Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients
Abstract
OBJECTIVES: There is little information about older adult psychiatric inpatients' capacity to consent to clinical decisions. In younger adults, lack of capacity is associated with poor insight and psychosis rather than cognitive impairment. We assessed the prevalence and predictors of mental capacity to make treatment and admission decisions in older psychiatric inpatients, and asked their views about who should make these decisions. METHODS: We interviewed 99 participants using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in three geographical locations. RESULTS: Fifty-two (52.5%) participants had capacity for admission and 38 (38.4%) for treatment decisions. Capacity was associated with not having dementia, and higher levels of insight and cognition. Those with depression were more likely to have capacity than those with psychosis. 75% of patients without capacity for admission were not detained legally. CONCLUSIONS: Patients can have capacity to make decisions in one area but not in others. Many people are admitted and treated in a way that is contrary to the human rights legislation. The new Deprivation of Liberty Safeguards in England and Wales are likely to apply to a significant proportion of older inpatients. Most people wanted doctors to make treatment and admission decisions and very few wanted their family to make decisions on their behalf.
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Recent studies of capacity in psychiatric patients have reported mixed results.
“Recent studies have analyzed capacity in psychiatric patients, with mixed results.”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Maxmin et al., 2009
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Systematic review on the prevalence of lack of capacity in medical and psychiatric settings
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- Authors
- Maxmin, K., Cooper, C., Potter, L., & Livingston, G.
- Affiliations
- University College London (GB)
- Corresponding author
- Livingston, Gill
- Venue
- International Journal of Geriatric Psychiatry
- Publisher
- Wiley
- Published
- 2009-11-13
- Volume
- 24
- Issue
- 12
- Pages
- 1367-1375
- ISSN
- 0885-6230 (ISSN-L)
- 1099-1166
- OpenAlex
- W2052738568
- Cited by
- 25
- References
- 16
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 1 · 2020: 3 · 2019: 2 · 2017: 2 · 2015: 1 · 2013: 3 · 2012: 2
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- decision-making capacity, informed consent, older adults, psychiatric inpatients, treatment decision-making, admission decisions, dementia, insight, psychosis, depression, Deprivation of Liberty Safeguards, human rights, surrogate decision-making
- MeSH terms
- Aged, Aged, 80 and over, Mental Disorders, Cognition Disorders, Decision Making, Dementia, England, Female, Humans, Informed Consent, Interview, Psychological, Male, Psychotic Disorders, Mental Competency
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