Tijdschrift voor gerontologie en geriatrie
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Tijdschr Gerontol Geriatr · Nov 2002
[The assessment of competence in cognitively impaired elderly persons: a closer look at the vignette method].
This article focuses on the assessment of competence of elderly persons both with and without cognitive impairment. In total 113 patients of a geriatric clinic were interviewed. Competence was assessed by using two clinical vignettes, representing respectively a hypothetical treatment situation with mild consequences (endoscopy) and one with severe consequences (operation for colon cancer). ⋯ No differences were found for reasoning and appreciation between the cognitively impaired and non-impaired elderly persons. We conclude that competence is less limited by cognitive impairment when assessed in a treatment situation with severe consequences. Therefore, the use of hypothetical vignettes should be carefully reconsidered.
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Competence or decision-making capacity are concepts, which are far from clear-cut. The normative consequences of an incapacity-judgment in elderly care require a balanced approach, which takes into consideration the risk of misuse in the context of the justification of interventions that are applied without consent of the patient. In this article a number of central issues in the debate on decision-making capacity are discussed. ⋯ A number of relevant aspects remain underexposed within this approach. A broader approach is explored, which takes into account the role of emotions, identity, and dialogue and deliberation. The different approaches are illustrated by way of a case example.
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Tijdschr Gerontol Geriatr · Nov 2002
[Competence to make decisions: the psychology of deliberate decision making].
This paper examines the psychological structure of mental competence, conceived of as competence in deliberate decision making. Analysis of that structure may be useful in understanding mental incompetence, as it occurs among some elderly persons. Mental competence not only depends on a number of cognitive abilities, such as foreseeing consequences, but also on the intactness of emotions, insight in one's own emotions, and abilities for emotion regulation.