Decision‐making capacity assessment for confused patients in a regional hospital: A before and after study

Objective Clinicians are challenged to decide when and how to conduct decision‐making capacity assessment and guardianship applications for confused hospitalised older patients. This study aimed to understand the characteristics of confused hospitalised older patients who require decision‐making capacity assessment and guardianship applications and to determine the impact of a locally introduced capacity testing procedure on the conduct of decision‐making capacity assessment and guardianship application in a regional hospital setting. Design Before and after study. Setting Regional New South Wales hospital. Participants Twenty‐four confused hospitalised older patients who had decision‐making capacity assessment during November 2014‐April 2015 and November 2015‐April 2016. Main outcome measure The impact of a standardised capacity testing procedure on the conduct of decision‐making capacity assessment. Results After capacity testing procedure implementation, there were significant improvements in the number of multidisciplinary team meetings, documentation of decision‐making capacity assessment process and length of stay. The majority of patients who required guardianship application was aged over 70 years, had a medical history of dementia, >20 days of acute hospital admission and had no evidence of future care‐planning. Conclusion Implementation of capacity testing procedure is likely to have contributed to the positive changes in the conduct of decision‐making capacity assessment and guardianship application process for confused hospitalised older patients. This study provides some evidence of decision‐making capacity assessment process gaps; and indicates clinical and demographic characteristics of confused hospitalised older patients who might require decision‐making capacity assessment and guardianship applications. The evidence of lack of appropriate future care‐planning for ageing patients and increasing hospital admissions of confused hospitalised older patients presents future challenges in rural health.