Your elderly mother was just discharged from the hospital and needs a bevy of home care services if she’s not to bounce back like a bad check: visiting nurses, physical therapists, delivery of assistive equipment like a shower chair to make bathing safe. Yet the day after discharge, she curtly tells each of these well-meaning visitors to “get lost” when they knock on the door. When you politely remind her how much she hated being in the hospital and that these folks would likely prevent her from being readmitted, she tells you she understands but, “I just don’t like having strangers in my house and I’m willing to take that risk.” So what’s going on here?
On the one hand, Mom could have all her marbles and be making a decision consistent with the way she lived her life: as a rugged individualist who makes her own decisions and is willing to live with the consequences. She has capacity. It is also possible that because of any number of factors — new medications, leftover confusion from the hospital, early dementia — that she is incapacitated.
My good friend Dr. Jason Karlawish is a pioneer in a field he calls neuroethics. He’s a geriatrician at the University of Pennsylvania who works closely with neurologists who care for and study patients with various degrees of memory loss and dementias like Alzheimer’s Disease. Last month, he gave a stunning presentation for attendees of the NYC Elder Abuse Confernce at the New School in New York City about the assessment of decision-making capacity of older adults with and without these disorders.
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Addressing Capacity Assessment