Cornerstones of Care Education Series at IOA

Capacity: What is It? How Do We Assess It? What happens When We Loose it?

This is the title of the last installment in the educational series from the Institute on Aging, titled Cornerstones of Care.

Capacity:

legal competency or fitness (capacity to stand trial), or

an individual's mental or physical ability

(source: Merriam-Webster Dictionary).

Why is the concept of capacity or competency so important to those who care for our aging population and for those who reach the age of 65? Here are statistics that shed some light on the importance of this ongoing discussion. In the year 2010 the US Census Bureau projects our population to have over 40 million people over the age of 65 (or 13% of the total population) and within this group 3-5% will suffer from dementia. At the age of 85 and above, the incidence of dementia is estimated at 40-50%, which combined with our growing longevity, will result in a population of 7 million Americans with some form of dementia by the year 2010. The threshold of competency, which in the majority of cases translates into financial competency, is one to watch carefully and in need of continuous fine-tuning and examination.

What is the impact of dementia on capacity?

Here is a list of symptoms of dementia:

- difficulty learning and retaining new information

- difficulty recalling relevant personal historical information

- difficulty understanding simple concepts

- difficulty expressing preferences and choices

- loss of mental flexibility

- impairment of judgement

- distortion of reality (psychotic delusions)

- vulnerability to undue influences/exploitation/abuse

Daniel C. Marson (Professor of Neurology and Director of the Alzheimer's Disease Center at the University of Alabama at Birmingham), defines capacity as 'competency' in these words:

"a theshold requirement, imposed by society, for an individual to retain decision making power in a particular activity or set of activities." Professor Marson, the key note speaker of the day, is introduced by moderator Erika Falk (IOA, SF Elder Abuse Forensic Center) as the 'financial capacity guy', with his added insights from a law degree from the University of Chicago. He demonstrates that when money is involved, the law comes into swift action, and the court rooms become the arena where our concepts, such as capacity, are redefined.

Where is the rule book for deciding who's no longer able to make financial or medical decisions? In a study presented by Marson it becomes clear that only with training and understanding of the various dementias can physicians make accurate assessments, which go unnoticed in routine examinations. The grasp of the limits of capacity or competency in clinical terms can then be of use in the court room, and applied to the laws surrounding the autonomy of the individual.

The legal, social and medical environments where today's developments in the definition of capacity take place, are represented in a panel discussion with speakers Judge Joyce Cram (Contra Costa County), Mary Counihan (formerly Director of Adult Protective Services) and physician Elizabeth Landsverk, (ElderConsult Medical Associates). In brief lectures about their professional experiences it becomes clear that our society is moving toward greater understanding of the challenges of our aging population.

For more information on these series go to: www.ioa.org/research/continuing_education/