Assessment of capacity in an aging society.

Abstract

Over the past 40 years, the assessment and scientific study of capacity in older adults has emerged as a distinct field of clinical and research activity for psychologists. This new field reflects the convergence of several trends: the aging of American society, the growing incidence and prevalence of dementia, and the patient rights, deinstitutionalization, and disability rights movements. Because of these forces, capacity issues now permeate the fabric of everyday life, whether in the form of guardianship petitions, questions of capacity to consent to treatment, the ability to make a new will, or participation in human research. In seeking to resolve these issues, families, clinicians, and legal professionals increasingly turn to psychologists to assess a capacity and to provide empirically supported judgments that properly balance autonomy and protection for the individual. Psychologists have taken a leading role in the development of functional assessment instruments that measure important aspects of the capacity construct. In addition, psychology has been a major contributor to the scientific study of capacity. In collaboration with colleagues from medicine and law, psychologists have articulated crucial theoretical frameworks that integrate legal, clinical, and ethical dimensions of the capacity problem. This article focuses on the evolution of theory, law, science, and practice in the evaluation of capacity in older adults and its recent culmination in a series of interdisciplinary handbooks sponsored by the American Psychological Association and the American Bar Association.

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.…”

Predictors of financial capacity performance in older adults using the Financial Competence Assessment Inventory

“…In later life, the ability to competently manage finances may be questioned due to incipient cognitive impairment as a result of neurocognitive decline, or impaired cognitive or decision-making capacity due to psychiatric disturbance (Moye et al, 2013). Questions concerning financial capacity often arise from concerned family members, healthcare professionals or, in some cases, the patients themselves.…”

“…When assessing financial capacity, informant reports should also be sought, as collateral information can provide useful information to inform clinical judgments of financial capacity (Pinsker et al, 2006;Sherod et al, 2009). Finally, assessment of psychiatric conditions, such as depression and anxiety, is recommended (Moye et al, 2013), as financial capacity may be affected by the cognitive, affective, or behavioral sequelae of such conditions.…”

“…These include semi-structured interviews, vignettes, and direct assessment of performance on items targeting financial management abilities (Marson et al, 2000;Marson, 2001;Griffith et al, 2003;Moye et al, 2013). Assessment of global or domain-specific aspects of cognitive functioning may be important, particularly if cognitive decline is suspected.…”

“…Assessment of financial capacity may be carried out by a variety of healthcare professionals, but ideally should be undertaken using both interview strategies and objective assessment data (Moye et al, 2013). Clinical judgment alone may prove unreliable if not well supported by objective data, for example, if clinicians hold different values from those of their patients (Braun et al, 2009).…”