Decision-making capacity evaluations: the role of neuropsychological assessment from a multidisciplinary perspective.

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State: Public
Version: author
License: CC BY 4.0
Serval ID
serval:BIB_51AA64464658
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Decision-making capacity evaluations: the role of neuropsychological assessment from a multidisciplinary perspective.
Journal
BMC geriatrics
Author(s)
Wood S., Bally K., Cabane C., Fassbind P., Jox R.J., Leyhe T., Monsch A., Trachsel M.
ISSN
1471-2318 (Electronic)
ISSN-L
1471-2318
Publication state
Published
Issued date
10/12/2020
Peer-reviewed
Oui
Volume
20
Number
1
Pages
535
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Decision-making capacity (DMC) in aging adults has become increasingly salient as the number of older adults, life expectancy, and the amount of wealth to be transferred from older generations have all increased. The accurate and reliable determination of older adults' DMC is a particularly important topic given its implication in legal, financial, and health decisions. Based upon the four-ability DMC model promulgated by Appelbaum and Grisso in the 1980's, a number of MacArthur Competence Assessment Tools have been developed and widely utilized. However, these tools do not include cognitive testing or other sources of objective data and have limited validity in a medico-legal setting, necessitating additional options for the evaluation of DMC. This is significant from the perspective of the patient because they have a vested interest in accurate and objective assessment of their DMC across domains.Given the disparities in the assessment of DMC, the authors propose, through this debate article, that the evaluation of DMC in the aging adult population utilize a combination of traditional interview and domain specific instruments and neuropsychological testing. To achieve a consensus on the issue, medical experts in a number of fields related to capacity evaluation, including psychiatry, neurology, neuropsychology, and general medicine were consulted and recruited as authors. Experts in Swiss law and ethics were also consulted and provided input.A tendency to focus on a single capacity, and in particular, the ability to consent to medical treatment, arose in the literature. Similarly, there are many instruments purporting to evaluate a single capacity (e.g., consenting to medical treatment, managing finances), while other areas important to the evaluation of DMC received little attention (e.g., activities of daily living, the ability to live independently, to marry, to resist undue influence, and to make a will or advanced care directive). Medical and legal experts in the multidisciplinary group agreed that there is a clear need for more consistency across evaluation of DMC domains and that a combined approach of traditional methods and neuropsychological testing provides a more thorough evaluation and better serves the patient.
Keywords
Autonomy, Capacity evaluation, Cognition, Decision-making, Informed consent
Pubmed
Web of science
Open Access
Yes
Create date
22/12/2020 11:02
Last modification date
14/01/2021 6:23
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