Health Care; University of Alberta led research is revolutionizing the way health professionals assess the decision-making capacity of seniors in Edmonton and across the province. The model led to a 60 percent drop in referrals to geriatricians and an 80 percent drop in the number of capacity interviews required when it was first piloted.
They recognized that we actually lacked a clinical process, said Jasneet Parmar, associate professor in the Department of Family Medicine and medical director of the Covenant Health Network of Excellence in Seniors’ Health and Wellness. They had legislative acts and policies; but there was no clarity on how to uncover the evidence to declare whether someone is capable or not.
The health care professionals
They developed an actual pathway to follow, said Lesley Charles, associate professor and director of the Care of the Elderly program at the U of A. They want to cut down on wasted time and testing for both the patient; also the health care professionals. The model has endorse by Covenant Health and Alberta Health Services and adopted in hospitals, medical clinics, home care, supportive living and nursing homes in Edmonton, Calgary and other Alberta centERs.
With the capacity assessment, it’s not their decision that you are judging, but the quality of their decision-making and whether they understand the consequences of their decision, said Parmar. For example, a patient at risk of falling may refuse to leave their home or wear a medical alert system.
First, the medical team must consider whether there is a significant trigger; so that warrants assessment an action or inaction that puts the patient at risk; also is felt to be due to impair decision making, such as wandering or failing to pay bills. The team ensures the patient is medically and psychiatrically stable before performing cognitive and functional tests.
Next, the health care team, the patient and their family come together to brain storm ways to keep the patient safe in their own home. That could mean giving a person who is at risk of falling a portable medical alert device to wear around their neck. Someone who keeps forgetting to turn off their stove could have an automatic timer install or rely on a microwave or Meals on Wheels instead.
Usually these are frail, elderly people with cognitive impairments; also their families are worried about them, said Charles. If you can solve that person’s problem, mitigate the risks and keep them home; so they would say that it’s a fairer process, she added. Nobody wants to take their rights away unless; so it’s an absolute last resort and it’s felt that it’s needed to protect their safety.
It requires extensive training of staff such as social workers, occupational therapists, nurses and physicians. Parmar estimates more than 1,000 Albertan and Canadian health care professionals; so they have through the decision making capacity assessment courses; also they have received requests to share the model from as far afield as Australia and Scotland.
A scenario in the training presentation begins, Think of all the decisions you make in a day where to live; so who your friends are, what you’re going to wear, what to do if you get sick When you see the relief in their faces; also you reduce their anxiety over how to address this complicated topic, it’s very rewarding. You make things simpler and easier for everyone. They always say to staff, remember, you want to do the assessment the way you want it done to you, said Parmar. They are all going to need it one day, and you want somebody to apply this process with integrity.