Current state of research on decision-making competence of cognitively impaired elderly persons
Current state of research on decision-making competence of cognitively impaired elderly persons
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DOI：
10.1176/appi.ajgp.10.2.151
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发表时间：
2002-03-01
影响因子：
7.2
通讯作者：
Caine, ED
中科院分区：
文献类型：
--
作者：
Kim, SYH;Karlawish, JHT;Caine, ED
随着认知受损老年人人数的增加，对他们同意治疗和参与研究的能力进行循证评估的必要性将会增加。作者对所有研究老年痴呆或认知障碍患者决策能力的英文文章进行了电子和手工文献检索，回顾了与方法学、临床和政策重要性相关的关键领域的文章。所确定的32项相关研究，即使在其对决策能力的定义和衡量方面，也存在高度差异。虽然丧失决策能力很常见，但许多痴呆症患者能够自己做出医疗和研究决定。在阿尔茨海默病中，记忆和执行功能缺陷预示着决策障碍。不过，至少在痴呆症的早期阶段，干预可能会提高决策能力。简短而简单的认知筛查可能有助于识别需要更深入评估的人。使用基于专家判断的方法可以减轻缺乏能力标准的问题。对认知障碍老年人决策能力的研究是一个新兴的领域。它开始产生具有实际意义的研究结果，保护自主权，我们是这群脆弱的老年患者。
As the number of cognitively impaired elderly persons increases, the need for evidence-based assessments of their capacity to consent to medical treatment and research participation will grow. The authors conducted an electronic and manual literature search for all English-language articles examining the decision-making capacity of elderly persons with dementia or cognitive impairment, reviewing articles in relation to key areas of methodological, clinical, and policy importance. The 32 relevant studies identified were highly heterogeneous, even in their definitions and measurements of decisional capacity Although incapacity is common, many persons with dementia are capable of making their own medical and research decisions. In Alzheimer disease, memory and executive-function deficits predict decisional impairment. Still, at least in early stages of dementia, interventions may improve decisional abilities. Short and simple cognitive screening may be useful by identifying persons In need of more intensive evaluations. The use of expert judgment-based methods may mitigate the problem of a lack of a criterion standard for competence. Research into the decision-making competence of cognitively impaired elderly persons is a growing field. It is beginning to yield findings with practical implications for preserving the autonomy and we are of this group of vulnerable elderly patients.