Decision-Making Capacity Assessments

Dementia Assessments

A decline in cognitive functioning, including memory, is a normal part of the aging process. But when cognition deteriorates beyond age-related expectations, it might be an indication that an individual is suffering from dementia.

Standard neuropsychological tests with appropriate age norms are used to assess current cognitive status and determine if the deterioration in mental function is due to dementia or some other, potentially reversible, underlying cause. Repeat assessment at some future date is also valuable in assessing potential decline with time.

Decision-Making Capacity Assessments

Capacity involves the process of decision-making. It considers a person’s knowledge and understanding of certain issues and his or her ability to understand and appreciate the consequences of the choices made around these issues. The ability to follow through with chosen options (initiation) is also integral to capacity. Decision-making capacity is a multi-factorial concept with multiple integrated domains.

Capacity is often delineated into Personal Capacity and Financial Capacity. Decisions related to personal capacity are often related to health-care issues and discharge planning (i.e., choice of residence). Financial capacity is often associated with issues such as testamentary capacity and financial management abilities.

The most common method of assessing capacity is through a detailed functional inquiry (i.e., a semi-structured interview focusing on the domains in question), in conjunction with standardized neurocognitive testing. Taking into account the adult’s actual functional abilities and the supports that are available to assist them with decision-making is also an integral part of the evaluation process.

Questions that a Capacity Assessment can answer:

1) Does the client need an alternate decision-maker? For example, does the client need a guardian or the Personal Directive activated?

2) If the Personal Directive needs to be activated, in what domains does the client lack capacity? Does the client lack capacity globally or are there pockets of capacity remaining?

3) Is the client able to write a Personal Directive and / or an Enduring Power of Attorney?

4) Is the client able to amend an existing Personal Directive or an existing Enduring Power of Attorney?

5) Does the client have testamentary capacity?

Capacity is a very complex and multifaceted topic. If you have any questions related to the assessment of capacity please do not hesitate to contact our clinic.