GERIATRICS

Capacity and Competence 


Context: Capacity concerns in setting of cognitive impairment / dementia / delirium / family or EPOA involvement

Key Principle

Decision-making capacity is the person’s ability to make a specific decision at a specific time.

Capacity is:

PrincipleMeaning
Decision-specificA person may have capacity for one decision but not another
Time-specificCapacity may fluctuate, especially with delirium, infection, pain, hypoxia or medications
FunctionalBased on the patient’s actual ability to understand and reason
DynamicCan improve or deteriorate
Not diagnosis-basedDementia, mental illness or disability does not automatically mean incapacity
Not score-basedMMSE/MoCA/GPCOG scores support but do not determine capacity

Adults are presumed to have capacity unless there is evidence to the contrary.

In Queensland, relevant legislation includes the Guardianship and Administration Act 2000 (Qld) and the Powers of Attorney Act 1998 (Qld).


Capacity vs Competence

TermMeaning
CapacityClinical assessment of ability to make a decision
CompetenceLegal determination, usually made by a court

In practice, clinicians often use the term capacity. Courts determine legal competence.


Core Elements of Capacity

The patient must be able to:

DomainClinical test
UnderstandUnderstand relevant information about the decision
RetainRetain the information long enough to make the decision
Use or weighConsider risks, benefits, alternatives and consequences
CommunicateCommunicate a clear and reasonably consistent choice

A patient can make a decision that others consider unwise and still have capacity, provided the above elements are met.


Practical Capacity Assessment Structure

1. Define the decision being assessed

Document the exact decision, for example:

Decision typeExample
Medical treatmentConsent to surgery, refusal of hospital admission
AccommodationStaying at home vs RACF placement
Financial/legalManaging finances, changing EPOA, making a will
SafetyDriving, accepting home supports
HealthcareMedication changes, investigations, advance care planning

Capacity should not be assessed globally unless the question itself is global.


2. Optimise conditions before assessment

Before assessing capacity, address reversible factors:

FactorAction
PainTreat pain first
HypoxiaCheck oxygen saturations and treat
HypoglycaemiaCheck BGL if clinically indicated
DeliriumScreen and treat underlying cause
Infection/metabolic disturbanceInvestigate and manage
Hearing/vision impairmentEnsure hearing aids, glasses
Language barrierUse accredited interpreter
Distress/distractionProvide calm, private environment
Medication effectsReview sedatives, opioids, anticholinergics, alcohol/substances

This is important because capacity may improve once reversible contributors are corrected.


3. Assess the four capacity domains

Suggested questions:

DomainExample questions
Understanding“Can you tell me in your own words what the problem is?”
“What treatment or option has been recommended?”
Retention“Can you tell me again what the options are?”
Weighing/reasoning“What do you think could happen if you accept this option?”
“What do you think could happen if you decline?”
Alternatives“Are there any other options you have considered?”
Communication“What would you like to do?”
Consistency“Is that still your decision after we have discussed the risks?”

Role of Cognitive Testing

Cognitive screening may support assessment but does not replace clinical capacity assessment.

ToolRole
MMSEGeneral cognitive screening; less sensitive for executive dysfunction
MoCAMore sensitive for mild cognitive impairment and executive dysfunction
GPCOGUseful Australian GP cognitive screening tool
RUDASUseful for culturally and linguistically diverse patients
KICAValidated for older Aboriginal and Torres Strait Islander people
CAMDelirium screening

Important documentation point: Cognitive score alone does not determine capacity. Low MMSE does not automatically mean incapacity, and normal cognition does not always guarantee capacity for complex decisions.


Dementia and Capacity

Dementia does not automatically remove capacity.

Patients with mild dementia may still have capacity for:

Possible retained capacity
Routine healthcare decisions
Simple medication decisions
Consent to basic investigations
Accommodation preferences
Some financial decisions

Capacity may be impaired in more advanced dementia due to:

Impairment
Poor insight
Executive dysfunction
Impaired judgement
Reduced ability to weigh risk
Fluctuating cognition
Communication impairment

Delirium and Capacity

Delirium commonly impairs capacity because of impaired attention, fluctuating cognition and disturbed reasoning.

If delirium is suspected:

Action
Treat as medical emergency
Identify cause: infection, metabolic disturbance, hypoxia, medications, pain, constipation, urinary retention
Delay non-urgent capacity decisions if possible
Reassess once delirium improves
Use substitute decision-maker only if the patient lacks capacity for the relevant matter

Mental Illness and Capacity

Mental illness does not automatically equal incapacity.

