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Unformatted text preview: New Directions in Aging Research Assessment of Decision-Making Capacity in Older Adults: An Emerging Area of Practice and Research Jennifer Moye 1 and Daniel C. Marson 2 1 VA Boston Healthcare System and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. 2 Department of Neurology and Alzheimers Disease Research Center, University of Alabama at Birmingham. 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. T HE field of capacity assessment is dominated by a fundamental tension between two core ethical principles: autonomy (self-determination) and protection (beneficence; Berg, Appelbaum, Lidz, & Parker, 2001). What should we do when an older adult, particularly one who is frail, vulnerable, dementing, or eccentric, begins to make decisions that put the elder or others in danger, or that are inconsistent with the persons long-held values? At what point does decision making that is affected by a neuropsychiatric disease process no longer represent competent decision making? These are some of the essential, and perplexing, questions of clinical capacity assessment. We use the term capacity to refer to a dichotomous (yes or no) judgment by a clinician or other professional as to whether an individual can perform a specific task (such as driving or living independently) or make a specific decision (such as con- senting to health care or changing a will). There are at least eight major capacity domains of relevance to older adults with neuropsychiatric illness, as presented in Table 1. Two of these require a broad set of cognitive and procedural skills independent living and general financial management. Other capacities, such as treatment consent, testamentary capacity (wills), research consent, sexual consent, and voting, are gener- ally narrower in scope, focusing on one or a small number of specific decisions requiring an underlying set of cognitive abilities. These narrow capacities, although technically legal capacities, are rarely subject to judicial review....
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This note was uploaded on 12/01/2011 for the course CLP 7934 taught by Professor Staff during the Summer '08 term at University of Florida.
- Summer '08