New Tool to Evaluate Decision-Making Capacity

Finding a balance between honoring the wishes of an older adult and protecting them from harm can be a challenge for protective service agencies and healthcare professionals, especially if the decisions being made go against the advice of family, doctor, or financial adviser.  But a new tool developed by two geriatricians will help gather information to guide adult protective services workers in determining the decision-making capacity of elderly adults, helping to protect them from neglect, abuse, or exploitation. 

According to a recent New York Times Health report, the new tool – the Interview for Decisional Abilities(IDA) was created to help train protective services workers to gather information from older adults and ascertain if they are able to make decisions for their care, living conditions or finances.  The tool helps to reveal whether or not a senior has the capacity to understand the risks they may face in their decisions making, and the potential consequences. 

The IDA tool has been used by California, New York City, and Massachusetts APS workers to help assess many issues of health and safety, self-neglect, refusal of physical care or medical treatment, and physical, psychological, or sexual abuse.  But it does not replace treatment by a psychiatrist; clients who demonstrate an inability to understand risks and consequences should receive a further clinical assessment. 

The IDA may also have broader uses for trust and estate lawyers and financial planners.  The creators, Dr. Jason Karlawish, and Dr. Mark Lachs, also believe the tool could help hospitals assess if a patient has the capacity to decide to return home upon discharge, rather than be transferred to a rehabilitation facility.  The IDA could also help long-term care facilities evaluate the decision-making capacity of new residents to ensure they fully understand the contracts they are asked to sign. 

Difficulty managing finances is a common, early sign of cognitive decline among older adults, and financial institutions are often faced with the difficult task of discerning what may be the financial exploitation of older adults.  Banks and other financial institutions may place a temporary hold on accounts if the financial exploitation of a vulnerable adult is suspected.  As awareness about elder abuse and fraud grows, more institutions are providing training to help employees address suspected financial exploitation and protect vulnerable adults.