Evaluating the caregiver's intervention in the elder's task performance: capacity versus actual behavior

As an elder's functional impairment increases, so in general does the tendency for the caregiver to intervene in the elder's daily activities and initiatives. To a certain extent, such intervention is necessary to compensate for the elder's loss of independent ability, and without such intervention, adverse outcomes for the elder are a possibility. The need for some intervention is usually clear-cut for advanced dementia, given its associated severe disability and handicap, but less clear in elders who are just beginning to show signs of cognitive decline. This study used the paradigm of medication management to look at whether the discrepancy between capacity for self-medication administration and actual self-administration behavior as demonstrated by the Medication Management Test (MMT) is greater for elders with poorer cognitive functioning. A sample of 51 cognitively impaired elders and 74 cognitively normal elders was used to look at the relationship between predicted capacity and actual self-administration of medication, stratifying by level of cognitive status. The highly significant concordance between the MMT score and caregivers' report of medication administration supports the expectation that capacity is influenced by cognitive status. In those discordant cases, further information is needed to interpret help in medication administration as excessive or insufficient intervention.