How would you make a determination of someone else's mental capacity?
Asked by
Cupcake (
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October 12th, 2010
Lets say you have an elderly family member. We’ll call her Grandma.
Grandma has a multitude of medical issues (heart failure, diabetes, thyroid dysfunction, kidney failure, etc.). She tries to play pharmacist and alters her medication regimen without medical advice. She sleeps ~20 hours a day and doesn’t even wake up to take vital medication.
Let’s say you have another family member… an uncle. Uncle convinces Grandma that they should take a vacation to Florida. Grandma agrees.
Given her fragile health state, poor decisions, excessive need for sleep and her physical reliance on others for daily activities (bathing, dressing, cooking, etc.) it does not appear to the rest of the family that this is a good decision (the last time she went to FL, an aunt had to fly down and fly her back home and nurse her back to health).
My perspective (you were going to ask, right?) is that (a) she doesn’t care about living and, what the heck, might as well go to Florida one more time or (b) she lacks mental capacity to understand the consequences of her actions, perhaps even lacks the capacity to understand her medical advice.
Feel free to comment on this scenario if you wish, but my real questions are:
– How would you determine if someone has mental capacity?
– What variables (I’m a stats person) would you use to calculate capacity?
– Does personal choice trump questionable capacity?
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12 Answers
Can you accompany her to a doctor’s appointment and discuss her status and a potential trip with her doctor?
@syz No, not personally. We are a bit estranged. Personally, I feel that she should be able to go… even if it “kills” her, so to speak.
The generation above me (other than the uncle) is very upset and feels she is being manipulated and used for a “free” vacation. They have met with the doctor in the past and feel that he will go along with Grandma… if she thinks she can handle it, he’ll support her.
Her next appointment is scheduled for the day of her departure.
Well, I’d research “capacity” first. I’m sure there are plenty of tests out there. Usually I think they use the ADLs and IADLs as a sign of capacity to serve self and perhaps think through what they need.
If they have a certain number of troubles with these, then they need assistance. They can be incompacitated somewhat or completely. Here’s an instrument to assess patients.
Interesting @nikipedia and @wundayatta.
According to the IADL instrument @wundayatta, she gets a 1 for using the telephone. That’s it. But I think she would be able to do most of the things in the mini-mental status exam. It would be interesting to do with her, though.
One of the big concerns of my aunts is her using the toilet by herself while traveling.
I’d have a gut reaction about it and trust it – it’s never failed me yet. Until she is declared mentally incapacitated, you can’t prevent her from taking this trip. And you know..it’s just Florida, not Africa.
Of course @Simone_De_Beauvoir. To some extent, I think my family thrives on drama and wants to make a big deal out of everything. No one will prevent her from traveling, they’ll just gossip about it.
I couldn’t care less about the gossip… but it did lead me to wonder how to differentiate between being physically sick + making poor medical decisions and mental capacity.
@Cupcake It’s a very hard thing to differentiate. The ‘standards’ we have in place are always changing and the borders are always hazy.
It’s Uncle’s mental capacity I’d be wondering about, if he asked her this, knowing all of what you said about her.
Usually a professional would be the reliable person to say if someone is “self directing” or not.
Does the ‘uncle’ who has offered to take her on this trip understand her current health problems and lifestyle? Is he capable of handling it and any medical emergency that comes up during the trip? If so, let it go and support the ‘grandmother’.
I may wrong, but it seems you are asking about the integrity of your grandmother’s INSIGHT and JUDGEMENT, not her capacity. Strictly speaking, when professionals do capacity evaluations, it’s in regards to a particular treatment in the hospital. For example, when a post-surgical patient is delirious and demanding to walk, I have to determine if he understands the consequences, etc. If he does not, I can deem him not to have capacity and give him a low, low dose of an antipsychotic or have him tied to the bed. This does not seem to be your grandmother’s case.
Every state has a different standard for power of attorney for medical, financial, and physical decisions. I don’t know the situation in your state. In California if we are worried that someone may not be competent to make decisions, we will try to place this person in a conservatorship where either a family member will make decisions for the patient, or a public official from the conservators office. We use this method if someone is permanently incapacitated for medical reasons (for example, dementia).
Another question is if your grandmother is psychiatrically ill. If so, her judgement may be impaired and her psychiatrist can place her on a hold depending on your state’s laws. In California, the state is very restrictive on holds and they can only be placed in cases of acute danger to self, danger to others, or grave disability. You cannot place psych holds for non-psych diagnoses.
Regardless of a formal evaluation, I am sure that a tough family meeting that includes everyone could abort this trip, even if feathers get ruffled.
Hope this helps.
@nikipedia
the mini-mental would not be a good test. It is a screening tool for possible dementia. It is not a diagnostic tool. If the person is positive (less than 24–27 out of 30, depending on age), then you have to follow up with a formal neuropsychological evaluation. Also, the mini-mental test only picks up Alzheimer’s and vascular dementia. It is not a good screening tool for frontal dementias or demential with lewy bodies.
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