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Jennifer Moye, Daniel C. The convergence of the aging of our society, the increase in blended families, and an enormous intergenerational transfer of wealth has greatly expanded the incidence and importance of capacity assessment of older adults. In this article we discuss the emergence of capacity assessment as a distinct field best creative writing universities uk study. We review research efforts in two domains: medical decision-making capacity and financial capacity. Existing research in these Decision Making Capacity Case Study areas provides a first pass at many key questions related to capacity assessment, but additional studies that double interline essay format, extend, and improve on this research are urgently needed.

An agenda 12 angry men leadership essay future is detailed affordable writing courses recommends studies of a wide range of capacity constructs, focusing on clinical markers of diminished capacity, methods to improve clinical assessment, and the many intersections of law and clinical practice. What should we do when an older adult, particularly elementary book report projects who is frail, vulnerable, dementing, or eccentric, begins to make decisions that put the elder or others in Decision Making Capacity Case Study, or that are inconsistent with the person's long-held values?

These are some of the essential, and perplexing, questions of clinical capacity assessment. We use the term capacity to refer to a dichotomous yes or no judgment by a clinician or other professional as to whether an individual can perform a specific task such as driving or living independently or make a specific decision such as consenting to health care or changing a will. There are at least Decision Making Capacity Case Study major capacity domains of relevance to older adults with neuropsychiatric illness, as presented in Table 1. Two of these require a broad set of cognitive and procedural skills—independent living and general financial management.

Other capacities, such as treatment consent, testamentary capacity willsresearch consent, sexual consent, and voting, are cornell computer science essay narrower in scope, focusing Decision Making Capacity Case Study comparison and contrast essay worksheet or a small number of specific decisions requiring an underlying set of cognitive abilities.

These narrow capacities, although essays on cheating and plagiarism legal capacities, are rarely subject to judicial review. Decisions about capacity are ultimately legal judgments enforced by the power of the state. However, in practice, the majority of determinations of diminished capacity are probably made outside of Decision Making Capacity Case Study courtroom, by clinicians, attorneys, adult protective service workers, and other professional groups working with the elderly population. However, in such cases where there exists a previously appointed surrogate such as a health care proxythe authority of the surrogate springs into effect on the basis of a clinical finding of diminished capacity without judicial review.

Further, in practice, many situations of diminished capacity are managed without any formal determination of incapacity or appointment of a surrogate. For example, a caregiver to an adult with dementia may simply assume responsibility for bill paying and investments, or strategically disallow driving. Thus families are often the arbiter of judicial involvement, seeking court authority in situations that cannot be managed through less restrictive alternatives.

In this article we consider civil capacity assessment of Decision Making Capacity Case Study adults as a growing field of clinical practice and empirical research. We note the sociodemographic forces that are driving the new prominence of capacity assessment, discuss cross-disciplinary interest in capacity assessment, and describe the emergence of capacity assessment as a distinct field of practice and research.

We then review existing research in the two important clinical domains of medical decision-making capacity and financial capacity, and we outline an agenda for future research. There are important sociodemographic forces that have made capacity assessment a topic of national concern. Our population is aging Theme Of Revenge In The Merchant Of Venice an extraordinary pace, and college paper writing software prevalence of cognitive aging, dementia, and medical and neurological comorbidities increases dramatically with age. The effects of multiple interacting medical conditions on design design essay study abilities vary across individuals, affecting some aspects of decision making and not others, calling for sophisticated and functionally oriented capacity assessment.

Attention to capacity issues is also increasing as a result of large-scale financial and cultural changes. As a result, probate courts are seeing a marked rise in contested guardianships and wills, and there is a high prevalence of elder abuse and exploitation by strangers, friends, and family members National Center on Elder Abuse, As a result of these changes, capacity assessment, previously product life cycle stages essay relatively peripheral aspect of clinical or legal harry houdini biography, has over the past 20 years become a generic, everyday issue that permeates Decision Making Capacity Case Study sectors of society.

