A urinary tract infection or nutritional deficiency can affect an older adult's cognitive ability and make them appear to lack capacity. Cognition may improve after these problems are addressed, so capacity assessment considers more than one observation.
Health problems can affect apparent capacity
Lawyers Mutual Insurance Company of North Carolina gives urinary tract infection and nutritional deficiency as examples of reversible causes that can affect an older client's cognitive ability. The author notes that cognition may improve greatly once those problems are addressed. For an individual health concern, the person and their clinician should discuss what is happening and when reassessment makes sense.
Assess more than cognition
Authors of a qualitative study on healthcare decision-making capacity in old age say an assessment protocol should cover cognition, functionality, depressive symptoms and decision-making abilities. They also highlight the need for a valid assessment tool.
Keep the particular decision in view
A review describes capacity evaluations as decision-specific. It says they typically integrate an interview about the decision, functional abilities, information from people familiar with the person and behavioral observations. Cognitive testing can support the evaluation, but is not determinative.
This page is general education only. It is not medical advice. Talk with your own doctor about your health.
Frequently asked questions
Does agreeing with a care plan establish capacity?
Not necessarily. Occupational therapists in a study of older adults' capacity for independent living said that when an older person went along with a proposed care plan, capacity was generally assumed and not formally assessed. They described assessments being triggered by disagreement with family or clinicians.
Is reduced decision-making capacity easy to miss?
It can be. A 2025 article on older cancer patients reports that decisional incapacity is often underrecognized in older adults. It also says whether capacity is assessed varies by clinician and care setting.
Can a remote assessment settle the question?
Not on current evidence. A scoping review found direct evidence on telehealth capacity assessments for cognitively impaired older adults remains limited. Evidence involving teleneuropsychology is even more limited.
Sources
- Assessing the Legal Capacity of Our Clients - Lawyers Mutual Insurance NC (Lawyers Mutual Insurance Company of North Carolina)
- Healthcare decision-making capacity in old age: A qualitative study (Frontiers in Psychology)
- The role of telehealth models, including teleneuropsychology, in assessing decision-making capacity in older adults with cognitive impairments: a scoping review (Frontiers in Psychology)
- Decision-making capacity evaluation in older cancer patients: A call to action (Palliative & Supportive Care)
- Assessing Older Adults' Decision-Making Capacity for Independent Living: Practice Tensions and Complexities (Journal of Applied Gerontology)
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