Advanced age and decisional capacity: The effect of age on the ability to make health care decisions

• A smaller proportion of older than younger patients lacked decisional capacity to make their own health care decisions.
• Though, cognitive disorders remained the main confounder for decisional incapacity, in particular in elderly patients.
• Whereas in patients <65 years, psychosis, substance use and neurological disorders caused decisional impairment.

ObjectiveCognitive disorders, including dementia, have been shown to be predictors of decisional incapacity, even more than psychotic or substance use disorders. Nonetheless, the impact of advanced age on decisional capacity remains understudied.MethodOut of more than 2500 consecutive psychiatric consultations performed by the Consultation-Liaison service at Bellevue Hospital Center in New York City, 266 completed decisional capacity assessments were identified and analyzed with respect to the indications for referral and the impact of age and other sociodemographic, medical and psychiatric variables on decisional capacity.ResultsBy itself, in this sample advanced age was not associated with impaired medical decision-making. In individuals ≥65 years old, among whom only 27% were deemed to have decisional incapacity, cognitive disorders including dementia remained the strongest association with this incapacity; meanwhile, in patients <65, decisional impairment was evident in 62%, and delirium, psychosis and neurological disorders caused more decisional impairment. The main indications for referral were placement refusals in those ≥65, while young patients were largely seen due to their desire to leave the hospital against medical advice.ConclusionAdvanced age by itself failed to be associated with decisional incapacity in this sample. In those ≥65, cognitive disorders remained the main association with such incapacity, versus psychosis, substance use and neurological disorders in younger patients.