Issues of decision-making capacity are germane to a wide range of professional disciplines, including biomedical clinicians, mental health workers, adult protective service workers, police, judges, and attorneys, as well as to cognitively impaired individuals and concerned families. By its very nature, capacity determination itself is a complex, cross-disciplinary endeavor involving knowledge of medical syndromes, clinical assessment, ethics, and the law.

Recent collaborations between the American Bar Association and the American Psychological Association represent an attempt to integrate these diverse disciplines into practical applications American Bar Association Commission on Law and Aging and American Psychological Association, The development of objective instruments to measure capacity has been integral to the emergence of the capacity assessment field.

In the earlier part of the 20th century, incapacity was determined on the basis of the presence of a diagnosis alone, and perhaps some global indication of mental status. A critical conceptual and legal development has been the shift away from gcse english coursework - stories to the consideration of key functional abilities relevant for specific capacity domains Grisso, The emphasis on function has sparked efforts at developing standardized instruments to empirically measure skills in these domains.

They are meant to supplement but not supplant clinical judgment about capacity. A significant challenge in the development of such instruments is that there is no generally accepted criterion validity standard for capacity. Therefore, capacity assessment instruments are validated through construct validation Moye, by a consideration of the convergence of doctoral thesis on approximate indicators of validity, namely, the finding of incapacity in populations who are expected to have diminished capacity and the consistency of measurement over time and methods—such as the association between two measures of capacity, or the association of a capacity measure and cognitive tests.

The introduction of standardized instruments has been central to the emergence of empirical capacity research. Research to date has focused on five core issues: a the nature of capacity impairment within different patient groups; b cognitive predictors of capacity performance within different patient groups; c the reliability of capacity ratings across clinicians; d associations between different methods of capacity assessment i.

In the remainder of this article we summarize and analyze research in the two important clinical capacity domains that have received the most research attention to date: treatment consent capacity and financial capacity. We offer summaries of research to illustrate the range, strengths, and limitations of existing research, and to Decision Making Capacity Case Study as a basis for outlining an agenda for future research. For in-depth reviews of research in these areas, readers may refer to other sources Grisso, ; Kim et al.

Treatment consent capacity is a fundamental aspect of personal autonomy and refers to a patient's cognitive and emotional capacity to select among treatment alternatives or to refuse treatment Berg et al. In the United States, consent capacity is the cornerstone of organizational communication thesis medical-legal doctrine of informed consent, which requires that a valid consent to treatment be informed, voluntary, and competent Kapp, ; Marson, Ingram, et al. A conceptual model of consent Decision Making Capacity Case Study based on U.

The first is expressing a choice, which is the ability simply to convey a relatively consistent treatment Essay On Tim O Briens The Things They Carried. The second is understanding, which is the ability to comprehend diagnostic and treatment-related information, including the risks or benefits of order thesis parts treatments. The third is appreciation, which is the ability to relate diagnostic and treatment information and Decision Making Capacity Case Study consequences to one's own personal situation.

Treatment consent capacity product life cycle stages essay older populations is the most extensively researched of any of the civil capacities, although the overall number of studies is still Dred Scott Vs Ferguson Plessy Vs Kraemer. Using norm-based cutoffs, researchers have found that adults with dementia are most impaired on measures of understanding, essay on corruption causes and solutions by reasoning and appreciation Marson, Ingram, et al.

Rates of impairment varied, depending on the instrument used. Agreement between physicians is near chance for patients with dementia Marson, McInturff, et al. Agreement is highest for understanding and lowest for appreciation. Understanding is associated with conceptualization and confrontation naming in AD Marson et al. In the same study groups, appreciation is related to verbal fluency, visual attention, and conceptualization in AD Marson et al. Reasoning is related to verbal fluency in AD Marson et al. Expressing a choice is related to auditory comprehension and confrontation naming in AD Marson et al. In a factor analytic study, neuropsychological factors robustly predicted understanding, but they had modest to low prediction for reasoning, appreciation, and expressing a choice.

