Skip to main content Accessibility help

Marginal Competence, Risk Assessment, and Care Decisions: A Comparison of Values of Health Care Professionals and Older Adults

  • Penny MacCourt (a1) and Holly Tuokko (a1)


Using a case scenario involving a marginally competent elderly woman living alone at risk, we assessed the care decisions made by older adults (n = 82) and health care professionals (HCPs, n = 87), and identified differences in the values underlying the care decisions. Overall, participants did not place a high value on independence when they appraised the risk to the client as high and safety as low. Under these conditions, elderly respondents tended to be more paternalistic in their decisions about care, while HCPs tended to be more beneficent. If the values of HCPs differ from those of elderly people, how likely is it that the care provided to marginally competent elderly people will be congruent with their wishes? The care provided by HCPs might be improved by incorporating knowledge of the values and perspectives of other older adults.

Par l’utilisation d’un scénario impliquant une femme âgée vivant seule compétent marginalement à risque, nous avons évalué les decisions liées aux soins réalisés par les adultes plus âgés (n = 82) et les professionnels de la santé (professionnels de la santé, n = 87), et les différences identifiées dans les valeurs qui sous-tendent les décisions relatives aux soins. Dans l’ensemble, les participants n’ont pas placé une grande valeur à l’independance quand on a évalué les risques pour le client comme plus élevé et la sécurité comme aussi bas. Dans ces conditions, les répondants âgés tendaient à être plus paternaliste dans leurs décisions concernant les soins, tandis que les professionnels de la sante ont tendance à être plus salutaire. Si les valeurs des professionnels de la santé diffèrent de ceux des personnes âgées, quelle est la probabilité que les soins dispensés aux personnes âgées peu compétentes seront conformes à leurs désirs? Les soins donnés par les professionnels de la santé pourrait être ameliorés en y incorporant la connaissance des valeurs et des perspectives des autres adultes âgés.


Corresponding author

*Correspondence concerning this article should be addressed to / La correspondance concernant cet article doit être adressées à: Penny MacCourt, PhD Centre on Aging. University of Victoria Sedgewick Building A104 PO Box 1700 STN CSC Victoria, B.C. V8W 2Y2 (


