Capacity to consent to treatment: Empirical comparison of three instruments in older adults with and without dementia
Capacity to consent to treatment: Empirical comparison of three instruments in older adults with and without dementia
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DOI：
10.1093/geront/44.2.166
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发表时间：
2004-04-01
期刊：
影响因子：
5.7
通讯作者：
Gurrera, RJ
中科院分区：
文献类型：
--
作者：
Moye, J;Karel, MJ;Gurrera, RJ
目的：这项研究的目的是比较患有痴呆症和非痴呆症的成年人同意治疗的能力，用三种工具进行评估。设计和方法：采用三种能力量表对88例轻、中度痴呆老年患者和88例匹配对照的4项法律同意就医能力指标进行比较。结果：痴呆症患者对治疗信息理解的法定标准的平均成绩低于对所有工具的对照，对一种工具的评价标准和对两种工具的推理标准也受到损害。然而，在分类评级中，大多数痴呆症成年人在所有决策能力上都在正常范围内。法律标准在三个文书中的执行情况有所不同，以提高认识和推理能力。影响：大多数患有轻度痴呆症的成年人可以参与法律标准定义的医疗决策，尽管记忆障碍可能会限制对诊断和治疗信息的理解。在痴呆症中，对治疗方案的推理评估应侧重于一个人是否能描述特定选择的显著原因，而对诊断和治疗信息含义的欣赏评估应侧重于一个人是否能描述各种选择对未来状态的影响。需要进行更多的研究，以确定评估工具和能力结构的可靠性和有效性。
Purpose: The purpose of this study was to compare adults with and without dementia on capacities to consent to treatment as assessed by three instruments. Design and Methods: Eighty-eight older adults with mild to moderate dementia were compared with 88 matched controls on four indices of legal competency to consent to medical treatment as assessed with three capacity instruments. Results: Mean performance of adults with dementia on a legal standard of understanding treatment information was impaired relative to controls on all instruments, and it was also impaired for an appreciation standard on one instrument and a reasoning standard on two instruments. However, in categorical ratings, most adults with dementia were within the normal range on all decisional capacities. Legal standards were operationalized differently across the three instruments for the capacities of appreciation and reasoning. Implications: Most adults with mild dementia can participate in medical decision making as defined by legal standards, although memory impairments may limit demonstration of understanding of diagnostic and treatment information. In dementia, assessments of reasoning about treatment options should focus on whether a person can describe salient reasons for a specific choice, whereas assessments of appreciation of the meaning of diagnostic and treatment information should focus on whether a person can describe the implications of various choices for future states. More research is needed to establish the reliability and validity of assessment tools and of capacity constructs.