title: Clinical evidence in guardianship of older adults is inadequate: findings from a tri-state study.
abstract: OBJECTIVE
  This preliminary study compared clinical evaluations for guardianship in three states with varying levels of statutory reform.
  
  
  METHODS
  Case files for 298 cases of adult guardianship were reviewed in Massachusetts, Pennsylvania, and Colorado, three states with varying degrees of statutory reform. The quality and content of the written clinical evidence for guardianship and the hearing outcome were recorded.
  
  
  RESULTS
  The quality of the written clinical evidence for guardianship was best in Colorado, the state with the most progressive statutory reform, earning a grade of B in our ratings, and worst in Massachusetts, a state with minimal reform, earning a grade of D - with nearly two thirds of the written evidence illegible. Information on specific functional deficits was frequently missing and conclusory statements were common. Information about the individual's key values and preferences was almost never provided, and individuals were rarely present at the hearing. Limited orders were used for 34% of the cases in Colorado, associated with more complete clinical testimony, but such orders were used in only 1 case in either Massachusetts or Pennsylvania.
  
  
  CONCLUSIONS
  In this study, states with progressive statutes that promote functional assessment are associated with increased quality of clinical testimony and use of limited orders. A continuing dialogue between clinical and legal professionals is needed to advance reform in guardianship, and thereby provide for the needs and protect the rights of adults who face guardianship proceedings.
authors.affiliation: VA Medical Center, 940 Belmont Street, Brockton, MA 02301, USA. jennifer.moye@va.gov
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moye
authors.forename: Stacey
authors.initials: S
authors.lastname: Wood
authors.forename: Barry
authors.initials: B
authors.lastname: Edelstein
authors.forename: Jorge C
authors.initials: JC
authors.lastname: Armesto
authors.forename: Emily H
authors.initials: EH
authors.lastname: Bower
authors.forename: Julie A
authors.initials: JA
authors.lastname: Harrison
authors.forename: Erica
authors.initials: E
authors.lastname: Wood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007872:Legal Guardians; D008297:Male; D008875:Middle Aged; D013219:State Government; D014481:United States