Financial and legal decision-making capacity in the aphasic population – a narrative review

Carr, Frances

doi:10.1177/0025817216669092

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…No communication aid currently exists to support financial decision-making capacity (DMC) assessments for persons with aphasia (PWA). (1) We sought to establish the validity, reliability, and feasibility of a newly constructed communication aid desigqned for this purpose.…”

Section: Introductionmentioning

confidence: 99%

“…In the presence of communication disorders, like aphasia, such assessments become challenging and require the use of a dedicated communication aid.No communication aid currently exists to support financial decision-making capacity (DMC) assessments for persons with aphasia (PWA). (1) We sought to establish the validity, reliability, and feasibility of a newly constructed communication aid desigqned for this purpose.…”

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confidence: 99%

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A Preliminary Assessment of the Psychometric Properties of a New Communication Aid to Support Assessments of Financial Decision-Making Capacity in People with Aphasia

Carr¹

2023

Can Geriatr J

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Background Financial decision-making is complex and requires an in-depth assessment. In the presence of communication disorders, like aphasia, such assessments become challenging and require the use of a dedicated communication aid. No communication aid currently exists to support financial decision-making capacity (DMC) assessments for persons with aphasia (PWA).(1) We sought to establish the validity, reliability, and feasibility of a newly constructed communication aid desigqned for this purpose. Methods A mixed methods study was performed, divided into three phases. Phase one was aimed at capturing current understanding of DMC and communication by community-dwelling seniors, using focus groups. The second phase involved the development of a new communication aid to assist with the assessment of financial DMC for PWA. The third phase aimed to establish the psychometric properties of this new visual communication aid. Results The new communication aid is a 37-page, paper-based document, with 34 picture-based questions. Due to unforeseen difficulties in participant recruitment for evaluating the communication aid, a preliminary evaluation was performed on the results from eight participants. These indicated the com-munication aid had moderate inter-rater reliability (Gwet’s AC1 kappa of 0.51 [CI 0.4362 to 0.5816, p < .000]), good internal consistency (0.76), and was usable. Conclusions This newly developed communication aid is one of a kind, and provides essential support for PWA requiring a financial DMC assessment, which was not previously available. Preliminary evaluation of its psychometric properties is promising; however, further validation is required to confirm its validity and reliability in the proposed sample size.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

A Preliminary Assessment of the Psychometric Properties of a New Communication Aid to Support Assessments of Financial Decision-Making Capacity in People with Aphasia

Carr¹

2023

Can Geriatr J

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“…7 No similar communication aids are available for other types of decision making. 8 The majority of research in DMC has been focused on patient consent within healthcare, with considerably less focused on financial DMC, almost all of which is related to understanding the financial decision-making process and how this becomes impaired in the context of certain neurodegenerative and psychiatric conditions. There is currently no research around financial DMC and aphasia, leaving a significant knowledge gap.…”

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confidence: 99%

“…There is currently no research around financial DMC and aphasia, leaving a significant knowledge gap. 8 Interestingly, despite the significant negative consequences that can arise following the assessment of financial DMC for aphasic individuals, no formal legislation exists dictating the role of communication supports within the DMC assessment process. 9 This has resulted in an absence of communication aids to support such assessments and a worrying knowledge-practice gap that is concerning for both medical and legal professions.…”

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confidence: 99%

The missing link for assessing financial decision-making capacity in individuals with aphasia

Carr

2022

Med Leg J

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Letter to the editorDecision-making capacity (DMC) is the ability to "understand information relevant to a decision" and "to retain and integrate this information into the decision making process, and communicate a decision", 1 and involves complex interactions between multiple cognitive domains, including attention, memory, and executive functioning and language. Financial DMC is "the ability to satisfactorily manage one's financial affairs in a manner consistent with personal selfinterest and values". 2 Financial capacity requires the presence of necessary financial skills, and is demonstrated through their financial knowledge and financial judgment (capacity). 3 Financial performance is reflected through the ability to manage one's financial demands. 3 Impairment of one or both of these components can affect financial DMC.The impact that certain cognitive and psychiatric conditions have on financial DMC is well established. 4 A neglected condition that also impacts on financial DMC is aphasia. 5 Aphasia is an "acquired neurogenic language disorder resulting from an injury to the brain, most typically the left hemisphere, that affects all language modalities", 6 which is characterised by impaired ability to communicate. Its incidence ranges from 10% within the general population, to 30% following a stroke. This is important given our ageing population and the fact that the incidence of developing aphasia and having a stroke increases with age.Aphasia poses unique challenges for the assessment of financial DMC. Essential components of the DMC assessment process include the transfer, understanding, and communication of information between the parties. In aphasia, the primary impairment involves difficulties with information processing, which arises from problems in language and in the cognitivecommunication process. This complicates the shared decision-making process, and limits the ability of the aphasic individual to participate and engage. As a result, the DMC assessment becomes difficult if not impossible to complete, and may not be attempted.

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“…There is a substantial literature addressing competency, decision-making capacity, and selfdetermination focusing on individuals with dementia, intellectual and developmental disabilities, psychiatric disturbances, and aphasia. [23][24][25][26][27] In comparison, relatively less attention has been directed to self-determination in PPA. Le Rhun and colleagues 28 reported that individuals with PPA who had high Mini-Mental State Examination scores, moderate aphasia, and fluent language on baseline clinical assessment subsequently retained greater autonomy in daily life.…”

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confidence: 99%

Ethical and Practical Challenges of the Communication and Behavioral Manifestations of Primary Progressive Aphasia

Tippett

Hillis

2020

Semin Speech Lang

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The communication and behavioral manifestations of primary progressive aphasia (PPA) present ethical and practical challenges for individuals with this clinical syndrome as well as for individuals who are involved closely in their care. In this article, cases representing all three PPA variants (logopenic variant, nonfluent agrammatic, semantic variant) are presented to illustrate commonly encountered situations in which self-determination is at risk in decisions about housing, driving, social interactions, finances, and treatment interventions. Potential approaches, including patient/family education, implementation of safeguards, redirection to meaningful activities, and protections against vulnerability in treatment decisions, are described to preserve autonomy in patients with this neurodegenerative clinical syndrome.

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Financial and legal decision-making capacity in the aphasic population – a narrative review

Cited by 7 publications

References 6 publications

A Preliminary Assessment of the Psychometric Properties of a New Communication Aid to Support Assessments of Financial Decision-Making Capacity in People with Aphasia

A Preliminary Assessment of the Psychometric Properties of a New Communication Aid to Support Assessments of Financial Decision-Making Capacity in People with Aphasia

The missing link for assessing financial decision-making capacity in individuals with aphasia

Ethical and Practical Challenges of the Communication and Behavioral Manifestations of Primary Progressive Aphasia

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