Conceptual Challenges and Practical Approaches to Screening Capacity for Self-care and Protection in Vulnerable Older Adults

摘要

Identifying impairments in the capacity to make and execute decisions is critical to the assessment and remediation of elder self-neglect. Few capacity assessment tools are available for use outside of health care settings and none have been validated in the context of elder self-neglect. Health and social services professionals are in need of validated tools to assess capacity for self-care and self protection during initial evaluations of older adults with suspected self-neglect syndrome. Currently, legal and medical declarations of incapacity and guardianship rely on clinical evaluations and instruments developed to assess only decision-making capacity. This paper first describes the conceptual and methodological challenges to assessing the capacity to make and execute decisions regarding safe and independent living. Second, the paper describes the pragmatic obstacles to developing a screening tool for the capacity for self-care and self protection (SC&P). Finally, the paper outlines the process for validation and field testing of the screening tool. A valid and feasible screening tool can then be used during field assessments by social services professionals to screen for potential impairments in the capacity for self-care and protection in vulnerable older adults.