Capacity to consent and refusing treatment.
Older people without dementia can consent to anything until they die.
You do not lose capacity to consent with “old age” and “ageing”.
Even with cognitive impairment and Alzheimer’s dementia, some patients retain the capacity to consent to some issues.
Consent is really task specific.
An impaired elderly person may not cope with complex legal documents or issues, but may be able to cope with simple decisions.
Their capacity to consent would need to be assessed by a Geriatrician at the time, dealing with the matter at hand.
To have capacity, the person needs to understand the issue that face them, the choices available to them and the consequences of those choices.
I always encourage families of older patients to get formal Enduring Guardianship and Enduring Power of Attorney as soon as possible whilst they are still able to do so.
Once the patient has lost the capacity, this can cause huge complications for the family trying to assist the elderly patient who becomes confused, agitated, resistive to outside help, and who can no longer manage their finances, their daily life affairs or make appropriate decisions about their medical treatment and where they should be living.
The loss of insight into an older person’s care needs is the most challenging and life-threatening situation an older person may have.
Loss of insight is one of the hallmarks of early Alzheimer’s dementia.
The person loses their capacity to make rational decisions about their life affairs, place of living or medical treatment.
Without a pre-existing Enduring Guardianship or Power of Attorney, then the choices that families can make are extremely limited to help their elderly parents.
If their elderly mother or father become aggressive or resistive to any help or interventions, then all the family can do is to wait for the crisis and until they cross the “Thin Red Line” when they end up in the public hospital Emergency Department in crisis.
For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.