Assessment of Competence in Older Adults

Abstract

Assessing mental competence and capacity is an issue of increasing significance in today’s “age of aging.” It parallels the growth of court challenges to legal and medical competence findings, with an enhanced emphasis on ethical and responsible professional practices. Changing demographics and societal pressures have triggered debates regarding decisions surrounding wealth transfer via wills and estate planning, together with escalating demands on caregivers, hospitals, and facilities caring for people experiencing cognitive decline, brain injury, and chronic illnesses and with the increased longevity of persons with dementia. With evolving social and economic perspectives on retirement, older adults, from “blue collar” to professional status, now remain longer in employment markets. Thus, we anticipate higher prevalence of cognitive and associated functional disability in the workforce and in the general population. Concern also emerges regarding vulnerability of persons with cognitive decline to exploitation. With escalating demands for competency assessments, a lack of clear evidence-based guidelines for these evaluations has the potential for significant harm to older adults, their families, and the public. Our chapter explores challenges, both in the field and research. To this end, we define competency and review its relationship with capacity and cognitive functions and specific functional domains relevant to older adults (e.g., mental health; cognitive, high- and low-gravity decision-making in health, medical, and legal; personal care and independence; and finance). Henceforth, we provide a step-by-step model for constructing competency assessments for older adults.