Capacity Evaluations
Capacity is broadly defined as an individual’s physical or mental ability; however, capacity is more precisely defined in reference to a specific task. For example, capacity to make decisions about one’s medical care might be defined as, “[T]he ability to understand information relevant to a treatment decision and to appreciate the reasonably foreseeable consequences of a decision or lack of a decision.” (Bioethics for Clinicians) Capacity is often confused with competency, which is an ultimate judgment by legal decision. The results of capacity evaluations are not legally binding; rather, in my practice, they are used to determine whether additional supports and/or assistance in certain areas would be beneficial to the testee.
When older adults experience cognitive changes, their loved ones may have concerns about their ability to safely maintain independence in certain areas. One thing I emphasize to clients and their families is that a dementia diagnosis, for example, does not equate to complete dependence in all areas of life — even as the disease progresses. Furthermore, capacity is domain-specific, meaning a person with dementia may lack the requisite capacity in one area but not another. Capacity is also fluid. Someone might lack capacity for a time, such as due to post-operative delirium, but regain capacity when the delirium has resolved.
Areas in which I am trained to evaluate capacity include:
Capacity to live independently
Capacity for medical decision-making
Capacity to manage one’s medications
Driving capacity
Capacity to manage one’s finances
Again, the results of these evaluation are not legally binding and are intended to provide individuals/families with information that helps determine whether supportive services or environmental changes are needed to maximize the safety of people with cognitive impairment. I do not address capacities for criminal matters, such as the capacity to stand trial.