Neuropsychological Correlates of Performance Based Functional Status in Elder Adult Protective Services Referrals for Capacity Assessments

Abstract

We have previously described high rates of executive function impairment in clients referred by Adult Protective Services (APS) to geriatric psychiatry for decision-making capacity assessments. The purpose of this study was to determine the independent relationship between neuropsychological screening instruments, particularly instruments sensitive to executive function, and performance-based functional tasks in elder referrals. Our retrospective medical review (n = 75/157 referrals completed all neuropsychological and functional assessments) revealed that only the Executive Interview (EXIT25) contributed independent variance to money management performance (R(2) = 0.29, p < 0.001), telephone use ability (R(2) = 0.39, p < 0.001), and summed performance (R(2) = 0.45, p < 0.001). Executive instruments may specifically inform decision-making capacity assessments.

Executive Function Impairment and Recidivism in Adult Protective Services Clients Referred for a Decision Making Capacity Assessment

“…Executive function measures have consistently been shown to correlate well with functional status (Johnson, Lui, & Yaffe, 2007). We have previously shown that executive function was the best predictor of elder APS clients' abilities to demonstrate how to read a bill, write a check, read a check register, use a check register, state what number to call in an emergency, and demonstrate how to use a telephone book (Schillerstrom, et al, 2013). Thus, APS clients with impaired executive processes may be unable to take advantage of as-needed or selfinitiated interventions and may need more restrictive oversight, such as daily provider services, home health management, or perhaps even guardianship to prevent recurrence of exploitation or neglect.…”

Decisional Capacity and Personality Disorders: Substantially Unable or Substantially Unwilling?

“…This includes the MacArthur Structured Assessment of Competencies of Criminal Defendants (MacSAC-CD), which was validated for schizophrenia and affective disorders (26), and the MacCAT-T, which was validated for schizophrenia and schizoaffective disorder (27). Similarly, up to this point impairment in executive function seems to be the most significant cognitive predictor of inability to obtain the standards required to maintain independence in decision-making (10,28). However, as demonstrated in the above cases, patients with severe personality disorders sufficient to impair decision-making do not necessarily have clinically significant executive function deficits and generally perform very well on global cognitive assessments.…”

“…This brings us back to the original concept for presenting these cases: Are patients with personality disorders substantially unable to care for themselves and manage their own lives, or are they better characterized as substantially unwilling ? If we refer to the data showing that executive function correlates reasonably with capacity and self‐care , then two paths are possible. The first way of interpreting this is to posit that the above clients are simply unwilling to provide adequate care for themselves, but theoretically they could perform appropriately since they are generally cognitively intact.…”

“…However, the Executive Interview (EXIT25) , which is a multitask assessment of executive function, contributed more mean variance to self‐care ability than any other cognitive measure at R 2 = 0.25 . EXIT25 performance contributes significant variance to money management ability ( R 2 = 0.29, p < 0.001) and telephone use ability ( R 2 = 0.39, p < 0.001) and is a risk factor for recidivism in adult protective services (APS) clients suspected of neglect and/or exploitation. The EXIT25 is also sensitive to clinically significant cognitive impairments in forensic settings missed by general cognitive screens .…”

Branching Condition of the Color-Word Interference Test Enhances Prediction of Meta-Tasking in Community-Dwelling Older Adults

“…Executive functioning (EF) is an umbrella term composed of complex and multidimensional processes such as working memory and mental flexibility, initiation and maintenance of behavior, inhibition and response selection, and meta-tasking (MT) (Suchy, 2015). EF has consistently been linked to requisite skills for independent living (Jefferson, Paul, Ozonoff, & Cohen, 2006;Marshall et al, 2011;Uemura, Yamada, Nagai, & Ichihashi, 2011), including financial management (Nakhla, 2019;Schillerstrom et al, 2013), medication or medical regimen management (Manning, Clarke, Lorry, Weintraub, Wilkinson, Duda, & Moberg, 2012;Stoer et al, 2008;Suchy et al, 2016;Suchy et al, 2020;Ziemnik & Suchy, 2019), driving (Brown et al, 2016;Hayashi, Rivera, Modico, Foreman, & Wirth, 2017;P-ope, Bell, & Stavrinos, 2017), and meal preparation (Craik & Bialystok, 2006;Jefferson, Paul, Ozonoff, & Cohen, 2006;Kosowicz & MacPherson, 2017).…”