Sometimes refusing to start chemotherapy is a rational decision, yet continuing to date someone is a flaw in decision making. It all depends on whether the person understands the potential outcomes of their decisions after weighing the pros and cons.
What is a Capacity Assessment?
I can’t fault someone in their 90’s who has multiple health problems and decides to forgo chemo that has a low chance of working. I do have serious concerns about someone who met someone online and has never met in person, and they are sending money to their ‘girlfriend’. What process can you use to see if someone is making decisions based on rational facts? A capacity assessment does just that.
A capacity assessment is an evaluation, done by a medical or mental health professional, to determine if a person can make a specific, informed decision for themselves. There are four criteria for a capacity assessment.
The Four Criteria of a Capacity Assessment
Understanding: The ability to verbalize and retain the facts of a choice and understanding the risks and benefits associated with that choice. A positive example, “I understand that this cancer will kill me but there is such a slight chance I will survive a very rough treatment. I choose to die in hospice with dignity.”
Appreciation: The ability to apply those facts to their own situation and accept their choice or lack of choice. A negative example, “Yes I know people are scammed by online love interests but Lorraine and I are different, even though we haven’t met.”
Reasoning: The ability to think through choices, compare risks and benefits and arrive at a decision. A positive example, “I can no longer live safely in my home. I know moving to a senior facility may drain my finances quicker but my quality of life will improve.”
Communication: The ability to clearly and consistently express one’s choice. A negative example,” I know I said I wouldn’t drive but I feel good this week.”
Who can do a capacity assessment?
Oftentimes a primary care doctor can either do an assessment or refer you to someone who can. That is a great place to start. Psychiatrists and psychologists can also do an assessment. Sometimes nurse practitioners and social workers can do a capacity assessment. If a decision is of a financial or legal nature, a banker, financial advisor or lawyer may need to be brough in to consult.
When to seek a capacity assessment
If someone is asked to make a major medical, financial or legal decision and they have signs of even mild dementia, a capacity assessment is a very good tool to see if the person is using reasonable thinking to make that decision. If someone is making decisions that seem out of character, such as someone who is very spendthrift, suddenly making major, discretionary purchases an assessment is warranted.
A Good Tool
While capacity assessment is a very useful tool, what you do with the information is key. Both family and the older adult need to agree to follow the recommendations of the findings. A therapist or social worker can help sort out options if there is more than one.