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Capacity issues and decision-making in dementia

Capacity to make one's own decisions is fundamental to the autonomy of the individual. Capacity is a functional assessment made by a clinician to determine if a patient is capable of making a specific decision. Competency is a global assessment and legal determination made by a judge in court....

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Autores principales: Hegde, Soumya, Ellajosyula, Ratnavalli
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109759/
https://www.ncbi.nlm.nih.gov/pubmed/27891023
http://dx.doi.org/10.4103/0972-2327.192890
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author Hegde, Soumya
Ellajosyula, Ratnavalli
author_facet Hegde, Soumya
Ellajosyula, Ratnavalli
author_sort Hegde, Soumya
collection PubMed
description Capacity to make one's own decisions is fundamental to the autonomy of the individual. Capacity is a functional assessment made by a clinician to determine if a patient is capable of making a specific decision. Competency is a global assessment and legal determination made by a judge in court. Capacity evaluation for a patient with dementia is used to determine whether the patient is capable of giving informed consent, participate in research, manage their finances, live independently, make a will, and have ability to drive. Patients with dementia cannot be assumed to have impaired capacity. Even a patient with moderate or severe dementia, with obviously impaired capacity may still be able to indicate a choice and show some understanding. Four key components of decision-making in a capacity evaluation include understanding, communicating a choice, appreciation, and reasoning. Assessment of capacity requires a direct interview with the patient using open-ended questions and may include both informal and formal approaches depending on the situation and the context. A baseline cognitive evaluation with a simple test to assess executive function is often useful in capacity evaluation. All capacity evaluations are situation specific, relating to the particular decision under consideration, and are not global in scope. The clinician needs to spend adequate time with the patient and the family allaying their anxieties and also consider the sociocultural context. The area of capacity has considerable overlap with law and the clinician treating patients with dementia should understand the complexities of assessment and the implications of impaired capacity. It is also essential that the clinician be well informed and keep meticulous records. It is crucial to strike a balance between respecting the patient autonomy and acting in his/her best interest.
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spelling pubmed-51097592016-11-25 Capacity issues and decision-making in dementia Hegde, Soumya Ellajosyula, Ratnavalli Ann Indian Acad Neurol Review Article Capacity to make one's own decisions is fundamental to the autonomy of the individual. Capacity is a functional assessment made by a clinician to determine if a patient is capable of making a specific decision. Competency is a global assessment and legal determination made by a judge in court. Capacity evaluation for a patient with dementia is used to determine whether the patient is capable of giving informed consent, participate in research, manage their finances, live independently, make a will, and have ability to drive. Patients with dementia cannot be assumed to have impaired capacity. Even a patient with moderate or severe dementia, with obviously impaired capacity may still be able to indicate a choice and show some understanding. Four key components of decision-making in a capacity evaluation include understanding, communicating a choice, appreciation, and reasoning. Assessment of capacity requires a direct interview with the patient using open-ended questions and may include both informal and formal approaches depending on the situation and the context. A baseline cognitive evaluation with a simple test to assess executive function is often useful in capacity evaluation. All capacity evaluations are situation specific, relating to the particular decision under consideration, and are not global in scope. The clinician needs to spend adequate time with the patient and the family allaying their anxieties and also consider the sociocultural context. The area of capacity has considerable overlap with law and the clinician treating patients with dementia should understand the complexities of assessment and the implications of impaired capacity. It is also essential that the clinician be well informed and keep meticulous records. It is crucial to strike a balance between respecting the patient autonomy and acting in his/her best interest. Medknow Publications & Media Pvt Ltd 2016-10 /pmc/articles/PMC5109759/ /pubmed/27891023 http://dx.doi.org/10.4103/0972-2327.192890 Text en Copyright: © Annals of Indian Academy of Neurology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Review Article
Hegde, Soumya
Ellajosyula, Ratnavalli
Capacity issues and decision-making in dementia
title Capacity issues and decision-making in dementia
title_full Capacity issues and decision-making in dementia
title_fullStr Capacity issues and decision-making in dementia
title_full_unstemmed Capacity issues and decision-making in dementia
title_short Capacity issues and decision-making in dementia
title_sort capacity issues and decision-making in dementia
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109759/
https://www.ncbi.nlm.nih.gov/pubmed/27891023
http://dx.doi.org/10.4103/0972-2327.192890
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