Resident Physician Perceptions About Assessment of Decision-Making Capacity: An Opportunity For Geriatric Psychiatrists

Abstract

Methods: We reviewed inpatient admissions to an acute psychiatry inpatient unit from Jan 1, 2012 April 1, 2012 to determine if Veterans admitted to the unit, had adequate exposure to PAD, and identify any gaps in the flow of information related to Psychiatric Advance Directives. Information regarding PAD is offered to psychiatric inpatients at the time of admission and on discharge. We studied the process which was used to provide this information, and if it was done in a timely manner. Results: The age of patients ranged from 22-85 with a median age of 52. The majority were males (93%). 55.5% of those admitted were African American, 43% Caucasian and 1.5% of Arab American, Asian and Latino origin. Majority of the patients had more than one diagnosis. The most common admitting diagnoses were Substance abuse and a Mood disorder secondary to substance use (44.4%). A dementia diagnosis was recorded for only 2% of admissions during this period. None of the 196 patients admitted during this period displayed an interest in pursuing PAD. We also noted through verbal interviews with staff, that nursing staff had poor training with regards to administering the PAD. e.g. there was no mechanism to evaluate the decision-making capacity of newly admitted psychiatric inpatients and there was no process to offer information related to PAD to patients when their capacity had improved. Conclusions: Veterans admitted to an acute psychiatric inpatient unit had poor information regarding Psychiatric advance directives. There was also no mechanism in place to determine the decision-making capacity of newly admitted and presumably incapacitated patients. There were also problems in the flow of information related to PAD to psychiatric inpatients. We recommend that staff on an inpatient psychiatric unit be given appropriate training in the understanding and implementation of Psychiatric advance directives. Provisions must also be made to train staff in the evaluation of decision-making capacity of psychiatric inpatients in relation to their ability to express their preferences for psychiatric treatment in the future. We recommend that psychiatric patients admitted on acute psychiatric inpatient units be given information related to Psychiatric Advance Directives on discharge or when their mental health condition has stabilized during their admission.