Would a person with dementia automatically be deemed as lacking capacity? (2023)

Would a person with dementia automatically be deemed as lacking capacity?

A dementia diagnosis doesn't necessarily mean you're unable to make important decisions at that point in time. But as symptoms of dementia get worse over time, you may no longer be able to make decisions about things like your finances, health or welfare. This is sometimes referred to as lacking mental capacity.

Assessment of capacity requires a direct interview with the patient using open-ended questions and may include both informal and formal approaches depending on the situation and the context. A baseline cognitive evaluation with a simple test to assess executive function is often useful in capacity evaluation.

The Mental Capacity Act 2005 explains how carers and family members can decide if someone with dementia is able to make decisions for themselves.

People with dementia may have difficulty making some decisions, but will be able to make other decisions themselves. For example, a person might not be able to make decisions about their medical treatment, but could make decisions about what they eat, or which television programmes to watch.

A person lacks capacity if their mind is impaired or disturbed in some way, which means they're unable to make a decision at that time. Examples of how a person's brain or mind may be impaired include: mental health conditions – such as schizophrenia or bipolar disorder.

A person must be assumed to have capacity unless it's proven otherwise. All practicable steps must be taken to support a person to make a decision. A person is not to be treated as lacking capacity because they make an unwise decision.

How is mental capacity assessed? The MCA sets out a 2-stage test of capacity: 1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use? 2) Does the impairment mean the person is unable to make a specific decision when they need to?

Patients have medical decision-making capacity if they can demonstrate understanding of the situation, appreciation of the consequences of their decision, and reasoning in their thought process, and if they can communicate their wishes.

Section 2 of the Mental Capacity Act 2005 says that “a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.”

What is considered lack of mental capacity?

Who lacks mental capacity? The answer is any person who is unable to make a particular decision or take a particular action at the time the decision or action needs to be taken.

Dementia is counted as a disability by the Equality Act 2010, as it causes “long-term physical, mental, intellectual or sensory impairments, which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others”.

People with dementia frequently lose the ability to speak as the disease progresses. However, they continue to communicate in other ways – through body language, gestures and facial expressions. When speech is difficult and the dementia is clouding how the person thinks – exhibiting a behaviour is a way of being heard.

The Act sets out a single clear test for assessing whether a person lacks capacity to take a particular decision at a particular time. It is for the person making the assertion of incapacity to prove that the patient lacks capacity. The test is 'on the balance of probabilities'.

There's no good reason to do that. If they're alert enough, they'll realize they made a mistake and feel bad about it. Even if they don't understand their error, correcting them may embarrass or be otherwise unpleasant for them.

In the codes of practice, the people who decide whether or not a person has the capacity to make a particular decision are referred to as 'assessors'. This is not a formal legal title. Assessors can be anyone – for example, family members, a care worker, a care service manager, a nurse, a doctor or a social worker.

The test to assess capacity

In order to decide whether an individual has the capacity to make a particular decision you must answer two questions: Stage 1 – Is the person unable to make a particular decision (the functional test)?

You can ask the person's doctor or another medical professional to assess their mental capacity. Follow the Mental Capacity Act code of practice when you check mental capacity.

By assuming someone has capacity, opportunities can be provided that enable the person to make their own decisions which helps them to feel empowered, confident and in control. Staff should always assume that a person can make their own decisions.

Presumption of capacity should be assumed. Every effort should be made to empower an individual to make their own decisions. Individuals have the right to make unwise decisions. If an individual lacks capacity, any decisions made about them must be in their best interest.

How would you support someone who does not have capacity to make decisions?

Supporting someone to make decisions themselves

provide all the relevant information they need. avoid overwhelming them with information. present all the options to them. explain the information in a way that's easy for them to understand, for example by using simple language or visual examples.

The functional test of capacity

The ability to retain the information long enough to make the decision; The ability to use, or 'weigh up' the information as part of the decision making process; and. The ability to communicate their decision through any means.

Four Component Model of Decisional Capacity. Capacity for healthcare is generally defined in terms of four dimensions or criteria: (a) Understanding, (b) Appreciation, (c) Reasoning, and (d) Expression of a Choice (Grisso & Appelbaum, 1998a; Roth, Meisel, & Lidz, 1977).

What triggered this assessment? What is the specific decision? What practicable steps have been taken to enable and support the person to participate in the decision-making process? Is the individual able to understand the relevant information?