Hide All
Alzheimer, Society, (n.d.). Retrieved from:
Arber, S., & Evandrou, M. (1993). Mapping and territory: Aging, independence and the life course. In Arber, S. & Evandrou, M. (Eds.), Ageing, independence and the life course (pp. 926). London: Jessica Kingsley.
Aronson, J. (1990). Old women’s experiences of needing care: Choice or compulsion. Canadian Journal on Aging, 9(3), 234247.
Bradley, J., Zia, M., & Hamilton, N. (1996). Patient preferences for control in medical decision making: A scenario-based approach. Family Medicine, 28, 496501.
Clark, P. (1991). Ethical dimensions of quality of life in aging: Autonomy versus collectivism in the United States. The Gerontologist, 31, 631639.
Clark, P. (1997). Values in health care professional socialization: Implications for geriatric education in interdisciplinary teamwork. The Gerontologist, 37(4), 441451.
Clemens, E., & Hayes, H. (1997). Assessing and balancing elder risk, safety and autonomy: Decision-making practices of health care professionals. Home and Health Care Services Quarterly, 16(3), 321.
Clemens, E., Wetle, T., Feltes, M., Crabtree, B., & Dubitzky, D. (1994). Contradictions in case management: Client-centred theory and directive practice with frail elderly. Journal of Aging and Health, 6(1), 7088.
Clouder, L. (2003). Becoming professional: Exploring the complexities of professional socialization. Health and Social Care, 2(4), 213222.
Degenholtz, H., Kane, A., & Kivnick, Q. (1997). Care-related preferences and values of elderly community-based LTC consumer: Can case managers learn what’s important to clients? The Gerontologist, 37(6), 767776.
Egri, C.P., & Ralston, D.A. (2004). Generation cohorts and personal values: A comparison of China and the United States. Organization Science, 15(2), 210220.
Feinberg, L., & Whitlatch, C., (2001). Are persons with cognitive impairment able to state consistent choices? The Gerontologist, 41(3), 374382.
Fitzsimmons, D., George, S., Payne, S., & Johnson, C.D. (1999). Differences in perception of quality of life issues between health professionals and patients with pancreatic cancer. Psycho-Oncology, 8, 135143.
Healy, T. (1999). Community-dwelling cognitively impaired frail elders: An analysis of social workers’ decisions concerning support for autonomy. Social Work in Health Care, 30(2), 2747.
Horowitz, A., Silverstone, B., & Reinhardt, J. (1991). A conceptual and empirical exploration of personal autonomy issues within family caregiving relationships. The Gerontologist, 312(1), 2331.
Kane, R. (2000). Values and preferences. In Kane, R. & Kane, R. (Eds.), Assessing older persons: Measures, meaning, and personal applications (pp. 237260). New York: Oxford University Press.
Kane, R., Bershadsky, B., & Bershadsky, J. (2006). Who recommends long-term care matters. The Gerontologist, 46, 474482.
Kane, R., Rockwood, T., Finch, M., & Philp, I. (1997). Consumer and professional ratings of the importance of functional status components. Health Care Financial Review, 19(2), 1122.
Kapp, M. (1997). Who is responsible for this? Assigning rights and consequences in elder care. Journal of Aging & Social Policy, 9(2), 5164.
Katz, A., Conant, L., Inui, T., Baron, D., & Bor, D. (2000). Council of elders: Creating a multi-voiced dialogue in a community of care. Social Science & Medicine, 50(6), 851860.
Kaufman, S. (1994). Old age, disease, and the discourse on risk: Geriatric assessment in U.S. health care. Medical Anthropology Quarterly, 8, 7693.
Kaufman, S. (1995). Decision making, responsibility, and advocacy in geriatric medicine: Physician dilemma with elderly in the community. The Gerontologist, 35(4), 481488.
Kaufman, S., & Becker, G. (1996). Frailty, risk, and choice: Cultural discourses and the question of responsibility. In Smyer, M., Schaie, K. & Kapp, M. (Eds.), Older adults’ decision-making and the law (pp. 4871). New York: Springer Publishing Company.
Keating, N., Fast, J., Connidis, I., Penning, M., & Keefe, J. (1997). Bridging policy in elder care. Canadian Journal on Aging, (Suppl.), 2241.
Kelly, L., Knox, J., & Gekoski, W. (1998). Women’s views of institutional versus community-based long-term care. Research on Aging, 20(2), 218245.
King, S., Collin, C., & Liken, M. (1995) Values and the use of community services. Qualitative Health Research, 5(3), 332347.
Kluge, E. (2005). Competence, capacity, and informed consent: Beyond the cognitive-competence model. Canadian Journal on Aging, 24(3), 295304.
Krothe, J. (1997). Giving voice to elderly people: Community-based long-term care. Public Health Nursing, 14(4), 217226.
Lawton, M., Moss, M., Hoffman, C., Grant, R., Have, T., & Kleban, M. (1999). Health, valuation of life, and the wish to live. The Gerontologist, 39(4), 406416.
Lindsay, C. (2000). Senior women. In Women in Canada (pp. 269280). Ottawa, Canada: Statistics Canada.
Mack, R., Salmoni, A., Viverais-Dressler, G., Porter, E., & Garg, R. (1997). Perceived risks to independent living: The views of older, community-dwelling adults. The Gerontologist, 37(6), 729736.
McCullough, L., Wilson, N., Teasdale, T., Kolpakchi, A., & Skelly, J. (1993). Mapping personal, familial, and professional values in long-term care decisions. The Gerontologist, 33(3), 324332.
Miller, D., & Bolla, L. (1998). Patient values. A guide to medical decision making. Acute Hospice Care, 14(4), 813829.
Moody, H. (1987). Ethical dilemmas in nursing home placement. Generations, Summer, 11(4), 1623.
Otto, R., Dobie, R., Lawrence, V., & Sakai, C. (1997). Impact of a laryngectomy on quality of life: Perspective of the patient versus that of the health care provider. Annals of Otology, Rhinology and Laryngology, 106, 693699.
Ouslander, J., Tymchuk, A., & Rahbar, B. (1989). Health care decisions among elderly long-term care residents and their potential proxies. Archives of Internal Medicine, 149, 13671372.
Porter, E. (1994). “Reducing my risks”: A phenomenon of older widows’ lived experience. Advances in Nursing Science, 17(20), 5465.
Raymond, L., & Wentworth, B. (1993). Autonomy and safety: The client’s perspective. Topics in Geriatric Rehabilitation, 9(1), 4756.
Reisberg, B., Ferris, S., de Leon, M., & Crook, T. (1982) The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 11361139.
Shidler, S. (1998). Participation of chronically ill older adults in their life prolonging treatment decisions: Rights and opportunity. Canadian Journal on Aging, 17(1), 123.
Silberfeld, M. (1992). The use of ‘risk’ in decision-making. Canadian Journal on Aging, 11(2), 124136.
Silberfeld, M., & Fish, A. (1994). When the mind fails: A guide to dealing with incompetency. London: University of Toronto Press.
Tuokko, H., MacCourt, P., & Heath, Y. (1999). Home alone with dementia. Aging & Mental Health, 3(1), 2127.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed