37 - Ethical Issues and Practical Strategies to Assess and Enhance Decisional Capacity in Older Adults

While the law tends to see decisional capacity as binary (present or absent), neuropsychologists recognize that functional abilities exist along a continuum, impacted by cognitive strengths and weaknesses and the context and complexity of the decisions being made. In this workshop, we will first review decisional capacity, guardianship and conservatorship, and two specific civil capacities relevant to the older adult—testamentary capacity and capacity to live independently. We will then examine practical and ethical challenges that arise when evaluating decision making in older adults, and provide a framework for assessing decisional capacity that incorporates legal standards, functional abilities, risk of harm, and individual choice. Finally, we will consider specific steps that can be taken to support, optimize, and/or restore decisional capacity, including treatments and accommodations that emphasize individual preference and autonomy. Case examples will be used throughout to highlight ethical, legal, and practical issues and the assessment strategies discussed.