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Capacity to make decisions on medication management in Chinese older persons with mild cognitive impairment and mild Alzheimer's disease

Published online by Cambridge University Press:  16 February 2012

Victor Wing-Cheong Lui*
Affiliation:
Department of Psychiatry, Tai Po Hospital, Hong Kong
Linda Chiu-Wa Lam
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
Rachel Ching-Man Chau
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
Ada Wai-Tung Fung
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
Billy Mou-Lam Wong
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
Grace Tak-Yu Leung
Affiliation:
Department of Psychiatry, Tai Po Hospital, Hong Kong
Kwok-Fai Leung
Affiliation:
Occupational Therapy Department, Queen Elizabeth Hospital, Hong Kong
Helen Fung-Kum Chiu
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
Jason H. T. Karlawish
Affiliation:
Division of Geriatric Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Paul S. Appelbaum
Affiliation:
Division of Law, Ethics, and Psychiatry, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, USA
*
Correspondence should be addressed to: Dr. Victor Wing-Cheong Lui, Department of Psychiatry, Tai Po Hospital, 9 Chuen On Road, Tai Po, Hong Kong. Phone: +852 26076111; Fax: +852 26623568. Email: victorluiwc@hotmail.com.

Abstract

Background: This study aimed to assess if decisional capacity and the four decision-making abilities related to decisions concerning medication management were impaired among community-dwelling Chinese older persons in Hong Kong with amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), as compared with cognitively normal older adults.

Methods: Two hundred and ninety-one Chinese community-dwelling older adults were recruited. The four decision-making abilities and decisional capacity were assessed by using the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED) and independent clinician ratings based on the definition in the UK Mental Capacity Act 2005, respectively.

Results: Ninety-nine participants (34%) were diagnosed with MCI and ninety-five (33%) with mild AD. Although almost all (96%) of the participants in the MCI group were found to be mentally competent to make decisions on medication management in clinician ratings, their decision-making abilities as measured by the ACED were significantly lower than those of the cognitively normal controls.

Conclusions: Results from this study suggest that abilities related to decisions on medication management are impaired before the clinical diagnosis of dementia is made. Use of specific and structured assessment of the relevant decisional abilities may enhance clinical judgment.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2012

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