Mental Health Concerns and The Older Adult
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should take steps to familiarize them- selves with the relevant policies and reg- ulations. Informed consent and diminished capacity The American Bar Association (ABA) and APA created a working group to ad- dress the diminished capacity of the older adult in 2008. The framework is aimed at the psychologist who could be called to determine capacity in a legal, a medical, an ethical, or a civil situation for the older adult in medical, long-term care, or pri- vate practice settings. The healthcare pro- vider should consult their scope of prac- tice for their role in determining capacity. The ABA and APA outline six domains for capacity: medical consent, sexual con- sent, financial, testamentary, driving, and independent living capacities (American Bar Association & American Psychologi - cal Association, 2008). The ABA and APA working group highlights the importance of cultural and age considerations. Cul- tural intricacies such as immigration sta- tus, language, health perceptions, family member roles, and economics must be considered. The ABA and APA caution against ageism and the surrounding neg- ative consequences. Clinical assessment and evaluation of older adult capacity is complex. Older adults have the right to informed consent for treatment. The healthcare provider must be aware of the importance of providing informed con- sent in conjunction with the client’s volun- tary competency. The APA (2022f) defines informed con - sent as a person’s voluntary agreement to participate in a procedure on the basis of his or her understanding of its nature, its potential benefits and pos - sible risks, and available alternatives. Informed consent is a fundamental
requirement of research with humans and typically involves having partic- ipants sign documents, prior to the start of a study, that describes specifi - cally what their involvement would en- tail and noting that they are free to de- cline participation or to withdraw from the research at any time. In therapeu- tic contexts, the principle of informed consent has provided a foundation for do not resuscitate (DNR) orders and other advance directives and for the natural-death acts that have been passed into law throughout the United States. Along the lines of DNR and advanced directives for the older adult is the legal concept of undue influence: Undue influence is defined as a dynam - ic between an individual and another person. It describes the intentional use of social influence, deception, and/ or manipulation to gain control of the decision making of another. For the healthcare worker, undue influence can be understood as a dynamic of a relationship when a person uses a role and power to exploit the trust, depen- dency, and/or fear of another. The role and power permit the person to gain control over the decision making of the victim. In cases of undue influence, a person may have full capacity. Alterna- tively, there may be a cognitive impair- ment that increases susceptibility and dependence. (ABA & APA, 2008, p. 14) Mental capacity can be questioned for the older adult. The healthcare provid- er must differentiate between capacity and competency. Competency is a le- gal (not a medical) concept. The APA (2022b) defines capacity as: ○ The maximum ability of an individual to receive or retain
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