MENTAL MENTAL CAPABILITYCAPABILITY

in thein the ELDERLYELDERLY

CASE PRESENTATIONCASE PRESENTATION

Mr Max RichMr Max Rich

WHAT IS FRAILTY?WHAT IS FRAILTY?

Irremediable dependenceIrremediable dependence

CAUSESCAUSES

cognitive impairmentcognitive impairment

mobility failuremobility failure

bothboth

DementiaDementia

Memory and other Cognitive Impairment

That Affects Daily Function

7

Causes of DementiaCauses of Dementia

• Common

– Alzheimer’s disease

– Vascular dementia

– Mixed AD and VaD

• Less Common– Frontal temporal dementia

– Dementia with Lewy Bodies

– Parkinson’s disease with dementia

– Normopressure Hydrocephalus

Progression

MILD

• forgets recent events

• trouble with complex tasks

• SLOW to understand and accomplish things

MODERATE

• Doesn’t know year or address

• Word-finding trouble

• Very poor short-term memory

SEVERE

• DoesnDoesn’’t recognize relatives t recognize relatives

• Wanders Wanders

• Needs constant supervisionNeeds constant supervision

Who needs evaluation?

A person may• Want to do an important task• Want to make a will• Apparently need help or protection• Have to make an important health

care decision

General Principles

• Capability is Particular• Capability is Presumed• Is incapability permanent?

Mental Incapability

CAUSESCAUSESEasy and Easy and

HardHard

EasyEasy

DementiaDementia

Mood DisordersMood Disorders

PsychosisPsychosis

HardHard

Disorders of judgementDisorders of judgement

Mental retardationMental retardation

Intermittent incapacityIntermittent incapacity

DeliriumDelirium

MedicationMedication

AlcoholAlcohol

Hardest

• Communication problemsCommunication problems• ““out of practice” at taskout of practice” at task

TESTAMENTARY CAPACITYTESTAMENTARY CAPACITY

The bar is low…

1. Nature and effect2. Assets3. Heirs4. Delusional?5. (Undue influence)

Who MIGHT be Incapable?

• Elderly• Strange• Emotional• Drunk etc

Screening For Dementia

1. MMSE (Folstein)2. Montréal Cognitive Assessment(MoCA)3. Sloan’s shortcut

Who ya gonna call??

• Client’s GP• Psychiatrist• Geriatrician• Neurologist

•GP with special interest

John P Sloan MD

tosloan@shaw.ca604 788 4037

24 hours