Moye Jennifer, Karel Michele J, Azar Armin R, Gurrera Ronald J
Boston VA Healthcare System, Brockton VA Medical Center, 940 Belmont Street, Brockton, MA 02301, USA.
Gerontologist. 2004 Apr;44(2):166-75. doi: 10.1093/geront/44.2.166.
The purpose of this study was to compare adults with and without dementia on capacities to consent to treatment as assessed by three instruments.
Eighty-eight older adults with mild to moderate dementia were compared with 88 matched controls on four indices of legal competency to consent to medical treatment as assessed with three capacity instruments.
Mean performance of adults with dementia on a legal standard of understanding treatment information was impaired relative to controls on all instruments, and it was also impaired for an appreciation standard on one instrument and a reasoning standard on two instruments. However, in categorical ratings, most adults with dementia were within the normal range on all decisional capacities. Legal standards were operationalized differently across the three instruments for the capacities of appreciation and reasoning.
Most adults with mild dementia can participate in medical decision making as defined by legal standards, although memory impairments may limit demonstration of understanding of diagnostic and treatment information. In dementia, assessments of reasoning about treatment options should focus on whether a person can describe salient reasons for a specific choice, whereas assessments of appreciation of the meaning of diagnostic and treatment information should focus on whether a person can describe the implications of various choices for future states. More research is needed to establish the reliability and validity of assessment tools and of capacity constructs.
本研究的目的是通过三种工具评估，比较患有和未患痴呆症的成年人在同意治疗能力方面的差异。
使用三种能力评估工具，对88名轻度至中度痴呆的老年人与88名匹配的对照组进行了四项医疗治疗同意法定能力指标的比较。
在所有工具上，患有痴呆症的成年人在理解治疗信息的法定标准方面的平均表现相对于对照组均受损，在一项工具的理解标准和两项工具的推理标准方面也受损。然而，在分类评级中，大多数患有痴呆症的成年人在所有决策能力方面都处于正常范围内。在理解和推理能力方面，三种工具对法定标准的操作方式有所不同。
大多数轻度痴呆的成年人可以按照法定标准参与医疗决策，尽管记忆障碍可能会限制对诊断和治疗信息的理解。在痴呆症中，对治疗选择推理的评估应关注一个人是否能描述特定选择的显著理由，而对诊断和治疗信息意义理解的评估应关注一个人是否能描述各种选择对未来状况的影响。需要更多研究来确定评估工具和能力结构的可靠性和有效性。