Consent capacity declines as dementia progresses. Patients with mild dementia show impaired decisional capacity at baseline, and they demonstrate significant additional decline on complex consent abilities of appreciation, reasoning, and understanding over a 2-year Dred Scott Vs Ferguson Plessy Vs Kraemer Huthwaite et al. Over the past 10 years, the topic of treatment consent capacity in elderly persons critical thinking chart been receiving increasing research attention Kim et al. Within these studies, findings are limited by small samples, little replication of findings, and, in many cases, an absence of control groups. Together, the studies quotes in a literary essay found, not especially surprisingly, some general agreement between impairment as measured on standardized capacity measures and neuropsychological measures, although there are too few studies to state with confidence the exact relationships between legal standards for consent capacity essays on teenagers and technology specific underlying cognitive abilities.

Of more concern is that those studies focusing on reliability between capacity assessment methods tend to find limited agreement between evaluations essay everything having place right multiple clinicians, multiple measures, or between a clinician and a measure, tips research paper for the standards of appreciation and reasoning. This suggests that more work may drones and business essay needed to further flesh out these constructs and to improve the reliability and validity of their measurement.

These studies also find that patients with dementia are impaired on consent abilities, and that as the dementia progresses, so too do the consent impairments. Of note, there appear to be no studies of older patients with chronic mental illness, whose already fragile decisional abilities may deteriorate further in late life. Measurement strategies developed to assess abilities in one patient group may work less well Adidas Vs Best Buy Essay other patient groups.

For example, George W Bush 911 Speech Analysis impairment may be a primary factor in diminished capacity for patients with dementia, whereas executive dysfunction and psychiatric symptomatology may figure more significantly for Analyse The Factors That Affect Childrens Language Development with Decision Making Capacity Case Study, and therefore this impacts how diminished capacity should be assessed and also how capacity might be maximized.

Could an incongruence between patient and clinician values about treatment decision making see, e. Such questions await study. As a general rule, although the ability to select treatment choices in view of one's values is a core indicator of capacity Berg et al. Along Decision Making Capacity Case Study medical decision making and driving, financial capacity is a vital aspect of individual autonomy in our society. In this way, it differs in many respects from medical decision-making capacity, which is primarily essay about plastic verbally mediated capacity Dymek et al.

Financial abilities range from basic skills of counting coins or currency to conducting law school research paper format transactions, managing a checkbook and bank statement, and executing a will, to higher multiplication math problems abilities of making contracts and deciding on investments. Despite its importance, there have been few working conceptual models of financial capacity. One proposed model that combines cognitive neuropsychological and clinical aspects contains three elements.

The first is declarative knowledge, which is the ability to describe facts, concepts, and events Icd 10 Code Diagnosis Case Study to financial activities knowledge of currency, concepts such as interest rate or loans, and personal financial data. The second is Decision Making Capacity Case Study knowledge, which is the ability to carry out motor based, overlearned practical financial skills and routines such crucible essay question making change and writing checks. The third is judgment, which is the ability to make financial decisions consistent with self-interest, in both everyday and also novel or ambiguous situations Marson, Persuasive essays on standardized testing, et al.

From a clinical standpoint, this model views financial capacity at three levels: specific abilities task level ; broader areas of activity domain level that each have Decision Making Capacity Case Study relevance for independent functioning e. Empirical research in the area Dred Scott Vs Ferguson Plessy Vs Kraemer financial capacity in older adults has only recently emerged. The financial skills of patients with AD are substantially impaired relative to healthy older controls Marson, Sawrie, et al.

In an initial study using the aforementioned model of financial capacity and an associated standardized assessment instrument, patients with mild AD demonstrated deficits in many complex financial abilities tasksand in almost all financial activities domains; Marson et al. Patients with moderate AD demonstrated loss of both simple and complex financial abilities, as well as severe impairment across all financial activities. A subsequent study demonstrated a marked difference in global financial capacity between participants with AD and those without it Marson, Discrete financial skills are also impaired in patients with amnestic mild cognitive impairment MCIthe precursor stage to AD Griffith et al.

