title: Decisional capacity of depressed elderly to consent to electroconvulsive therapy.
abstract: The purpose of this article is to determine the abilities of severely depressed elderly to consent to electroconvulsive therapy (ECT) and to investigate the impact of educational intervention on their capacity. Forty severely depressed adults referred for ECT, with Mini-Mental State Examination scores greater than 20, were recruited. Using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), decisional capacities were assessed at baseline and reassessed after education. Between the 2 assessments, all subjects received standard education, and half of the group was subsequently randomized to receive further education. At baseline, the geriatric group scored lower on understanding, reasoning, and choice and higher on appreciation. After education, all MacCAT-T scores increased for both age groups. Depressed elderly in the sample, as a group, had adequate decisional capacities to consent to ECT. They showed greater improvement in decisional capacity with education. The findings highlight the importance of providing education to the elderly to optimize their ability to give informed consent.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. lapid.maria@mayo.edu
authors.forename: Maria I
authors.initials: MI
authors.lastname: Lapid
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Rummans
authors.forename: V Shane
authors.initials: VS
authors.lastname: Pankratz
authors.forename: Paul S
authors.initials: PS
authors.lastname: Appelbaum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000628:therapy*; D003657:Decision Making; D003865:Major Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D008609:Mental Status Schedule; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation / Q000331:legislation & jurisprudence; D011567:Psychiatric Department, Hospital; D012047:Rehabilitation Centers; D016896:Treatment Outcome