Forensic psychiatric evaluation of legal capacity in older adults: Clinical and cognitive correlates

Forensic psychiatric evaluation of capacity is commonly requested in clinical practice, particularly in relation to financial decision-making and power of attorney. However, empirical data describing real-world assessment processes and associated clinical factors remain limited. This study examined patients referred for forensic psychiatric evaluation of capacity in a specialized outpatient setting and explored the relationship between routinely administered cognitive screening measures and clinical determinations. A retrospective analysis was conducted on 1247 individuals aged 60-98 years who underwent evaluation between 2020 and 2026. Sociodemographic characteristics, clinical assessments, and results of cognitive screening tools-including the Standardized Mini-Mental State Examination (MMSE), Verbal Fluency Test, and Clock Drawing Test-were analyzed in relation to clinical capacity determinations. Most individuals (90.9%) were assessed as possessing capacity, while 9.1% were considered to lack capacity and were recommended for guardianship. Individuals lacking capacity were older, had fewer years of education, and demonstrated lower performance across all cognitive measures. In multivariable analyses, MMSE and verbal fluency scores were associated with clinical determinations of capacity, whereas demographic variables were not independently associated. ROC analyses showed that MMSE had the highest discriminatory performance among individual measures. Cognitive screening results were interpreted as supportive information within a comprehensive forensic evaluation rather than as standalone determinants of legal capacity. These findings reflect routine clinical practice and highlight the importance of integrating cognitive, clinical, and contextual factors in forensic capacity assessments.