Outcomes of a Decision-Making Capacity Assessment Model at the Grey Nuns Community Hospital

Lesley Charles, Utkarsha Kothavade, Suzette Brémault-Phillips, Karenn Chan, Bonnie Dobbs, Peter George Jaminal Tian, Sharna Polard and Jasneet Parmar
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Lesley Charles: Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
Utkarsha Kothavade: Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
Suzette Brémault-Phillips: Department of Occupational Therapy, University of Alberta, Edmonton, AB T6G 2G4, Canada
Karenn Chan: Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
Bonnie Dobbs: Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
Peter George Jaminal Tian: Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada
Sharna Polard: Library Services, Covenant Health, Edmonton, AB T6L 5X8, Canada
Jasneet Parmar: Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada

IJERPH, 2022, vol. 19, issue 3, 1-10

Abstract: BACKGROUND. With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we implemented a DMCA Model that includes a care pathway, worksheets, education, and mentoring. The objective of this study was to assess the impact of the utilization of this patient-centered DMCA model on the need for Capacity Interviews. METHODS. This was a retrospective quality assurance chart review of patients referred for DMCA to the Geriatric Service at the Grey Nuns Community Hospital from 2006–2020. The Geriatric Service is run by Family Physicians with extra training in Care of the Elderly. We extracted patient demographics, elements of the DMCA process, and whether Capacity Interviews were performed. We used descriptive statistics to summarize the data. RESULTS. Eighty-eight patients were referred for DMCAs, with a mean age of 76 years (SD = 10.5). Dementia affected 43.2% (38/88) of patients. Valid reasons for conducting a DMCA were evident in 93% (80/86) of referrals, and DMCAs were performed in 72.6% (61/84). 85.3% (58/68) of referrals identified the need for DMCA in two to four domains, most commonly accommodation, healthcare, and finances. Two to three disciplines, frequently social workers and occupational therapists, were involved in conducting the DMCAs for 67.2% (39/58) of patients. The Capacity Assessment Process Worksheet was used 63.2% of the time. Capacity Interviews were conducted in only 20.7% of referrals. Following the DMCAs, 48.2% (41/85) of those assessed were deemed to lack capacity. CONCLUSION. This study suggests that the DMCA Model implemented has decreased the need for Capacity Interviews while simultaneously respecting patient autonomy. This is an important finding as DMCAs carried out following this process reduced the need for both a Capacity Interview and declarations of incapacity while simultaneously respecting patient autonomy and supporting patients in their decisions in accordance with the legislation.

Keywords: decision-making capacity assessment; care of the elderly; geriatrics (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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