Competence and the Elderly Patient with Cognitive Impairments

Abstract

Objective: The purpose of this paper is to discuss the assessment of competence in the elderly, focusing particulary on individuals with cognitive impairments. Method: An analysis of autonomy forms the basis of an ethical discussion which attempts to modify the existing concept of competence. Results and conclusion: A discussion of the factors which influence competence is presented including variations in situation, task and degree of risk. A critical analysis of four standards of competence is presented, leading to a discussion of the standards which can most successfully promote self-determination in elderly patients. Finally, three classes of competence are suggested which extend the criteria of competence to patients with cognitive deficits.