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Elderly mentally disordered offenders are underresearched and poorly understood, but Fazel et al (2001a ) demonstrated high levels of ‘hidden’ psychiatric morbidity in a sample of male prisoners over 60 years of age.

The cases of the former Chilean dictator Augusto Pinochet and of Ernest Saunders, involved in the Guinness financial affair, illustrated the inherent difficulties of the older person in the forensic setting. This was demonstrated when Saunders became the first case to make a full recovery from a diagnosis of Alzheimer's dementia.

In Fazel et al's two related papers (2001a , b ), significant levels of both psychiatric and physical morbidity are clearly evident that will surely have future service implications as the elderly prisoner population continues its inevitable rise. Prison services for elderly inmates have been slow to develop despite the Reed report (Department of Health & Home Office, 1992) that acknowledged the complex nature of elderly prisoners and demanded a ‘holistic’ approach in their management.

Yorston (1999) contemplates the future of old age forensic psychiatry as a subspeciality akin to those of learning disabilities and child and adolescent psychiatry. As the number of elderly mentally disordered offenders presenting currently is small, but increasing, he suggests that a regional tertiary referral service for the most difficult or serious cases, with close links between the relevant forensic and old age services, might be preferable at this time.

An integrated approach between old age and forensic services using their different areas of expertise will make assessment and management of elderly offenders more comprehensive, as opposed to management by one team alone. This is in keeping with standards 2 (person-centred care) and 7 (mental health) of the National Service Framework for Older People (Department of Health, 2001), which emphasise the importance of an integrated approach to assessment and care-planning through liaison with specialist services for older people. Standard 2 also suggests that the National Health Service and local councils should ensure a flexible and integrated approach to service provision, regardless of professional or organisational boundaries.

To date, elderly offender research has almost exclusively been retrospective but the studies by Fazel and colleagues suggest that a substantial prospective study of elderly offenders would not only be feasible but also desirable to improve our poor knowledge of this important group.