Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients.
OBJECTIVE
There is little information about older adult psychiatric inpatients' capacity to consent to clinical decisions. In younger adults, lack of capacity is associated with poor insight and psychosis rather than cognitive impairment. We assessed the prevalence and predictors of mental capacity to make treatment and admission decisions in older psychiatric inpatients, and asked their views about who should make these decisions.


METHODS
We interviewed 99 participants using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in three geographical locations.


RESULTS
Fifty-two (52.5%) participants had capacity for admission and 38 (38.4%) for treatment decisions. Capacity was associated with not having dementia, and higher levels of insight and cognition. Those with depression were more likely to have capacity than those with psychosis. 75% of patients without capacity for admission were not detained legally.


CONCLUSIONS
Patients can have capacity to make decisions in one area but not in others. Many people are admitted and treated in a way that is contrary to the human rights legislation. The new Deprivation of Liberty Safeguards in England and Wales are likely to apply to a significant proportion of older inpatients. Most people wanted doctors to make treatment and admission decisions and very few wanted their family to make decisions on their behalf.
Department of Mental Health Sciences (Archway Campus), University College London, Holborn Union Building, Highgate Hill, London, UK.
Kate
K
Maxmin
Claudia
C
Cooper
Laurence
L
Potter
Gill
G
Livingston
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000523:psychology / Q000628:therapy; D003657:Decision Making; D003704:Dementia / Q000523:psychology; D004739:England; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D007406:Interview, Psychological; D008297:Male; D016743:Mental Competency / Q000523:psychology*; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy