[Cognitive impairments and decision-making abilities in elderly and senile patients.]

Medical and legal professionals face the challenge of assessing capacity and ability to make medical, legal and financial decisions in dementia patients who have a disrupted decision-making process. While such assessments have traditionally focused on the capacity for complex reasoning and executive functions, research in decision-making has shown that motivational and metacognitive processes are also important. With the number of dementia patients expected to rise in the next few decades, there needs to be an understanding of how dementia patients are disrupting decision-making. Physicians who treat older adults need to know which health care decision-making tasks are the most challenging for such patients to maximize decision-making when possible. For people with dementia, clearer criteria for determining medical and legal capacity are needed. Different levels of impairment of decision-making ability are not linear. There needs to be a balance of support and empowerment, and a balance of raising awareness and opportunity for harm. In patients at risk of developing disability, decision-makers who are in the best interests of the patient should be identified beforehand.