Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Departments of Acute General Medicine and Geratology, John Radcliffe Hospital, Oxford, UK.
Age Ageing. 2023 Sep 1;52(9). doi: 10.1093/ageing/afad171.
Hospital clinicians find mental capacity assessment challenging and may lack the necessary skills. Given high rates of cognitive impairment, data on mental capacity assessment in real-world hospital cohorts are required to inform the need for staff training and workforce planning.
In unselected medical inpatients, we determined the rate and outcome of mental capacity assessment by decision type and underlying brain/mind disorder, and recorded the discipline of the assessor.
We included consecutive patients (October-November 2018; November-December 2019) admitted to the complex medicine unit providing acute multidisciplinary care for multi-morbid patients (age ≥ 16 years, average age > 80 years). Audit data were collected at ward multidisciplinary meetings and extracted from electronic patient records.
Among 892 patients (mean/SD age = 82.8/8.6, 465 male), 140 (16%) required mental capacity assessment (40/140 (29%) had ≥2 assessments) with 203 assessments in total of which 162 (80%) were done by doctors. Capacity was deemed lacking in 124 (61%) assessments, most commonly in delirium with/without other co-morbid conditions (94/114, 82%) or dementia (9/12, 75%) with lower rates in other disorders (15/27, 56%), and no formal diagnosis of brain/mind disorder (6/50, 12%). Cognitive test scores were overall lower in those lacking capacity (mean/SD abbreviated-mental-test-score = 5.2/2.6, range = 0-10 versus 6.8/2.8, P = 0.001, range = 1-10). Decisions involving discharge planning were most often assessed (48%) followed by treatment (29%), discharge against medical advice (12%) and others (11%).
Mental capacity assessments were performed frequently and often repeated, justifying the need for robust training in the practical application of the principles of capacity assessment for staff managing complex older patients.
医院临床医生发现进行心理能力评估具有挑战性，并且可能缺乏必要的技能。鉴于认知障碍的高发病率，需要有真实世界医院队列中有关心理能力评估的数据，以便为员工培训和劳动力规划提供信息。
在未经选择的住院内科患者中，我们根据决策类型和潜在的脑/精神障碍确定了心理能力评估的比率和结果，并记录了评估者的学科。
我们纳入了 2018 年 10 月至 11 月和 2019 年 11 月至 12 月连续入住为患有多种疾病的患者提供急性多学科治疗的复杂内科病房的患者（年龄≥16 岁，平均年龄> 80 岁）。审核数据是在病房多学科会议上收集的，并从电子患者记录中提取。
在 892 名患者中（平均/标准差年龄=82.8/8.6，465 名男性），有 140 名（16％）需要进行心理能力评估（40/140（29％）进行了≥2 次评估），共进行了 203 次评估，其中 162 次（80％）由医生进行。在 124 次（61％）评估中被认为缺乏能力，最常见于伴有/不伴有其他合并症的谵妄（94/114，82％）或痴呆（9/12，75％），其他疾病的发生率较低（15/27，56％），并且没有正式的脑/精神障碍诊断（6/50，12％）。缺乏能力的患者的认知测试分数总体较低（简短精神测试评分的平均值/标准差=5.2/2.6，范围=0-10 与 6.8/2.8，P=0.001，范围=1-10）。涉及出院计划的决策评估最为常见（48％），其次是治疗（29％），不遵医嘱出院（12％）和其他（11％）。
心理能力评估经常进行，并且经常重复，这证明了为管理复杂老年患者的员工提供有关能力评估原则的实际应用的强化培训是必要的。
