Laura Morton / The New York Times
Carol King, who has Alzheimer’s disease, with her son, Geoffrey King, in her room at a San Francisco residence for older adults, July 18, 2017. Carol King was detained by police after an incident in the residence last summer. Confrontations with police officers are increasing as the ranks of older Americans swell and dementia becomes more widespread.
Tuesday, July 25, 2017 | 2 a.m.
It was the sort of incident that happens at facilities that care for people with dementia.
At a residence for older adults in San Francisco last summer, Carol King momentarily left a common sitting area. When King returned, she found that another resident had taken her chair, a nurse who witnessed the episode later reported. She grabbed the usurper’s wrist.
Though staff members intervened promptly and nobody appeared injured, the other resident (who also had dementia) called 911 to say she had been attacked. Soon, King’s son, Geoffrey, was summoned and four police officers arrived.
Over objections from staff members and her son, the officers decided to place King on an involuntary psychiatric hold, which allows a 72-hour detention when an officer believes someone is unable to care for herself or poses a danger to herself or others.
As they searched and handcuffed King and placed her in a patrol car, “she started crying,” her son recalled.
At the Psychiatric Emergency Services department at San Francisco General Hospital, a psychiatrist found King “calm and cooperative,” showing no evidence of psychiatric illness, and released her seven hours after she was detained.
Such episodes may become increasingly common. The ranks of the elderly are growing, and with them the number of people with dementia. As a result, older people and law enforcement officers are crossing paths more frequently, recent data suggests — sometimes with terrible consequences.
Consider arrest rates. From 2002 to 2012, the rate fell by 11 percent among those ages 18 to 64, according to federal data analyzed by researchers at the University of California, San Francisco.
But the arrest rate rose by 23 percent for people over 55. It rose even more markedly — by 28 percent — among those over 65, more than 106,000 of whom were arrested in 2012, the last year for which statistics are available.
“These contacts are occurring more frequently,” said Dr. Brie Williams, a geriatrician and director of the university’s Criminal Justice Aging Project.
Arrests constitute only one measure of involvement, of course. Police are asked to find people with dementia who wander and to bring them home. They stop in for safety checks when family or doctors worry about elders’ welfare.
Especially when people have dementia, “they may be disrupting a neighborhood or engaging aggressively with someone they don’t know, and the police end up being called,” Williams said. Nursing home staff members, too, may call 911 when they feel unable to handle belligerent patients.
Such interactions can be helpful — or they can go very wrong. For Geoffrey King, a civil rights lawyer, it’s clear which category his mother’s detention fell into. “This was such a profound breakdown of procedure and good sense,” he said.
The acting police chief disagreed, saying last summer that the officers had acted within department policy and state law, and had “a duty and obligation to take action to protect the other residents from assaultive behavior.”
King has filed a complaint with the San Francisco Police Department’s accountability division, accusing officers of excessive force, unlawful detention and violations of disability law.
Yet King recognizes that “as bad as it was, it could have been a lot worse,” he said.
And that’s certainly true. In other high-profile cases last year:
• A county sheriff’s deputy in Minneapolis, Kansas, used a Taser on a 91-year-old nursing home resident with Alzheimer’s who refused to get into a car for a doctor’s visit.
• After a 65-year-old in San Jose, California, was arrested and charged with trespassing, a judge — informed that the man had Alzheimer’s — dismissed the charge. But deputies at the jail released him before a friend arrived to pick him up, and he wandered onto a highway, was hit by a car and killed.
• In Bakersfield, California, a 73-year-old man with dementia was walking in his neighborhood late at night when a woman he approached noticed something in his pocket that she thought might have been a gun. When the police arrived and told him to raise his hands, he ignored their shouts, walked toward them and was shot and killed. The object in his pocket proved to be a crucifix.
To Williams, these episodes underscore the need to improve the way police officers react when they encounter older citizens. “This is a specialized group in need of specialized responses,” she said.
There’s no definitive explanation for why arrest rates are climbing among old people. (And they remain far higher among younger groups.)
But beyond dementia, which Williams hypothesizes accounts for much of the increase, she points out that older adults can behave impulsively because of transient medical issues like delirium, dehydration, infection or the effects of medications.
Hearing loss becomes common among those in their 60s. When the police shout commands, can older people understand what they are saying? Mobility declines, too. If they are told to get down on the ground, or to climb into a patrol car while handcuffed, how quickly can they comply if they are frail? Will their attempts lead to falls and injuries?
When an older person is spotted urinating in public, “is there a medical reason for engaging in what’s traditionally seen as criminal behavior?” Williams asked.
Since 2011, the San Francisco Police Department has incorporated a two-hour course on dealing with older residents, developed by geriatricians at the University of California, San Francisco, into its weeklong crisis intervention training.
Trainees learn about aging and use kits that replicate its effects, including glasses that impair vision as glaucoma or cataracts might, and popcorn kernels placed in shoes to mimic the discomfort of diabetic neuropathy.
“People generally have a hard time putting themselves in others’ shoes,” said Sgt. Kelly Kruger, who helped develop the training. “This brings it home.”
Officers also receive a guide to local programs and services for older adults, so they can refer those who need help.
A study published this year by UCSF geriatricians showed that the officers’ knowledge, including their understanding of age-related health changes that can affect safety during police interactions, increased significantly after training.
To date, nearly 750 officers, of about 1,800 total, have gone through the program, said Sgt. Laura Colin, one of the trainers. Though the Police Department has added more classes recently, training every officer — the goal — will take another six years.
While other cities have contacted the university to express interest, Williams knows of no other police departments that have adopted training programs about aging.
A pity. Police interactions with old people are likely to increase, she pointed out, simply because there are more old people. When officers better understand how to respond, “they are so relieved,” Williams said, adding, “They just want to know what to do.”
