Considerations of informed consent and decision-making competence in older adults with cognitive impairment.
Including older adults with cognitive impairment in research studies is necessary to ensure that interventions designed to improve care are effective for all older adults. However, issues related to capacity to consent raise many difficult questions that nurse researchers must address. Protecting vulnerable participants while simultaneously maintaining autonomy and moving important research forward can be challenging. Assessing the decision-making abilities of understanding, appreciation, reasoning, and expressing a choice is an important aspect of determining decision-making capacity. Yet although this is the prominent rational method for judging decision-making competence, it does not take into consideration the importance of culture, values, and emotions. This article focuses on the assessment of decision-making capacity to consent, recommendations for obtaining informed consent in older adults with cognitive impairment, the use of surrogate decision makers, strategies to maximize research participation, and directions for future research.
Mayo
Ann M
AM
Hahn School of Nursing and Health Sciences, University of San Diego, 5998 Alcala Park, San Diego, CA 92110-2492, USA. amayo@sandiego.edu
Wallhagen
Margaret I
MI
D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D028744:Ethics Committees, Research / Q000941:ethics / Q000458:organization & administration; D015577:Geriatric Assessment / Q000379:methods*; D005851:Geriatric Nursing / Q000941:ethics / Q000331:legislation & jurisprudence / Q000379:methods; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D016743:Mental Competency / Q000331:legislation & jurisprudence / Q000523:psychology; D009730:Nursing Assessment / Q000941:ethics / Q000331:legislation & jurisprudence / Q000379:methods*; D010344:Patient Advocacy / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D018579:Patient Selection / Q000941:ethics; D026684:Personal Autonomy; D014481:United States