MEDICAL DECISION MAKING ABILITIES IN DEMENTIA
Principal Investigator: JENNIFER A MOYE
Abstract: DESCRIPTION (Applicant's abstract): Three recent developments have created a critical need and an opportunity to better understand medical decision making abilities in cognitively impaired elderly adults. First, the Patient Self-Determination Act has mandated patient participation in medical decisions. Second, the legal system has shifted the basis for determining competency to participate in medical decisions, now emphasizing specific decision-making capacities rather than general mental conditions. Third, new forensic assessment instruments have been released which aim to assess these decisional capacities. Yet legal standards are not scientifically grounded and instruments to measure these require additional validation. These developments have occurred in the context of a large and growing number of adults surviving into old age during which time they are at increasing risk for dementia and compromised decision-making capacities. The proposed research aims to provide an empirical basis for evaluating competency consent through investigation of four questions: 1) What is the construct validity of the four decisional capacities recognized in the law? 2) How do these decisional capacities relate to cognitive abilities? 3) Which of these decisional capacities are impaired in early dementia and to what extent? 4) What is the progression of decisional impairments over time? Results of the proposed research have potential implications in scientific, clinical, and legal settings. The results will link legal standards for competency to cognitive abilities, providing a more scientifically grounded model of decisional making in the context of competency; enhance the reliability and validity of assessments of patients' capacities to participate in medical decisions; and suggest ways in which clinical policy and legal standards could be changed to be more consistent with clinical science.
Funding Period: 1998-09-15 - 2004-06-30
more information: NIH RePORT
- Cognitive performance predicts treatment decisional abilities in mild to moderate dementiaR J Gurrera
Department of Psychiatry, Harvard Medical School, VA Boston Healthcare System, Boston, MA, USA
Neurology 66:1367-72. 2006..To examine the contribution of neuropsychological test performance to treatment decision-making capacity in community volunteers with mild to moderate dementia...
- Three methods of assessing values for advance care planning: comparing persons with and without dementiaMichele J Karel
Veterans Affairs Medical Center, 940 Belmont Street, Brockton, MA 02301, USA
J Aging Health 19:123-51. 2007..Although values assessment methods show promise, further item and scale development work is needed. Older adults with dementia should be included in clarifying values for advance care planning to the extent that they desire and are able...
- Agreement between instruments for rating treatment decisional capacityRonald J Gurrera
Mental Health Service, VA Boston Healthcare System, Harvard Medical School Department of Psychiatry, Boston, MA, USA
Am J Geriatr Psychiatry 15:168-73. 2007..The objective of this study was to measure agreement between three treatment decisional capacity assessment instruments in mild to moderate dementia...