipe
  • Difficulty completing familiar tasks at home, at work or at leisure
  • Problems with words in speaking or writing
  • Struggling with vocabulary, having problems finding the right word, or calling things by the wrong name
  • Decreased or poor judgment
  • Withdrawal from work or social activities
  • Changes in mood or personality
  • Becoming confused, suspicious, depressed, fearful or anxious

How can I help someone if I observe these problems?

  • Encourage the person to seek medical help.

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 treatable, and early diagnosis increases the chances of successful treatment.

The Alzheimer’s Association has developed a checklist called “Preparing for Your Doctor’s Visit” for the Chronic Care Networks for Alzheimer’s Disease project.  This form can either be completed by the individual or by concerned friends or family members.

Whatever the cause of the dementia, it is best to find out sooner rather than later. It may be caused by Alzheimer’s disease or another condition, such as multiple sclerosis. There is no cure for Alzheimer’s disease, but the drugs now available to treat Alzheimer’s disease can help some people maintain their mental abilities for months and even years.

  • Encourage the person to make plans for their practice, including making arrangements for their families and clients.

With a 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.

For a 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.

A 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.

For a family member, friend, or colleague, accepting certain signs of aging as something other than normal and deciding to take action can be a big hurdle. The person may even resist seeking medical help.

It may help to seek advice from a professional about how to address these concerns with your friend or family member. The State Bar of California is here to help. If you have questions, please contact the State Bar Lawyer Assistance Program at 877-527-4435 or LAP@calbar.ca.gov.

Further Resources


What is depression? National Institute of Mental Health. 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

Visiting Your Doctor. Alzheimer's Assocation. http://www.alz.org/alzheimers_disease_visiting_with_your_physician.asp 

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 Association. http://www.alz.org/what-is-dementia.asp

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 California. http://ethics.calbar.ca.gov/Ethics/SeniorLawyersResources/ClosingaLawPractice.aspx

Agreement to Close a Law Practice in the Future. State Bar of California. http://ethics.calbar.ca.gov/Ethics/SeniorLawyersResources/ClosingaLawPractice.aspx

Hydrocephalus Association. http://www.hydroassoc.org/