Assessment of decision capacity in elderly Malakouti S.K TPI/IUMS Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Paternalism: limit sb’s autonomy to prevent harm to self/ or losing some benefit Paternalism is justified for ability to make decision not any action/consequences to harm him/herself Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

It refers to a judge’s ruling as to whether an individual has been deemed capable of making their own decisions Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

it is generally accepted that a ruling of incompetence cannot be made solely on the basis of a medical diagnosis, age, level of education, or personal eccentricity Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

An adjudication of competence or incompetence is based on an assessment of the individual’s decisional capacity and that individual’s demonstrated ability or inability to carry out a plan. Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

other factors that may be influencing their ability to decide. This would include emotional state, functional ability, psychosocial situation (especially with regard to coercion), and financial and environmental limitations Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Specific testing can measure cognitive dysfunction, and observing the person’s decision-making process can demonstrate his or her inability to complete the decision- making task capably Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Anatomical bases for competency Frontal, decision making Temporal, memory Parietal, language Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Medical decision making (1) appreciation of the disorder (2) understanding of the treatment and risks or discomforts (3) appreciation of the treatment (4) understanding of alternate treatments (5) reasoning (6) expressing a choice Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Self care and capability Inability to care for self or to accept the help needed to remain safe in his or her present environment What is more evident is the impact of frontal lobe dysfunction. The inability to plan, initiate action, monitor one’s behavior, and self- correct are essential to being able to care for oneself. Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

There are times when an individual remains able to make medical decisions and decisions related to self-care but is no longer capable of managing the finances. When bills are going unpaid or gross mistakes are made in handling money, then someone else will need to take over financial management. Specific tests for measuring the ability to calculate, to understand a checkbook, to monitor bank accounts Seyed Kazem Malakouti, MD,Iran University of Medical Sciences