Does this patient have medical decision-making capacity?

Area of Science:

• Geriatric Medicine
• Medical Ethics
• Clinical Psychology

Background:

• Evaluating a patient's capacity to make medical decisions is crucial, especially when incapacity is suspected.
• Assessments should be specific to the medical decisions at hand.

Observation:

• Incapacity was found in 2.8% of healthy elderly controls versus 26% of medicine inpatients.
• Clinicians correctly identified incapacity in only 42% of affected patients, despite accurate diagnosis when made.
• The Mini-Mental State Examination (MMSE) showed utility only at extreme scores (<20 or >24).

Findings:

• The Aid to Capacity Evaluation (ACE) demonstrated strong diagnostic accuracy (LR+ 8.5) and is easily performed.
• The Hopkins Competency Assessment Test (LR+ 54) and Understanding Treatment Disclosure (LR+ 6.0) also showed utility.
• The ACE is freely available online with a training module, making it a practical tool.

Implications:

• Incapacity is prevalent in medical inpatients and frequently overlooked.
• Physicians need reliable instruments to aid in assessing decision-making capacity.
• The ACE is the most suitable instrument for assisting physicians in capacity assessments.