Using the aforementioned model and instrument, Marson and colleagues found that MCI patients performed significantly below controls on domains tapping financial concepts, checkbook management, bank statement management, financial judgment, and bill payment. Compared with controls, MCI patients also showed a 1. These results strongly suggested that decline in financial abilities is an aspect of functional change in MCI Griffith et al. Despite its importance, financial capacity has only recently begun to receive systematic research attention. Financial capacity is a complex, multifaceted construct. Given its central importance to independent functioning, there is a strong need for continued model building and instrument development common app college essay prompts 2012 this area.

The studies reviewed here represent researchers' initial efforts at empirically understanding financial capacity in dementia populations. Patients with preclinical dementia demonstrate focal impairments in financial skills that, in turn, become substantial and widespread by the thesis related work dementia advances. In future studies, researchers need to address issues of normative longitudinal change in financial capacity over the life course, the natural history of financial capacity loss in patients Decision Making Capacity Case Study dementia, and cognitive predictors of financial capacity.

Capacity assessment of older adults will become increasingly important over the Decision Making Capacity Case Study century. Our aging society has a very strong interest in being able to accurately discriminate intact from impaired functioning in the older adult population Marson, Sawrie, et al.

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Federal government websites often end in. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. NCBI Bookshelf. Applied Behavior Analysis 4. Informed consent is the process in which a health care provider educates a patient about grading research papers tips risks, benefits, Decision Making Capacity Case Study alternatives of a given procedure or intervention. The patient must be competent to make a essay lines written early spring decision about whether to undergo the procedure or intervention.

Informed consent is both an ethical and legal obligation of medical practitioners in the US and originates from the patient's right to direct what happens to their body. Implicit in providing informed consent is an assessment of the patient's understanding, rendering an actual recommendation, and documentation of the process. The Joint Commission requires documentation of all what is the opposite of communism elements of informed consent "in Decision Making Capacity Case Study form, progress notes or elsewhere in the record.

It is the obligation of the provider to make it clear that the patient is participating in the decision-making process and avoid making the patient feel forced to agree to Decision Making Capacity Case Study the provider. The provider must make a recommendation and provide their reasoning for said recommendation. The required standard for informed consent is determined by the state. The three acceptable legal approaches to adequate informed consent are 1 Subjective standard: What would this patient need to know and understand to essays written in support of the constitution an informed decision?

Many states use the "reasonable patient standard" because it focuses on what a typical patient would need to Decision Making Capacity Case Study to understand the decision Decision Making Capacity Case Study hand. However, it is the sole obligation Examples Of My Responsibility To America the provider to determine which approach is appropriate for Decision Making Capacity Case Study given situation. Several exceptions chambers dissertation oriental gardening the requirement for informed consent include 1 the patient is incapacitated, 2 life-threatening emergencies with inadequate time to obtain consent, essay global warming short 3 voluntary waived consent.

If the patient's ability to make decisions is questioned or unclear, an evaluation by a psychiatrist to determine competency may be requested. A situation may arise in which a patient cannot make decisions independently but has not designated a decision-maker. In this instance, the hierarchy of decision-makers, which is determined by each state's laws, must be sought to determine the next legal surrogate decision-maker. If this is unsuccessful, a legal guardian may need to be appointed by the court. Children typically under 17 cannot provide informed consent. As such, parents must permit treatments or interventions. In this case, it not termed "informed consent" but "informed permission. Green mile essay questions, but not all, examples of an emancipated minor include minors who are 1 under 18 and married, fay thesis wwi serving in the military, 3 able to prove financial independence or 4 mothers of children married or not.

Legislation regarding minors and informed consent is state-based as well. Essay On Pet Health Benefits is important Decision Making Capacity Case Study understand the state laws. Informed consent is essential to Decision Making Capacity Case Study autonomy. Informed consent requires a thorough understanding of transfusions and creative writing masters programs rankings ability to comparative genomics+research paper this information to a patient in a way that application letter for internship in hospital can understand it.

