The CGS is performing more capacity assessments over time. The majority of the patients are elderly and have dementia. There is a need to train specialist nurses and general practitioners to perform capacity assessments. A resource kit has been developed for this purpose. Methods This was a retrospective study. Ethics approval for this study was obtained. A list of all patient contacts made by the CGS between 1 December and 30 June was obtained from the hospital database.
The clinical letters for each patient were reviewed. The initial referral was not always solely for the purpose of capacity assessment, but the patient was included in this study if the clinician who saw the patient considered a capacity assessment necessary and performed one. A set of data was recorded on a password-protected spreadsheet; gender, ethnicity, date of birth age at the time of assessment were calculated using Microsoft Excel software , date of assessment, diagnosis, referrer, reason for referral, assessor, degree of competence, existence of EPOA, whether referral under the PPPR Act was recommended and the presence of any complex family situations.
Diagnosis was categorised into the most commonly seen clinical causes of cognitive impairment; dementia, mental disorder, intellectual impairment, and delirium. The degree of capacity was recorded in four separate categories; capacity for personal welfare, financial welfare, ability appoint an EPOA, and testamentary capacity, and the subject was recorded as competent, partially competent or incompetent for each category.
Not applicable was recorded if an assessment was not done for a particular category. Results visits were made by the CGS between 1 January and 1 July , which included 87 capacity assessments. Number of capacity assessment referrals in each 6-month period Figure 1 shows the number of capacity assessments referred to the CGS between 1 January and 1 July in six month intervals. Table 1. Capacity assessment outcome for patients with dementia and non-dementia diagnosis Diagnosis. Mixed competency. Dementia Non-dementia. Note: One patient with dementia had unknown competency for testamentary capacity and therefore was excluded from this table.
Discussion The number of capacity assessments have increased since indicating the demand for capacity assessment is increasing. Examples include entering a financial contract, managing accommodation, paying bills, appointing an EPOA or writing a will. Establish the trigger — Discuss with the referrer and other relevant sources what events led to concerns about capacity and what the risks are as a result.
Capacity assessments are invasive; is there any other way to resolve the issue? Determine the likely timeline of the cognitive impairment Decide on the best time to perform the assessment. Conduct the assessment in a private location free from interruption. Step 2: Performing the assessment A translator or other aide to communication such as written information may be required. Try to engage the patient in the process, explain what is being done and why.
Part A: Assessing the ability to understand the situation and its consequences Discuss the relevant issue with the patient. Part C: Assessing the ability to reason and express a choice Ask the patient to discuss which option they prefer and how they reached that decision. Patients are legally considered competent until proven otherwise. Note that the legal test of competence differs depending on which part of capacity is being examined. This is described in sections 10, 25 2 b, 12, and 94 1 of the PPPR act They should be encouraged to appoint an EPOA if they have not done so already.
Advice can be given to the substitute decision maker for example whether placement in residential care is required etc. If patients lack capacity health professionals involved with assessing their capacity have a duty of care to manage any capacity deficits.
Competence Assessment in Dementia | SpringerLink
This may involve ensuring that any overlying delirium is managed, cognitive enhancers considered for dementia and vascular risk factors are optimally controlled. Heath professionals should also ensure that patients have community supports such as home help where needed.
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- Review of capacity assessments and recommendations for examining capacity?
Step 4: Documenting the assessment Capacity assessments should contain detailed descriptions of the assessment date, sources of information, medical and cognitive history, current living arrangements and care needs. Recommendations based on the result of the assessment should be given. Summary We performed a review of the capacity assessments assessments of patients informed decision making ability performed by the Community Geriatrics Department at Middlemore Hospital over a three and a half year period.
Method clinical letters were reviewed. Results There were 87 capacity assessments on 82 unique patients. Conclusion The CGS is performing more capacity assessments over time. References Appelbaum PS.
Competence Assessment in Dementia
Assessment of patients' competence to consent to treatment. N Engl J Med.
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Psychiatr Serv. Lai JM, Karlawish J. Assessing the capacity to make everyday decisions: a guide for clinicians and an agenda for future research. Am J Geriatr Psychiatry. Ten myths about decision-making capacity. J Am Med Dir Assoc. ISBN: Who can decide? Within the context of an aging population, a key question is how to best inform decisions regarding occupational competence, using cognitive competence as an indicator.
The Cognitive Competency Test CCT is a tool used to evaluate cognitive competence and inform judgments about occupational competence in individuals with dementia. This thesis incorporates two studies that identified cognitive components that predict occupational competence in individuals with dementia, and examined the construct validity of the CCT, using a framework developed by Samuel Messick.
A Delphi study, conducted amongst Canadian occupational therapists with experience in dementia care, generated a consensus regarding the components of cognitive competence essential to predict occupational competence in persons with dementia. A second study employed a retrospective chart review and examined the dimensional structure of the CCT and its relationship with other clinical measures typically used in dementia care.
Occupational therapists identified ten cognitive components essential to predict occupational competence in individuals with dementia. The structure of the CCT is a unitary factor that demonstrates correlations to some clinical measures commonly used in dementia care. University of Queensland Library. Open to the public ; RC University of Western Australia Library. C65 Book English Show 0 more libraries Open to the public Book English Monash Health.
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