Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients
Article first published online: 20 APR 2009
Copyright © 2009 John Wiley & Sons, Ltd.
International Journal of Geriatric Psychiatry
Volume 24, Issue 12, pages 1367–1375, December 2009
How to Cite
Maxmin, K., Cooper, C., Potter, L. and Livingston, G. (2009), Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients. Int. J. Geriat. Psychiatry, 24: 1367–1375. doi: 10.1002/gps.2272
- Issue published online: 13 NOV 2009
- Article first published online: 20 APR 2009
- Manuscript Accepted: 17 FEB 2009
- Manuscript Received: 11 NOV 2008
There is little information about older adult psychiatric inpatients' capacity to consent to clinical decisions. In younger adults, lack of capacity is associated with poor insight and psychosis rather than cognitive impairment. We assessed the prevalence and predictors of mental capacity to make treatment and admission decisions in older psychiatric inpatients, and asked their views about who should make these decisions.
We interviewed 99 participants using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in three geographical locations.
Fifty-two (52.5%) participants had capacity for admission and 38 (38.4%) for treatment decisions. Capacity was associated with not having dementia, and higher levels of insight and cognition. Those with depression were more likely to have capacity than those with psychosis. 75% of patients without capacity for admission were not detained legally.
Patients can have capacity to make decisions in one area but not in others. Many people are admitted and treated in a way that is contrary to the human rights legislation. The new Deprivation of Liberty Safeguards in England and Wales are likely to apply to a significant proportion of older inpatients. Most people wanted doctors to make treatment and admission decisions and very few wanted their family to make decisions on their behalf. Copyright © 2009 John Wiley & Sons, Ltd.