Division of Care of the Elderly, Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2T4, Canada.
Department of Occupational Therapy, University of Alberta, Edmonton, AB T6G 2G4, Canada.
Int J Environ Res Public Health. 2022 Jan 29;19(3):1560. doi: 10.3390/ijerph19031560.
With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we implemented a DMCA Model that includes a care pathway, worksheets, education, and mentoring. The objective of this study was to assess the impact of the utilization of this patient-centered DMCA model on the need for Capacity Interviews.
This was a retrospective quality assurance chart review of patients referred for DMCA to the Geriatric Service at the Grey Nuns Community Hospital from 2006-2020. The Geriatric Service is run by Family Physicians with extra training in Care of the Elderly. We extracted patient demographics, elements of the DMCA process, and whether Capacity Interviews were performed. We used descriptive statistics to summarize the data.
Eighty-eight patients were referred for DMCAs, with a mean age of 76 years (SD = 10.5). Dementia affected 43.2% (38/88) of patients. Valid reasons for conducting a DMCA were evident in 93% (80/86) of referrals, and DMCAs were performed in 72.6% (61/84). 85.3% (58/68) of referrals identified the need for DMCA in two to four domains, most commonly accommodation, healthcare, and finances. Two to three disciplines, frequently social workers and occupational therapists, were involved in conducting the DMCAs for 67.2% (39/58) of patients. The Capacity Assessment Process Worksheet was used 63.2% of the time. Capacity Interviews were conducted in only 20.7% of referrals. Following the DMCAs, 48.2% (41/85) of those assessed were deemed to lack capacity.
This study suggests that the DMCA Model implemented has decreased the need for Capacity Interviews while simultaneously respecting patient autonomy. This is an important finding as DMCAs carried out following this process reduced the need for both a Capacity Interview and declarations of incapacity while simultaneously respecting patient autonomy and supporting patients in their decisions in accordance with the legislation.
随着老年人口的增加，预计痴呆症患者的数量将会增加，因此需要进行决策能力评估（DMCA）的人数也会增加。然而，许多医疗保健专业人员觉得自己还没有准备好进行 DMCA。自 2006 年以来，我们实施了一个 DMCA 模型，其中包括护理途径、工作表、教育和指导。本研究的目的是评估利用这种以患者为中心的 DMCA 模型对能力访谈需求的影响。
这是对 2006 年至 2020 年期间向格雷·努恩斯社区医院老年科转诊进行 DMCA 的患者进行的回顾性质量保证图表审查。老年科由接受过老年护理额外培训的家庭医生管理。我们提取了患者的人口统计学资料、DMCA 流程的要素以及是否进行了能力访谈。我们使用描述性统计来总结数据。
有 88 名患者被转诊进行 DMCA，平均年龄为 76 岁（标准差=10.5）。43.2%（38/88）的患者患有痴呆症。在 86%（80/86）的转诊中，有明确的进行 DMCA 的合理理由，在 84%（61/84）的患者中进行了 DMCA。68%（58/85）的转诊需要在 2-4 个领域进行 DMCA，最常见的是住宿、医疗保健和财务。有 2-3 个学科，通常是社会工作者和职业治疗师，参与了 67.2%（39/58）患者的 DMCA。63.2%的情况下使用了能力评估过程工作表。仅对 20.7%的转诊进行了能力访谈。在 DMCA 之后，85%（41/85）的评估对象被认为缺乏能力。
本研究表明，实施的 DMCA 模型减少了对能力访谈的需求，同时尊重了患者的自主权。这是一个重要的发现，因为按照这个流程进行的 DMCA 减少了对能力访谈和无能力宣告的需求，同时尊重了患者的自主权，并根据立法支持患者在决策中做出自己的选择。
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