I must admit that my absence from IVN this week has been directly caused by one of the most horrible life events I have ever experienced -- the sudden worsening of my own grandmother's Alzheimer's dementia.

She's almost 96 years old; it's to be expected. But it's still a rough life event to see the sudden downturn, then having to have meetings with lawyers, social workers, and health care professionals on how to improve her quality of life.

My grandmother was a life-long voter. She voted in every election she was eligible to vote in, and took the entire process very seriously. She read the newspapers, watched the debates, and made political contributions where she saw fit.

Over a decade ago, she stopped driving and started having "mail-in" ballots sent to her home so that she could still participate in the process.

With Alzheimer's now fully set in and living in a long-term care facility, my grandmother is definitely not alone. According to the Alzheimer's Association, 82 percent of seniors over 75 years of age have some form of dementia.

We live in a society that is aging, with the over 65 segment of the population being the fastest growing segment of the United States' population. With this demographic shift, we are going to have to face the realities of an aging society -- including determining when a person is no longer cognizant enough to vote.

The Journal of the American Medical Association (JAMA) took up this issue in 2004 and laid out many of the hazards and roadblocks involved within the subject. Some legal issues they addressed included:

• The autonomy of the individual, along with the right to vote, is one of our greatest freedoms;
• The integrity of the election system must be protected; and
• Voting fraud must be prevented.

One neurologist, commenting on the 2000 presidential election -- where Florida's slim victory gave George W. Bush the White House -- was aghast when a patient's wife discussed taking her husband with advanced dementia to vote. The patient, who thought it was 1942 and Franklin D. Roosevelt was president, contributed to one of the closest races ever in presidential election history.

The neurologist pressed the issue, asking the wife how he voted, including if he went into the both alone, or needed assistance. What he found out unnerved him -- the wife freely admitted to showing him which candidate to vote for. In the words of the doctor, "she essentially voted twice."

Existing Laws are Arcane and Inapplicable

About 25 states limit the right to vote for those who are deemed mentally incompetent, and largely those under the guardianship of another. A universal, modern, or applicable version of most of these laws simply doesn't exist. For instance, the Kentucky Constitution explicitly states:

"Idiots" and "insane" persons shall not have the right to vote. - KY. CONST. §145(3)

By today's verbiage and political rhetoric, this would disqualify most of the state from voting, as each party takes jabs at the other, often using the exact verbiage.

The other issue is that unlike mental illness, dementia patients are rarely under guardianship or a ward of the court. Instead, their treatment is mostly carried out by arranged durable power of attorney, health care proxies, trusts, and living wills.

The JAMA article takes up this issue with three interesting points on what needs to be done to improve voting in patients with dementia:

• "[D]evelopment of a method to assess capacity to vote;
• [I]dentification of appropriate kinds of assistance to enable persons with cognitive impairment to vote; and
• [F]ormulation of uniform and workable policies for voting in long-term care settings."  JAMA 2004

This model is the most relevant presented -- and states should take notice. It's not enough to have a standard of when a person can or can't vote, when in reality it works out that the person helping them vote is essentially voting twice. As Americans continue to age, long-term care settings could become the new trend in polling sites, and measures need to be in place to protect everyone's rights, from the individual's to the integrity of the entire system.

Where Should We be Drawing the Line?

Any form of law that forces a certain segment of the population to prove that they are capable of voting has historically been a recipe for abuse and disaster.

From voter aptitude tests in the American South to having to prove citizenship in the American Southwest (and other places as well), these laws were designed for one purpose -- to disenfranchise people.

With the population explosion of the over 65 segment, this problem is only going to get worse, not better -- and it is a problem that needs addressed by our lawmakers, most likely at a national level.

I don't have any cut and dry answers, but one thing I do know for certain is that no one, even the primary caregiver of an elderly voter, should ever have the opportunity to vote twice in any election.

Photo Credit: Lightspring / shutterstock.com