Assessment of Decision-Making Capacity in Older Adults: An Emerging Area of Practice and Research

Abstract

The convergence of the aging of our society, the increase in blended families, and an enormous intergenerational transfer of wealth has greatly expanded the incidence and importance of capacity assessment of older adults. In this article we discuss the emergence of capacity assessment as a distinct field of study. We review research efforts in two domains: medical decision-making capacity and financial capacity. Existing research in these two areas provides a first pass at many key questions related to capacity assessment, but additional studies that replicate, extend, and improve on this research are urgently needed. An agenda for future is detailed that recommends studies of a wide range of capacity constructs, focusing on clinical markers of diminished capacity, methods to improve clinical assessment, and the many intersections of law and clinical practice.

Family Role in Decision Making of Health Seeking Behavior on Elderly in Tabanan Regency, Bali, Indonesia

“…This is due to a decline in various cognitive functions of the elderly. A study conducted by Jennifer Moye and Daniel C. Marson reveals that there is a disruption in the ability to make consent of a patient suffering from dementia [34].…”

Guidelines for Psychological Practice with Older Adults.

“…Conflicts sometimes arise among family members, formal caregivers, and physically frail or cognitively impaired older adults because some concerned individuals may believe that these older adults do not possess the ability to make decisions about their own lives that can affect their safety and well-being. Psychologists are sometimes called upon to evaluate one or more domains of capacity of older adults (e.g., medical, financial, contractual, testamentary, or independent living decision making; Moye, Marson, & Edelstein, 2013 Psychologists working with older adults are encouraged to be prepared to work through difficult ethical dilemmas in ways that balance considerations of the ethical principles of beneficence and autonomy-that is, guarding the older adult's safety and well-being as well as recognizing the individual's right to make his or her own decisions to the extent possible (Karel, 2011;Marson et al, 2011;Moye & Marson, 2007). This dilemma is especially relevant to older adults with serious mental illness living in long-term care settings.…”

Ethics and Intimate Sexual Activity in Long-Term Care

“…As one author has written, in reference to sexuality and Alzheimer's disease, "As they say, when you have seen one case, you have only seen one case" [20]. There is increased acceptance in medical ethics that capacity is decision-specific [21]. Inability to make a decision about medical treatment or to manage finances should not be assumed to denote sexual consent incapacity.…”