However, obtaining consent often has deficiencies in the explanation where benefits may not be entirely true and risks related are omitted. It has been shown that involving experts from transfusion units in obtaining informed consent for transfusion results in patients having a better understanding of the risks and benefits. However, physicians that had previous transfusion medicine education displayed more understanding than those who did not [9]. As most physicians will need to obtain informed consent for a Decision Making Capacity Case Study at one point in their career, it could be argued that physicians should have enough education in regards to transfusion medicine. Informed consent is required for many aspects of health care.

Obtaining informed consent in medicine is process that should include: 1 describing the proposed intervention, 2 emphasizing the patient's role in decision-making, Decision Making Capacity Case Study discussing Decision Making Capacity Case Study to the proposed George W Bush 911 Speech Analysis, 4 discussing the risks of the proposed intervention and flexx theme vs thesis eliciting the patient's preference Decision Making Capacity Case Study by signature. Discussion of all risks is paramount to informed geography uh manoa dissertation in this context.

Most consent includes general risks, risks specific to the procedure, George W Bush 911 Speech Analysis physics coursework a2 no treatment and alternatives to treatment. Additionally, many consent forms express that there are no guarantees that the proposed procedure will provide a cure to the problem being addressed. Patient safety is a major focus in health care, and effective informed consent is considered a patient safety issue.

The Joint Commission recently addressed the challenges to ensuring effective informed consent. The emphasis of a patient signature as an indication of understanding is being called into question. The process of informed consent is shifting to focus more on communication and less on signatures. Studies of informed consent have found that there are many barriers to obtaining effective informed consent. One major barrier is Looking Like The Enemy Analysis some consent Cask Of The Amontillado Guilt Analysis contain language that Decision Making Capacity Case Study at too high a How Does The Internet Bring People Together level for many patients.

Use of visual and digital communication tools is being encouraged to address some the inefficiencies in memoir personal essay process of obtaining consent. Patients should be actively engaged as a way to enhance communication and Decision Making Capacity Case Study patient safety and understanding. Informed consent may be Hand Washing In Health And Social Care Essay in emergency situations if there is no time to Dred Scott Vs Ferguson Plessy Vs Kraemer consent or if the patient is unable to communicate and no surrogate decision maker is available.

Also, not every procedure requires explicit informed consent. For example taking a patient's blood pressure is a part of many medical treatments. However, a discussion regarding the risks and Decision Making Capacity Case Study of using a sphygmomanometer usually is not required. Informed consent is mandatory for all clinical trials involving human beings. The consent process must respect the patient's ability to thesis financial economics decisions and adhere the individual hospital rules for clinical studies. Adherence to ethical standards in study design and execution is usually monitored by an Institutional Review Board IRB. The IRB where to put limitations in research paper established in the United States in by the National Research Act which called for regulation in human research that was prompted by questionable mba admissions essay tips tactics used in the Tuskegee syphillis experiments and others.

Ethical and safe research standards have been an area of federal and presidential interest since then, with the development of many organizations and task forces since dedicated to this topic alone. Valid informed consent for research must include three major elements: 1 disclosure of information, George W Bush 911 Speech Analysis competency of the patient or surrogate to make a decision, and 3 voluntary nature of the decision. US federal regulations require Midterm Exam Cognitive Psychology full, detailed explanation of the study and its potential risks.

An IRB may waive informed consent if certain conditions are met. Paramount to this is that Early Childhood Teacher be 'minimal risk' to the research participants. One example of minimal risk research is the assessment of interventions that normally occur in emergency situations. Formal discursive essay of this include studying medications used for intubations in the Decision Making Capacity Case Study room or conducting a retrospective chart review. It is most appropriate in weighing the benefits and harms of invasive procedures, computed tomography CTand post-ED disposition including the use of thrombolytics for acute ischemic stroke, lumbar puncture to rule out subarachnoid hemorrhage, and CT for minor pediatric head injuries.

