Stokes Louis, Maden Michelle, Williams Nefyn, Jacob Nina, Scott Sion, Shepherd Victoria, Gates Cara, Jones Liz, Barker Sandra, Hunter Marie-Clare, Smith Grahame, Prout Hayley, Ingle Mishel, Curtis Ffion, Hill Ruaraidh, Griffiths Alys Wyn
The University of Sheffield Institute for Translational Neuroscience, The University of Sheffield, 358a Glossop Road Sheffield, Sheffield, South Yorkshire S10 2HQ, United Kingdom.
Liverpool Reviews and Implementation Group Liverpool, University of Liverpool, Liverpool, United Kingdom.
Age Ageing. 2025 May 3;54(5). doi: 10.1093/ageing/afaf119.
Mental Capacity legislation defines when a person lacks capacity and subsequently supports individuals to make as many decisions as possible for themselves. Whilst frameworks exist, care home staff often feel unsupported with insufficient knowledge and training. This review aimed to understand barriers and facilitators of implementing mental capacity legislation in care homes for older adults in the United Kingdom.
A systematic review was conducted and 3041 potentially relevant studies identified, with 13 studies eligible for inclusion. 11 focused on the Mental Capacity Act (2005) and two on the Adults with Incapacity (Scotland) Act 2000. Barriers and/or facilitators were extracted and subsequently mapped to the Capability, Opportunity and Motivation model and Theoretical Domains Framework.
Barriers included poor access to training, low staff confidence and a lack of understanding about using legislation in context. Conversely, staff reported in-person training using real-life examples, robust organisational policies and processes and respecting person-centred care were key facilitators. Sense-checking conversations were conducted with care home staff (n = 18) to interpret findings in the context of current practice.
This review presents complex and multi-faceted barriers preventing the implementation of mental capacity legislation in care homes for older adults. Whilst care home staff have now started to appreciate the importance of such legislation, insufficient time, resources and an inability to track staff knowledge prevents effective implementation of the law. Future research should explore how staff are trained about legislation and identify best practices.
《精神能力法》规定了一个人何时缺乏能力，并随后支持个人尽可能多地为自己做出决定。虽然存在相关框架，但养老院工作人员常常感到缺乏支持，因为他们知识和培训不足。本综述旨在了解在英国养老院实施《精神能力法》的障碍和促进因素。
进行了一项系统综述，共识别出3041项潜在相关研究，其中13项研究符合纳入标准。11项研究聚焦于《2005年精神能力法》，两项研究聚焦于《2000年苏格兰无行为能力成年人法》。提取障碍和/或促进因素，随后将其映射到能力、机会和动机模型以及理论领域框架。
障碍包括培训机会少、工作人员信心不足以及对在实际情境中运用该法律缺乏理解。相反，工作人员报告称，使用实际案例的面对面培训、完善的组织政策和流程以及尊重以个人为中心的护理是关键促进因素。与养老院工作人员（n = 18）进行了意义检验对话，以便在当前实践背景下解读研究结果。
本综述提出了阻碍在老年养老院实施《精神能力法》的复杂且多方面的障碍。虽然养老院工作人员现已开始认识到该法律的重要性，但时间、资源不足以及无法跟踪工作人员知识情况阻碍了该法律的有效实施。未来研究应探索如何对工作人员进行法律培训，并确定最佳实践方法。
