Decision-Making Capacity in the Elderly Population

As the elderly population ages, the ability to make informed decisions is a key area of concern. When an elderly individual is vulnerable, lonely, frail, or dementing, does that put these individuals in potential danger? These factors may cause individuals to make decisions that go against their core values or level of understanding – increasing their risk of being scammed or making a choice that threatens their health.

No matter which way you slice it – age can dramatically affects one’s decision-making skills. Cognitive functioning is reduced with age, affecting memory, attention, judgment, problem solving, and decision-making. As working memory declines, elderly individuals are not able to grasp and hold as much data as they once did.

Too much information can be overwhelming – essentially affecting decision-making. Elderly individuals are prone to make a decision based on what they recognize and know, instead of what is best. In some cases, information just needs to be presented to seniors in a way that allows them to make better decisions.

In other cases, individuals do not display decision-making abilities that would protect their health and their livelihood. Whether this is due to illnesses or medication, at what point does one’s ability to make decisions mean that they’re no longer competent? How do you measure ‘competent’ decision-making?

There are many areas which may be affected if an individual no longer has the decision-making capacity to ensure their safety and overall well-being. From critical health decisions to financial management, a diminished capacity to make informed decisions could be detrimental.

When it comes to treatment, capacity to consent is another area that is of major concern to physicians, patients, and the Health Care Consent Act. In Ontario, there are legislations that require informed consent before treatment is administered. Of course, there are exceptions within certain emergency situations, however, this is the only exception. When faced with a condition such as dementia, at some point, one’s ability to make decisions will be significantly hindered.

This is important, especially in terms of prescribed medications, such as powerful antipsychotics, as well as upcoming concerns regarding euthanasia in Canada. Under the Health Care Consent Act, individuals who are capable of consenting to treatment must understand the information presented to them and appreciate the possible consequences of that decision.

No one wants to make important decisions for a loved one, but if someone in your family has been diagnosed with dementia or is continually making more decisions due to cognitive decline – discussing arrangements is critical. A Power of Attorney for Personal Care, for instance, can be appointed and should be someone who holds a genuine concern regarding the individual’s welfare.

How do you reach this point? How is one’s decision-making capacity assessed? Whether a decision needs to be made regarding treatment or the admission into a long-term care facility, ask yourself some of the following questions.

  • Does the individual understand the possible outcomes if treatment is not administered?
  • Can the individual explain how treatment or care would potentially improve their condition?
  • Does the individual possess realistic expectations about the situation? Do they still connect and understand their own personal reality? For example, someone may refuse a blood transfusion due to their religion. Even if their loved ones do not agree, the individual would still be considered capable of decision-making, because they understand the reality of their current situation.
  • Has the individual reflected a reduced ability to make decisions and communicate within regular day-to-day situations?
  • Has the individual suffered from a condition or event that would impair their ability to reason and communicate? Do they suffer from a mental health condition? Have they been diagnosed with dementia? Have they suffered from stroke-induced brain damage?

Unfortunately, sometimes situations are not strictly black and white. A person’s consent can change and sometimes, individuals some they’re competent to make certain decisions, but lack the ability to make others. Perhaps someone understands and is able to make decisions regarding their day-to-day treatment, but lacks the understanding regarding potential long-term outcomes.

If your loved one is showing signs of a diminished decision-making capacity, it’s important to discuss your options as early as possible. Some prefer to make a living will while they’re still competent – helping their loved ones make decisions that respect the individual’s wishes.

For legal information and related advice, please visit the Consent and Capacity Board or the Health Care Consent Act.

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