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Mental capacity assessments among general hospital inpatients referred to a specialist liaison psychiatry service for older people

  • Fedza Mujic (a1), Maite Von Heising (a1), Robert J. Stewart (a2) and Martin J. Prince (a1) (a3)

Background: Mental capacity has been little studied among older general hospital inpatients.

Methods: A retrospective analysis was undertaken of routinely collected data (age, gender, ethnicity, admission diagnosis, psychiatric diagnosis, Mini-mental State Examination score, whether capacity was assessed, the outcome of that assessment, and discharge destination) on referrals to a liaison psychiatry service for older people (2003–2006) from medical and surgical teams at a large London teaching hospital.

Results: 1267 patients were referred to the service, of whom 379 (30%) were assessed for capacity. The most common mental capacity issues were placement (303 assessed of whom 54% lacked capacity), treatment (86 assessed, 59% lacking capacity) and finances (70 assessed, 79% lacking capacity). Cognitive impairment, dementia and delirium, rather than mental disorders were associated with incapacity. Those assessed and deemed to lack capacity for placement decisions were twice as likely to be placed in a care home, and four times as likely to be placed in an elderly mentally ill (EMI) facility, independent of dementia diagnosis and cognitive functioning.

Conclusion: Referrals to a liaison psychiatry service for older people for assessment of mental capacity are common. The main mental capacity issues in older people were those linked to discharge planning. The relatively high proportion of those found to have capacity when capacity had been queried by referring clinicians attests to the important role of specialist liaison teams, particularly in complex cases, in protecting the autonomy of vulnerable older people, and avoiding institutionalization.

Corresponding author
Correspondence should be addressed to: Dr F. Mujic, South London and Maudsley NHS Foundation Trust, Liaison Psychiatry for Older People, Department of Psychological Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, U.K. Phone: +44 20 32995854; Fax: +44 20 32995855. Email:
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P. S. Applebaum (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357, 18341840.

C. Ball and A. MacDonald (2002). Clinical capacity assessment. Psychiatric Bulletin, 26, 394.

N. Brindle and J. Holmes (2005). Capacity and coercion: dilemmas in discharge of older people with dementia from general hospital settings. Age and Ageing, 34, 1620.

R. Cairns , J. Evans and M. Prince (2004). The impact of NICE guidelines on the diagnosis and treatment of Alzheimer's disease among general medical hospital inpatients. International Journal of Geriatric Psychiatry, 19, 800802.

R. Cairns (2005b). Reliability of mental capacity assessment in psychiatric in-patients. British Journal of Psychiatry, 187, 372378.

L. B. Dunn , M. A. Nowrangi , B. W. Palmer , D. V. Jeste and E. R. Saks (2006). Assessing decisional capacity for clinical research or treatment: a review of instruments. American Journal of Psychiatry, 163, 13231334.

E. Etchells (1999). Assessment of patient capacity to consent to treatment. Journal of General Internal Medicine, 14, 2734.

M. Folstein , S. Folstein and P. R. McHugh (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.

T. Grisso , P. S. Appelbaum , E. P. Mulvey and K. Fletcher (1995). The MacArthur treatment competence study. II Measures of abilities related to competence to consent to treatment. Law and Human Behavior, 19, 127148.

J. Holmes , K. Bentley and I. Cameron (2003). A U.K. survey of psychiatric services for older people in general hospitals. International Journal of Geriatric Psychiatry, 18, 716721.

J. B. Jourdan and L. Glickman (1991). Reasons for requests of competency in a municipal general hospital. Psychosomatics, 32, 413416.

S. Y. H. Kim , E. D. Caine , J. G. Swan and P. S. Appelbaum (2006). Do clinicians follow a risk-sensitive model of capacity determination? An experimental video survey. Psychosomatics, 47, 325329.

F. E. Knowles , J. Liberto , F. M. Baker , P. E. Ruskin and A. Raskin (1994). Competency evaluation in a VA hospital – a 10-year perspective. General Hospital Psychiatry, 16, 119124.

R. Martin (2008). Declining financial capacity in patients with mild Alzheimer's disease: a one-year longitudinal study. American Journal Geriatric Psychiatry, 16, 209219.

J. Moye and D. C. Marson (2007). Assessment of decision-making capacity in older adults: an emerging area of practice and research. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 62, 311.

J. Moye , R. J. Gurrera , M. J. Karel , B. Edelstein and C. O'Connel (2006). Empirical advances in the assessment of the capacity to consent to medical treatment: clinical implications and research needs. Clinical Psychology Review, 26, 10541077.

F. Mujic , C. Hanlon , D. Sullivan , G. Waters and M. Prince (2004). Comparison of liaison psychiatry service models for older patients. Psychiatric Bulletin, 28, 171173.

G. Owen , G. Richardson , A. S. David , G. Szmukler , P. Hayward and M. Hotopf (2008). Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study. British Medical Journal, 337, 4042.

B. W. Palmer , L. B. Dunn , P. S. Appelbaum and D. V. Jeste (2004). Correlates of treatment-related decision-making capacity amongst middle-aged and older patients with schizophrenia. Archives of General Psychiatry, 61, 230236.

B. W. Palmer , L. B. Dunn , C. A. Depp , L. T. Eyler and D. V. Jeste (2007). Decisional capacity to consent to research among patients with bipolar disorder: comparison with schizophrenia patients and healthy subjects. Journal of Clinical Psychiatry, 68, 689696.

R. Rao (2001). Sadly confused: the detection of depression and dementia on medical wards. Psychiatric Bulletin, 25, 177179.

V. Raymont (2004). Prevelence of mental incapacity in medical inpatients and associated risk factors. The Lancet, 364, 14211427.

V. Raymont , A. Buchanan , A. S. David , P. Hayward , S. Wessely and M. Hotopf (2007). The inter-rater reliability of mental capacity assessments. International Journal of Law and Psychiatry, 30, 112117.

S. Ripley , S. Jones and A. MacDonald (2008). Capacity assessment on medical in-patients referred to social workers for care home placement. Psychiatric Bulletin, 32, 5659.

P. Whelan , K. Lawson and S. W. Burton (2007). Service innovation: an old age liaison psychiatry service. Psychiatric Bulletin, 31, 145147.

J. G. Wong , I. C. H. Clare , M. J. Gunn and A. J. Holland (1999). Capacity to make health care decisions: its importance in clinical practice, Psychological Medicine, 29, 437446.

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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
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