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Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients
Author(s) -
Maxmin Kate,
Cooper Claudia,
Potter Laurence,
Livingston Gill
Publication year - 2009
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.2272
Subject(s) - mental capacity , psychiatry , dementia , psychosis , competence (human resources) , hospital admission , cognition , informed consent , legislation , psychiatric hospital , psychology , depression (economics) , medicine , disease , law , social psychology , alternative medicine , pathology , political science , economics , macroeconomics
Objectives There is little information about older adult psychiatric inpatients' capacity to consent to clinical decisions. In younger adults, lack of capacity is associated with poor insight and psychosis rather than cognitive impairment. We assessed the prevalence and predictors of mental capacity to make treatment and admission decisions in older psychiatric inpatients, and asked their views about who should make these decisions. Methods We interviewed 99 participants using the MacArthur Competence Assessment Tool for Treatment (MacCAT‐T) in three geographical locations. Results Fifty‐two (52.5%) participants had capacity for admission and 38 (38.4%) for treatment decisions. Capacity was associated with not having dementia, and higher levels of insight and cognition. Those with depression were more likely to have capacity than those with psychosis. 75% of patients without capacity for admission were not detained legally. Conclusions Patients can have capacity to make decisions in one area but not in others. Many people are admitted and treated in a way that is contrary to the human rights legislation. The new Deprivation of Liberty Safeguards in England and Wales are likely to apply to a significant proportion of older inpatients. Most people wanted doctors to make treatment and admission decisions and very few wanted their family to make decisions on their behalf. Copyright © 2009 John Wiley & Sons, Ltd.