Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Mar;93(1):35-53.
doi: 10.1007/s11126-020-09867-7. Epub 2021 Jan 2.

Decision-Making Capacity in Healthcare: Instruments Review and Reflections About its Assessment in the Elderly with Cognitive Impairment and Dementia

Ana Saraiva Amaral  1   2   3 , Rosa Marina Afonso  4   5 , Mário R Simões  6   7   8 , Sandra Freitas  6   7   8
Affiliations
Review

Decision-Making Capacity in Healthcare: Instruments Review and Reflections About its Assessment in the Elderly with Cognitive Impairment and Dementia

Ana Saraiva Amaral et al. Psychiatr Q. 2022 Mar.

Abstract

The prevalence of neurodegenerative diseases has been significantly increasing in the last decades, and it is expected to continue to grow. These health disorders can impair patients' decision-making capacity in healthcare. The capacity to make healthcare decisions is a fundamental pillar of informed consent, therefore, it should be carefully assessed. Clinicians' assessment, when not supported by a standardized tool, has revealed to be unreliable, so the recourse to an instrument of capacity assessment is crucial. The present paper aims to identify and summarize published instruments of healthcare decision-making capacity. To do so, a search of peer-reviewed articles in English, Portuguese and Spanish was conducted. A total of eighteen articles, detailing seventeen assessment instruments were selected. Instruments differ on format, structure, assessed abilities and psychometric properties. Likewise, instruments' targeted population also varies, with a few being specifically developed for patients with dementia. Although a high number of instruments were found, there is still no gold standard for healthcare decision-making capacity assessment. The lack of a gold standard highlights the need for more research in this field, as well as an effort to develop guidelines and normative data, in order to improve clinical practices.

Keywords: Capacity assessment; Dementia; Healthcare decision-making; Mild cognitive impairment.

PubMed Disclaimer

References

    1. Moye J, Gurrera RJ, Karel MJ, Edelstein B, O’Connell C. Empirical advances in the assessment of the capacity to consent to medical treatment: clinical implications and research needs. Clin Psychol Rev. 2006;26:1054–77. https://doi.org/10.1016/j.cpr.2005.04.013 . - DOI - PubMed
    1. Galietta M, Garcia-Mansilla A, Stanley B. Assessing civil capacities. In: Weiner IB, Otto RK, editors. Handbook of forensic psychology. 4th ed. New Jersey: Wiley; 2013. p. 219–36.
    1. Grisso T, Appelbaum PS. Assessing competence to consent to treatment: a guide for physicians and other health professionals. New York: Oxford University Press; 1998.
    1. Palmer BW, Salva GN, Harmell AL. Healthcare decision-making capacity. In: Demakis GJ, editor. Civil capacities in clinical neuropsychology. New York: Oxford University Press; 2012. p. 69–94.
    1. Appelbaum P, Grisso T. Assessing patients’ capacities to consent to treatment. N Engl J Med. 1988;319:1635–8. https://doi.org/10.1056/NEJM198812223192504 . - DOI - PubMed

Publication types

LinkOut - more resources