title: Advanced age and decisional capacity: The effect of age on the ability to make health care decisions.
abstract: Cognitive disorders, including dementia, have been shown to be predictors of decisional incapacity, even more than psychotic or substance use disorders. Nonetheless, the impact of advanced age on decisional capacity remains understudied.
  
  
  
  Out of more than 2500 consecutive psychiatric consultations performed by the Consultation-Liaison service at Bellevue Hospital Center in New York City, 266 completed decisional capacity assessments were identified and analyzed with respect to the indications for referral and the impact of age and other sociodemographic, medical and psychiatric variables on decisional capacity.
  
  
  
  By itself, in this sample advanced age was not associated with impaired medical decision-making. In individuals ≥65years old, among whom only 27% were deemed to have decisional incapacity, cognitive disorders including dementia remained the strongest association with this incapacity; meanwhile, in patients <65, decisional impairment was evident in 62%, and delirium, psychosis and neurological disorders caused more decisional impairment. The main indications for referral were placement refusals in those ≥65, while young patients were largely seen due to their desire to leave the hospital against medical advice.
  
  
  
  Advanced age by itself failed to be associated with decisional incapacity in this sample. In those ≥65, cognitive disorders remained the main association with such incapacity, versus psychosis, substance use and neurological disorders in younger patients.
authors.affiliation: University Hospital Zurich, University of Zurich, Department of Consultation-Liaison Psychiatry, Ramistrasse 100, 8091 Zurich, Switzerland.
authors.forename: Susanne
authors.initials: S
authors.lastname: Boettger
authors.affiliation: Bellevue Hospital Center, New York University, Langone Medical Center, Department of Psychiatry, 462 First Avenue, NY, NY 10010, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Bergman
authors.affiliation: University Hospital Zurich, University of Zurich, Department of Consultation-Liaison Psychiatry, Ramistrasse 100, 8091 Zurich, Switzerland.
authors.forename: Josef
authors.initials: J
authors.lastname: Jenewein
authors.affiliation: University Hospital Zurich, University of Zurich, Department of Consultation-Liaison Psychiatry, Ramistrasse 100, 8091 Zurich, Switzerland. Electronic address: soenke.boettger@usz.ch.
authors.forename: Soenke
authors.initials: S
authors.lastname: Boettger
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000523:psychology*; D001294:Attitude to Health; D003072:Cognition Disorders / Q000453:epidemiology / Q000523:psychology*; D003657:Decision Making / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000523:psychology*; D008609:Mental Status Schedule; D008875:Middle Aged; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Advanced age; Assessment; Competence; Decisional capacity; Medical comorbidities; Psychiatric illness