Should capacity assessments be performed routinely prior to discussing advance care planning with older people?

Kiriaev, Oleg; Chacko, Emme; Jurgens, JD; Ramages, Meagan; Malpas, Phillipa; Cheung, Gary

doi:10.1017/s1041610217002836

Cited by 9 publications

(10 citation statements)

References 30 publications

(33 reference statements)

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“…Vignettes can be incorporated into tailored questioning on such points, particularly to assess appreciation and evaluation abilities. 32 Appointing a proxy decision-maker requires that a person understand the nature of this role and the authority they are entrusting to the proxy. The capacity to appoint a proxy-and therefore to complete the proxy nomination part of an ARD-may be present even among people who are assessed as unable to consent to a particular study, especially those involving more complex research designs.…”

Section: E R H E R Hmentioning

confidence: 99%

Advance Research Directives: Dementia Researchers' Views on a Prototype Directive and Implementation Strategies

Ries

Mansfield

2021

Ethics & Human Research

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Advance research directives (ARDs) enable people to document preferences for future research participation in the event of incapacity. This article reports on interviews with 11 dementia researchers in Australia that focused on the content of a prototype ARD and processes for making and using ARDs. Participants agreed that an ARD template should provide information to explain research and the rationale for making a directive, allow the person to nominate trusted individuals to be involved in future decisions, and record the person's general willingness or unwillingness to be involved in research. Providing a list of various research activities elicits preferences and risk tolerances in more detail. Priority groups for ARD implementation include people with a diagnosis involving progressive cognitive impairment and people interested in research. Researchers and health and legal professionals have a role in promoting ARDs. Our findings suggest that, as a voluntary strategy, ARDs could promote appropriate inclusion in research.

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Section: E R H E R Hmentioning

confidence: 99%

Advance Research Directives: Dementia Researchers' Views on a Prototype Directive and Implementation Strategies

Ries

Mansfield

2021

Ethics & Human Research

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“…Currently accepted criteria for a person to demonstrate the capacity to consent are: an understanding of the issues, an appreciation of how this information applies to them and its implications for the future, the ability to explain the reasoning for their choices, and the ability to communicate their decision voluntarily and without internal or external coercion (Kiriaev, et al, 2018). Politely asking people if they can answer some questions about their memory gives them the appearance of being autonomous, consenting participants to the MMSE while circumventing the processes necessary for making an informed decision and ensuring people's cooperation in their own disenfranchisement.…”

Section: Consent (And Lack Thereof)mentioning

confidence: 99%

Unmapping the Mini-Mental State Exam (MMSE)

Machado¹

2021

Preprint

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This study is a critical discourse analysis of the Mini-Mental State Exam (MMSE), an assessment tool used to screen older adults for cognitive impairment worldwide. In it, I deconstruct and unmap two unofficial versions of the MMSE to reveal how its discursive practices are grounded in ageism, ableism, sanism, and other forms of oppression. I challenge the MMSE’s status as a neutral container for knowledge by uncovering how it actively defines “cognitive impairment” and “cognitively impaired” identity formation through epistemic violence. I discuss five key issues: consent, scoring, claims-making, voice, and copyright. Lastly, I reflect on how hegemonic discourses about “dementia” keep older adults and people with cognitive impairments in their social place while maintaining the multi-billion dollar “care” industry. This study highlights how social workers are implicated in injustices against older adults that are often hidden. I hope it will be the impetus for transformative change in this field. Keywords: Mini-Mental State Exam, short cognitive test, discourse analysis, unmapping, cognitive impairment, older adults, gerontology, anti-oppressive practice

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“…A lack of mental capacity for decision making and uncertainty of engaging ACP were also identified as barriers to undertake ACP for older people, particularly during their EOL [42]; these barriers compromised the quality of EOL care for patients with impaired mental capacity compared with those who only have cancer [43,44]. The process of informed consent needs to anticipate potential loss of capacity during the course of treatment and how a participant’s willingness to participate in certain care is upheld if they lose capacity.…”

Section: Impact Of Acp For Older People With Cancermentioning

confidence: 99%

“…This principle has been strongly recommended in the latest report on ACP for people with dementia in all care settings proposed by the National Health Service (NHS) in England to guide the assessment of a person’s capacity on decision making [45]. The benefit of ACP for people with cognitive impairment and dementia has been confirmed by previous systematic reviews [7]; however, timing to assess the cognitive impairment of older adults and the criteria of excluding them from participating in an ACP still challenge healthcare professionals and impede clinical practices [43]. Therefore, some practical principles regarding mental capacity assessment and how to assist older adults with cancer make decisions for their future care are provided in the following section.…”

Section: Impact Of Acp For Older People With Cancermentioning

confidence: 99%

Advance Care Planning for Older People with Cancer and Its Implications in Asia: Highlighting the Mental Capacity and Relational Autonomy

2018

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With dramatically increasing proportions of older people, global ageing has remarkably influenced healthcare services and policy making worldwide. Older people represent the majority of patients with cancer, leading to the increasing demand of healthcare due to more comorbidities and inherent frailty. The preference of older people with cancer are often ignored, and they are considered incapable of making choices for themselves, particularly medical decisions. This might impede the provision of their preferred care and lead to poor healthcare outcomes. Advance care planning (ACP) is considered an effective intervention to assist older people to think ahead and make a choice in accordance with their wishes when they possess capacity to do so. The implementation of ACP can potentially lead to positive impact for patients and families. However, the assessment of mental capacity among older adults with cancer might be a crucial concern when implementing ACP, as loss of mental capacity occurs frequently during disease deterioration and functional decline. This article aims to answer the following questions by exploring the existing evidence. How does ACP develop for older people with cancer? How can we measure mental capacity and what kind of principles for assessment we should apply? What are the facilitators and barriers when implementing an ACP in this population? Furthermore, a discussion about cultural adaptation and relevant legislation in Asia is elucidated for better understanding about its cultural appropriateness and the implications. Finally, recommendations in relation to early intervention with routine monitoring and examination of capacity assessment in clinical practice when delivering ACP, reconciling patient autonomy and family values by applying the concept of relational autonomy, and a corresponding legislation and public education should be in place in Asia. More research on ACP and capacity assessment in different cultural contexts and policy frameworks is highlighted as crucial factors for successful implementation of ACP.

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Should capacity assessments be performed routinely prior to discussing advance care planning with older people?

Cited by 9 publications

References 30 publications

Advance Research Directives: Dementia Researchers' Views on a Prototype Directive and Implementation Strategies

Advance Research Directives: Dementia Researchers' Views on a Prototype Directive and Implementation Strategies

Unmapping the Mini-Mental State Exam (MMSE)

Advance Care Planning for Older People with Cancer and Its Implications in Asia: Highlighting the Mental Capacity and Relational Autonomy

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