What triggered the mental capacity assessment? A mental capacity assessment should be undertaken when the capacity of a patient to consent to treatment is in doubt. Lack of capacity cannot be demonstrated by referring to a person's age or appearance, condition or any aspect of their behaviour.

Some types of decisions (such as marriage or civil partnership, divorce, sexual relationships, adoption and voting) can never be made by another person on behalf of a person who lacks capacity.

The legal test of mental capacity is one of a person's ability to make a particular decision at a particular point in time, rather than of his ability to make decisions generally. For example, a person may have capacity to pay bills but lack the capacity to manage investments.

Physicians assess the decision-making capacity of their patients at every clinical encounter. Patients requiring careful assessment can be easily identified using standardized evaluations performed by means of a directed clinical interview or the use of a formal assessment tool such as the ACE^3,12 or the MacCAT.

Being unconscious or barely conscious may cause a temporary lack of capacity, this is because in this state of mind, your awareness and response to your surroundings is significantly less than on an ordinary day, or in more severe cases, you have no awareness of your surroundings and are unable to respond to the same.

It can be: permanent, where someone's ability to make decisions is always affected. This could be because of a stroke or brain injury, severe dementia or learning disability. temporary, where someone has capacity at some times but not others.

Are dementia patients considered disabled?

Dementia can be disabling. However, for the SSA to pay you benefits, your condition needs to prevent you from working for more than 12 months. If you cannot work 40 hours a week due to your dementia symptoms, you should apply for Social Security Disability (SSD/SSDI) or Supplemental Security Income (SSI) benefits.

While dementia does affect mental health, it is not a mental illness, but a disorder of the brain that causes memory loss and trouble with communicating.

Alzheimer's disease progressively destroys brain cells over time, so during the early stages of dementia, many do recognize something is wrong, but not everyone is aware. They may know they are supposed to recognize you, but they can't.

“People living with Alzheimer's may enjoy talking about their families, friends, and the things they like in life, whether it's a hobby, an old TV show, or their favorite foods.”

People with dementia think about the same things that any human thinks about — emotions, relationships, daily life, tasks to accomplish, and more. Receiving a life-changing diagnosis of dementia does not strip a person of their humanity and personhood.

The MCA sets out a 2-stage test of capacity: 1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use? 2) Does the impairment mean the person is unable to make a specific decision when they need to?

People with dementia may have difficulty making some decisions, but will be able to make other decisions themselves. For example, a person might not be able to make decisions about their medical treatment, but could make decisions about what they eat, or which television programmes to watch.

Telling the truth could be cruel

So when we hear about using therapeutic fibbing to lie to someone with dementia, it might seem cruel and wrong at first. But always sticking to the truth, especially about an emotional subject or something trivial, is more likely to cause your older adult pain, confusion, and distress.

How can you tell the difference between dementia and confusion?

However, while delirium refers to a sudden onset of confusion and disorientation, dementia is a progressive condition. It can occur over the course of months and years. Unlike delirium — which usually goes away fairly quickly with treatment — dementia remains a long-term condition.

You can ask the person's doctor or another medical professional to assess their mental capacity. Follow the Mental Capacity Act code of practice when you check mental capacity.

In the codes of practice, the people who decide whether or not a person has the capacity to make a particular decision are referred to as 'assessors'. This is not a formal legal title. Assessors can be anyone – for example, family members, a care worker, a care service manager, a nurse, a doctor or a social worker.

The capacity of large numbers of people to make certain decisions about their life is affected on either a temporary or a permanent basis. A person with a learning disability may lack the capacity to make major decisions, but this does not necessarily mean that they cannot decide what to eat, wear and do each day.

Thus, any licensed physician, physician assistant, or nurse practitioner can and should be able to assess and determine capacity. The foundation of this assessment is the mental status exam (MSE); one cannot determine capacity without this.

The law recognizes three categories of individuals who lack the capacity to contract: minors, individuals with psychological disabilities, and intoxicated persons. If anyone from these categories enters into a contract, the agreement might be considered "voidable" by them.

How is capacity assessed? To have capacity to make a particular decision at a given time a person must be able to: understand the information relevant to the decision, including the consequences of making or not making the decision. retain that information long enough to make the decision.

The Meaning of Lack of Capacity

Lack of capacity is defined in Section 2 of the Mental Capacity Act 2005. This section states that people lack the capacity if a mental impairment prevents them from making decisions. Lack of capacity can apply to both the short and long term.