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How do we determine if someone who has Dementia is competent to make decisions for him or herself?

April 7th, 2014

I saw this news clip about a couple living in Vancouver.  According to the excerpt, they went to the hospital to find a family physician and they were held (against their will), diagnosed with Dementia, and deemed unable to make decisions for themselves.  It is quite disturbing when you watch the clip.  As a capacity assessor, I know that determining someone’s ability to make decisions for themselves is not simple.  I would like to give the hospital the benefit of the doubt that they took all the necessary steps to evaluate fully the couple’s capacity before detaining them against their wishes.

It is not an easy task to determine capacity.  As a social worker, I use a combination of standardized measures and a thorough interview.  I also consult with family or other interested parties and review medical records available to me.  Paramount to evaluating capacity is determining if a person understands and appreciates an event, situation, document, medical treatment, etc.   Each situation must be evaluated independently and capacity should be established based on a specific question.  For example, does this person have the capacity to refuse a medical procedure?  Does he have capacity to live autonomously at home?  Does she have the capacity to sign a deed of sale?  In addition, capacity can vary based on many factors, such as the illness, medication interactions, acute infections, time of day, etc.  It is important the capacity assessor considers these factors with each assessment.

One thing that I have learned over the years is that we must delve into “layers” in our interview.  It is not enough to ask somebody how they organize their groceries and meals.  Their response might be reasonable and clear.  Yet, when I look in their refrigerator (with their consent) and find expired food and multiples of the same items a different picture is painted.  I can show them the food package, ask them to find the expiration date and then have them explain what the process is to protect one’s health based on labels.  This “layer” of questioning often illustrates that a person is not capable to manage this activity even though their initial response seemed appropriate.

Another example I can share stems from an interview I conducted with a gentleman who had Alzheimer’s disease.  Upon first glance (and first conversation) he seemed cognitively intact.  He knew he had diabetes.  He knew how to monitor and track his glucose levels, but when asked what he does with a reading of “30”, he stated he “writes it in his log” and does nothing else.  This man was able to continue with a routine that he had followed for the previous thirty years without problem.  However, he had poor judgment in evaluating what “number” identifies a risk to his well-being.  He also lacked organization to formulate an appropriate intervention.

I hope that the hospital in the above mentioned clip did their due diligence in evaluating capacity.  Seniors are vulnerable and those who need protection should be given it.  Those who remain competent should be supported in making their own decisions, even if they are risky.  We all have the right to self-determination as long as we understand the risks and benefits to that situation.

Here is the clip to which I am referring: http://news.ca.msn.com/canada/video/?videoid=cbcc2014-0304-2053-0018-244642165900

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