214 - End-of-life decision-making capacity in older people with serious mental illness

Carla Kotzé,Louw Roos,René Ehlers

doi:10.1017/s1041610221001472

Abstract

ABSTRACTObjectives:The study’s main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Design, Setting, and Participants:This was a cross-sectional, observational study, done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness.Measurements:Socio-demographic, diagnostic, and treatment data were collected before administration of the Mini- Cog and a semi-structured clinical assessment of end-of-life decision-making capacity. Finally, the standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardised instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results:According to the semi-structured decision-making capacity assessment, 65% of participants had decision-making capacity for end-of-life decisions. The Assessment of Capacity to Consent to Treatment scores were significant (p<0.001) when compared to decision-making capacity. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p<0.001); a duration of serious mental illness of 30-39 years (p=0025); having a diagnosis of schizophrenia spectrum disorders (p=0.0007); and being admitted involuntarily (p<0.0001).Conclusions:Two thirds of older people with serious mental illness had decision-making capacity and were able to engage in end-of-life care discussions. Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

Highlights

Medications with anticholinergic activity are widely prescribed for a variety of medical, surgical, and psychiatric illnesses
Agitation is experienced by over 90% of individuals with Alzheimer’s disease (AD) which increases morbidity and mortality and contribute to caregiver burden
215 – ECN Awards: Anticholinergic Burden: A Study in a Psychiatry of Later Life Cohort Liam C

Summary

Introduction

Medications with anticholinergic activity are widely prescribed for a variety of medical, surgical, and psychiatric illnesses. There is strong evidence that the cumulative anticholinergic properties of such medications (i.e., the anticholinergic burden) contributes to significant longer-term adverse effects, including dementia, impaired mobility, and increased mortality. The anticholinergic burden is often not given due consideration when cliniciansprescribe or review medications in routine clinical practice. This is of particularrelevance in services working with elderly patient populations, who are both more likely to experience polypharmacy and more vulnerable to medication adverse effects. Greater awareness of the risks of anticholinergic prescribing may lead to improvements in longer-term cognitive and physical functioning,and subsequently decreased disease burden on individuals and society as a whole

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