A patient with depression, psychosis, bipolar disorder or anxiety may still have capacity if they can understand, retain, weigh information and communicate a decision.

Capacity may be impaired if symptoms directly affect the decision, for example:

Example
Delusional beliefs driving refusal of lifesaving treatment
Severe depression causing nihilistic reasoning
Mania causing grossly impaired judgement
Psychosis preventing understanding of reality-based information

Enduring Power of Attorney — QLD Context

In Queensland, an Enduring Power of Attorney (EPOA) generally becomes active for relevant matters when the person loses capacity for that matter.

Important points:

Principle
Memory impairment alone does not activate EPOA
Dementia diagnosis alone does not activate EPOA
If the patient has capacity, the patient remains the decision-maker
EPOA involvement should match the specific area of incapacity
The patient should still be involved as much as possible

Substitute Decision-Making Hierarchy — Queensland

If the patient lacks capacity for a health matter, consider:

OrderSubstitute decision-maker
1Advance Health Directive, if valid and applicable
2Enduring Power of Attorney for health/personal matters
3Statutory Health Attorney

A statutory health attorney is usually a spouse/de facto partner, unpaid carer, close friend or relative, depending on circumstances.


Can a GP Assess Capacity?

Yes. GPs can assess capacity for many routine clinical decisions, including:

GP capacity assessment examples
Consent to treatment
Refusal of hospital admission
Medication decisions
Acceptance of home supports
RACF placement discussions
Driving concerns
Advance care planning discussions

However, more complex, disputed or high-risk matters may require specialist assessment.


When to Involve a Specialist or MDT

Consider referral to geriatrics, old age psychiatry, neurology, neuropsychology, occupational therapy or social work when there is:

SituationReason
Diagnostic uncertaintyDementia subtype unclear
Fluctuating cognitionDelirium vs dementia unclear
Rapid cognitive declineNeurology/geriatrics input
Young-onset cognitive impairmentSpecialist workup required
Severe BPSDOld age psychiatry/geriatrics
Family conflictMedico-legal risk
Suspected elder abuseSafeguarding concern
Complex financial/legal decisionHigher threshold
Changing EPOA or willLegal/testamentary capacity issue
Driving safety concernOT driving assessment may be required
High premorbid function with subtle declineNeuropsychology may clarify deficits

Role of Neuropsychology

Neuropsychological assessment is useful when the capacity question is complex or cognition is subtle.

IndicationPurpose
Mild cognitive impairmentMore sensitive testing
High premorbid functioningDetect subtle decline
Diagnostic uncertaintyClarify cognitive pattern
Legal disputeObjective assessment
Testamentary capacityDetailed cognitive evaluation
Financial capacity disputeExecutive function assessment
Return-to-work concernFunctional cognition assessment

Documentation Template

Capacity assessment note

Decision assessed:
Capacity to make decision regarding: [specific decision].

Clinical context:
Patient assessed in context of [dementia/delirium/family concern/refusal of treatment/accommodation decision].

Optimisation of assessment:
Assessment performed in a calm environment. Pain/distress addressed. Hearing/vision aids used as required. Interpreter used/not required. No evidence of acute delirium/intoxication/hypoxia at time of assessment, or reversible factors considered.

Information provided:
Discussed diagnosis/current concerns, proposed options, benefits, risks, alternatives and consequences of declining recommended care.

Patient response:

DomainFindings
UnderstandingPatient was able/unable to explain the relevant information in their own words
RetentionPatient was able/unable to retain the information during the consultation
Weighing/reasoningPatient was able/unable to weigh risks, benefits and alternatives
CommunicationPatient was able/unable to communicate a clear and consistent decision

Cognitive screening:
[MMSE/MoCA/GPCOG/RUDAS/CAM] performed/not performed. Result: [score]. Result considered supportive only and not determinative of capacity.

Conclusion:
On assessment today, the patient does / does not demonstrate capacity to make the specific decision regarding [decision].
Capacity assessment is decision-specific and time-specific.

Plan:

  • Patient remains primary decision-maker if capacity present.
  • If capacity lacking, involve substitute decision-maker according to Queensland hierarchy.
  • Treat reversible contributors if present.
  • Consider MDT/specialist input if complex, disputed or high-risk.
  • Reassess capacity if clinical condition changes.

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