Time to take away the car keys or the checkbook? Evaluating capacity
June 26, 2013
I’ve seen it twice in less than a month. First was the silver-haired woman whose car passed mine, headed in the wrong direction, when she turned into the freeway off-ramp. I honked to get her attention. She kept going. As she continued on the off-ramp, a chorus of horns were blaring. Even if she realized they were aimed at her, all her options were dangerous by that point.
Next, I saw a silver-haired gentleman stopped by a CHP officer after he turned into the same off-ramp. He may lose his license, which is better than the other possibilities.
Longevity brings its own issues, for which we need to be prepared. Whenever an older person is in a decision-making position — whether behind the wheel, in the checkbook or in the kitchen — it raises the question: “Does this person have the capacity to do so safely?”
Unfortunately, there is no single test to determine a person’s capacity. The abilities needed to drive are different from those needed to manage finances, make a will or make medical decisions.
Safety is the overriding consideration when determining capacity. Ensuring that older adults are safe from physical, emotional, and financial harm caused by their own actions — or the actions of others — is the first part. Making sure they do not inadvertently harm others is the other part of that equation.
Generally, the more serious the risk, the higher the functioning needed. The American Bar Association and the American Psychological Association collaborated on an approach to determining such capacity.
The joint publication “Assessment of Older Adults with Diminished Capacity, A Handbook for Lawyers” recommends letting a trained and experience clinician make a formal assessment, especially when it is important to:
• Clarify specific areas of diminished capacity
• Give advice on strategies to enhance capacity
• Identify the need for protective action
• Address concerns of family members
A neuropsychological evaluation offers the information needed to determine individual ability for decision making about the capacities in question. The evaluation addresses such fundamental abilities as memory for new information, communication or comprehension problems, visual-spatial difficulties, lack of mental flexibility, difficulty with calculation and problem solving.
The evaluation also identifies treatable conditions that may be interfering with capacity, such as grief, depression, anxiety and stress.
It is difficult to watch a loved one’s abilities decline and to restrict privileges, some of which define a person’s adult life. It is even more difficult to see your loved one harmed or harming others. If you have concerns about an older adult’s ability to manage the activities of daily life safely, a neuropsychological evaluation is the only definitive answer.
Dr. Bonnie Connor is a California licensed psychologist (PSY 22446) allied with Sierra Nevada Memorial Hospital. She has a private practice in Nevada City, where she specializes in neuropsychological services for older adults, active duty military, first responders, and individuals with concussion and brain injury. For information, see http://bonnieconnor.com.