A practice guideline for assessment of competency and capacity of the older adult.

Abstract

The practitioner involved in competency and capacity assessment of the older adult faces two major problems. The first is a lack of agreement on conceptual models to organize the clinician's planning for the demands of and response to the assessment task. The second is the problem of a changing legal context in which the competency assessment occurs. Moye (1996) summarized the lack of consensus on conceptual definitions and assessment techniques for competency in elderly adults. Without a conceptual ly coherent and empirical ly substantiated basis for competency assessments, the pract i t ioner must rely on clinical exper ience and disconnected research findings in performing these assessments. The potential for low interrater rel iabil i ty in unstandardized clinical assessments, such as that descr ibed by Marson, Mclngurf f , Hawkins , Bartolucci , and HarreU (1997) , is not acceptable given the potential consequences of these assessments for individual au tonomy and, i f adjudicated, for civil liberties. The changing legal context of competency assessment and differences among states in defining competency pose another problem for practitioners. Anderer (1990) noted that state legal definitions of competency have been moving from a generalized concept of incompetence to a more specific construct of incapacity to perform specific tasks needed to maintain 'a safe and secure environment for the individual and to manage critical day-to-day functions. Some states require a competent outcome (i.e., responsible decisions) to document competency. Other states require a competent process (i.e., informed decisions). The concept of competency is in fact giving way to language that addresses specific capacities, such as the capacity to manage funds and the capacity to make informed decisions about medical treatment. The modem legal concept of competency gener-