Capacity and Cognition Flashcards
What is cognition?
Mental processes and thoughts
Which screening tools can you use to assess cognition?
MMSE
MoCA
AMTS
What must be considered when assessing cognition?
Baseline cognition Medications Pain Alcohol/drug use Environmental factors - sleep deprivation
What would you check in a confusion screen?
TFT - hypothyroid = confusion
B12 and Folate
Glucose
Calcium - hypercalcaemia = confusion
How would you assess between delirium and chronic cognitive impairment?
CAM screening tool
- acute change in mental state?
- Mental state fluctuate throughout day?
- difficulty in focussing and attention?
- thinking disorganised and incoherent
- level of consciousness?
How can you assess pain in the non-verbal demented population?
Abbey pain scale
- vocalisation - whimpering
- facial expression - grimacing
- body language - rocking/guarding
- behavioural changes
- physiological changes - BP/tempterature
- physical changes - skin tears/ulcers
How can you assess ADL’s in the frail population?
Katz-ADL score:
- Transferring
- Toileting
- Bathing
- Dressing
- Feeding
- Continence
- Mobility
What are IADL’s?
Activities that are not necessary for basic functioning but required to live independently in the community:
- Maintain house
- Manage money
- Moving around community independently
- Preparing meals
- Taking medication
- Safety and emergency procedures
What are the key statements in the Mental Capacity Act 2005?
Assume a person has capacity to make a decision unless proven otherwise
Where possible, help people make their own decisions
Dont treat a person as lacking capacity just because they make an unwise decision
If you make a decision for a person lacking capacity, it must be in their best interests
Treatment and care provided for someone lacking capacity must be the least restrictive to their basic rights and freedoms
What is a lasting power of attorney?
2 different roles. You can grant lasting power of attorney to person/people to make decision about:
- health and welfare
- financial affairs and property
Can be same person/people for both roles.
How do you test for capacity?
1 Does the person have an impairment of their mind or brain - due to illness or external factors such as drug/alcohol use
2 Does impairment mean person is unable to make specific decisions when required
What must someone be able to do for you to say they have capacity?
Understand information relevant to decision
Retain information
Use or weigh up information as part of decision making process
What is an advanced decision?
- Legally binding document to refuse treatment.
- Treatment specific
- Written, signed, witnessed if regarding life sustaining treatments
- Can be withdrawn if have capacity
- Overrules courts, LPA and best interestes
What is the process of making a decision for a patient without capacity that has an advanced directive?
1 Decide a person doesn’t have capacity
2 Determine if they have advanced directive
3 Contact family, carers, GP etc.
4 Determine if advanced directive is applicable and valid. If not:
5 Make decision in patients best interests
6 Document why you haven’t followed the advance directive
When would an advanced directive be invalid?
Withdrawn whilst still had capacity
Gave LPA authority to overrule
Demonstrated they had clearly changed their mind
