End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness
| Autor: | Johannes Lodewikus Roos, Carla Kotze, Rene Ehlers |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
decision-making capacity
Psychiatry medicine.medical_specialty business.industry RC435-571 end-of-life Mental illness medicine.disease elderly End of life decision Psychiatry and Mental health Vignette serious mental illness Structured interview medicine values Psychiatric hospital Observational study Older people business Diagnosis of schizophrenia Original Research |
| Zdroj: | Frontiers in Psychiatry, Vol 12 (2021) Frontiers in Psychiatry |
| ISSN: | 1664-0640 |
| DOI: | 10.3389/fpsyt.2021.752897/full |
| Popis: | Background:The study's main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Methods:A cross-sectional, observational study, was done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness. The Mini-Cog and a semi-structured clinical assessment of end-of-life decision-making capacity was done before a standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardized instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results:The Assessment of Capacity to Consent to Treatment scores correlated (p< 0.001) with the outcomes of the semi-structured decision-making capacity evaluation. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p< 0.001); a duration of serious mental illness of 30–39 years (p= 0025); having a diagnosis of schizophrenia spectrum disorders (p= 0.0007); and being admitted involuntarily (p< 0.0001). A main finding was that 65% of participants had decision-making capacity for end-of-life decisions, were able to express their values and engage in advance care discussions.Discussion and Conclusion:Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Many older patients with serious mental illness can engage in end-of-life discussions and can make autonomous decisions about preferred end-of-life care. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values. |
| Databáze: | OpenAIRE |
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