Abstract
BackgroundIn the modern world with new family structures, international migration and increased life expectancy, there is a growing need for legal ways of assisting elderly with impaired mental capacity to decide about their life and assets. There are few studies about the physician’s role when a court appoints proxies for vulnerable elderly. Many doctors do not know how to assess mental capacity, and most lawyers and judges know little about medicine.MethodsApplications for a custodian sent to the Stockholm Chief Guardian’ Office in Sweden were used. Physician’s statements to the court for elderly with memory impairment were selected and 260 statements were scrutinized with regard to formal quality, the narrative content and the physician who wrote it.ResultsThe quality of the statements varied from one sentence to excellent. Most statements were written by senior family practitioners or geriatricians. Seventeen % of the statements were handwritten and had more formal shortcomings than machine/computer written statements.The majority of patients needed massive help with daily life and economy. Median age was 84 years of age. MMSE score was given in 20% of the cases and varied from 6–27.A diagnosis of dementia was established in 57%. At the time of application, at least 48% were in a hospital or nursing home and at least 27% were in their private home. Only 5% were living with a spouse or a child. In 53% of the cases, the doctor knew the patient, but in 40% of the cases, the identity of the patient was not confirmed. The physician found that 54% were unable to understand the idea of getting a custodian, but out of those very vulnerable elderly, 20% had signed consent and 57% were considered able to be heard in court.ConclusionsThere is a large variation in the quality of physicians’ statements to the court concerning the mental capacity of elderly patients with cognitive impairment. Many statements have serious short-comings, and the system is not safe. There is a strong need for guide-lines, and additional training for all professionals involved.
Highlights
In the modern world with new family structures, international migration and increased life expectancy, there is a growing need for legal ways of assisting elderly with impaired mental capacity to decide about their life and assets
Modern life with increased life expectancy, international migration, new family structures and new values highlight the need for legal ways of assisting elderly with impaired mental capacity to decide about their life and assets
The Mental Capacity Act (MCA) of England and Wales is an example of a modern legislation designed to protect adults with reduced decision-making capacity [8,9,10]
Summary
In the modern world with new family structures, international migration and increased life expectancy, there is a growing need for legal ways of assisting elderly with impaired mental capacity to decide about their life and assets. Modern life with increased life expectancy, international migration, new family structures and new values highlight the need for legal ways of assisting elderly with impaired mental capacity to decide about their life and assets. The European Dementia Consensus Network reviewed how competence (capacity) assessment in dementia is practised in a number of European countries [7] and found a large variety of legislations and practices. Lawyers often take for granted that physicians, at least psychiatrists, know how to assess mental capacity. Many physicians do not know how to do this, and medical schools rarely teach assessment of mental capacity. The progress in research and clinical care in the past decades has totally changed the concept of dementia and cognitive disorders, but this is seldom mirrored by revised legislation
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