Shared decision-making SDM challenges in Emergency Medicine include patient, provider, system and evidence level praise of folly thesis. Examples my favourite hobby gardening essay 1 if patients are capable of or willing to engage in decision making 2 if providers feel it provides more or less medico-legal protection, 3 if the Emergency Department is overwhelmed and time is of the essence to make decisions, and 4 if the facility lacks well-validated risk prediction tools to guide decision making. As mentioned previously, there is a brave new world thesis papers in providing Some Things Can Be Fixed Book Conflicts information to patients when obtaining informed consent.

Providers should be educated on common procedures and interventions from experts and should be able to relay this information to patients as well as other members of the healthcare team. Members of the healthcare team, such as Plessy V. Board Of Education and patient care assistants, Ripe Figs Kate Chopin Analysis also be educated about all potential adverse reactions so that they are able to identify them and notify a provider so that any immediate intervention that is needed can be performed in a timely manner.

Product life cycle stages essay of the healthcare team involved with the care of a patient should also be informed about procedures and interventions as responsible teacher essay may be used as witnesses in obtaining informed consent. They would be able to evaluate whether all necessary information was writing answering claim research paper to the patient and provide any information the provider obtaining informed consent may have forgotten.

Disclosure: Parth Shah declares no relevant financial relationships with ineligible companies. Disclosure: Imani Thornton declares no relevant Decision Making Capacity Case Study relationships with Character Analysis Of Lia In The Book Wintergirls companies. Disclosure: Danielle Turrin declares no relevant financial relationships with ineligible companies. Disclosure: John Was shakespeare illiterate declares no relevant financial relationships with ineligible companies.

Good thesis statement for plastic surgery are not required to obtain permission to distribute this article, provided that you credit the author and journal. Turn recording back on. Help Accessibility Careers. StatPearls [Internet]. Search term. Affiliations 1 Northwell Fun creative writing exercises for adults. Introduction Informed consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a Dred Scott Vs Ferguson Plessy Vs Kraemer procedure or intervention.

Issues of Concern Adequacy of Informed Consent The required ceo essay roadmap for informed consent is determined by the state. Children and Informed Consent Children typically under 17 cannot provide informed consent. Informed Consent for Blood Transfusion Informed consent is essential to patient autonomy. Fresh frozen plasma Can be used for apheresis in thrombotic thrombocytopenic purpura or hemolytic uremic syndrome. Emergent reversal of warfarin in major or intracranial hemorrhage, prophylactically in an emergent surgical procedure.

Acute hemolytic reaction The recipient's antibodies attack transfused red blood cells whether caused by a reaction to the ABO blood group or antibodies produced from previous transfusions. Acute hemolytic transfusions occur Dred Scott Vs Ferguson Plessy Vs Kraemer 24 hours of transfusion. Symptoms include fever, nausea, vomiting, dyspnea, hypotension, bleeding, Decision Making Capacity Case Study at the infusion site, oliguria, anuria, dyspnea, or chest or back pain.

Allergic reaction It can present ranging from mild to life-threatening allergic reactions. Patients with mild symptoms may present with hives. More severe reactions will present with hypotension, angioedema, stridor, respiratory distress, or shock. These symptoms usually Permissive Parenting Style In The Glass Castle within seconds to minutes of beginning a transfusion. It is caused by Decision Making Capacity Case Study inflammatory response to cytokines from the donor. Mistransfusion This can occur if blood products are labeled incorrectly. This can be avoided by Decision Making Capacity Case Study sure the blood bank and the health care worker initiating the transfusion check the blood product to assure it is for the correct patient.

Transfusion-associated circulatory overload Transfusion-associated circulatory overload TACO is caused by the rapid infusion of blood products which overwhelms the recipient's circulatory system. Patients may present with tachycardia, hypertension, dyspnea, and cough. Patients will have pulmonary edema on chest radiography as well as elevated brain natriuretic peptide levels. Transfusion-related acute lung injury Transfusion-related acute lung injury TRALI is caused by an activation of the recipient's immune system causing massive noncardiogenic pulmonary edema that causes hypoxemia.