Date of Award

6-3-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Margaret Drickamer

Abstract

Although caregivers are often faced with determining whether their relatives have the decisio- making ability to solve everyday functional problems, it is unknown whether caregivers' immediate opinions reflect more formal clinical assessments. In this study, we examine whether caregivers' assessments of decision-making ability are consistent with measurements of decision-making ability using the Assessing Capacity in Everyday Decision-making (ACED). This study was cross-sectional, performed in an outpatient specialty clinic. For 39 patients with mild to moderate cognitive impairment, we asked caregivers a series of questions about the patients' overall and specific decision-making ability. Responses were scored on a five-point Likert scale. We measured patient decision-making ability using the ACED instrument. In our analysis, we examined the correlates of caregiver perceptions and determined its relationship with measured decision-making ability using multivariate linear regression. The Spearman correlation coefficients between all caregiver perceptions of patient decision-making ability and ACED scores were less than 0.24 (P > .13). Multivariate analyses, adjusting for the time the caregiver spent with the patient, showed a non-significant relationship between the caregiver perceptions of decision-making as compared to the ACED and the amount of time the caregiver and patient were together. Caregiver opinion may not be reflective of actual measures of decision-making ability. Broader use of objective instruments may be needed to help accurately identify impaired decision-making ability. Disagreement between caregivers' Likert scoring and ACED scores was not predicted by the amount of time the caregiver spent with the patient or by patient or caregiver gender. Caregivers were more likely to underestimate patient decision-making in the categories of meal preparation, medication administration and overall. They were equally likely to over- and underestimate patient decision-making in the category of finances. The caregivers relationship to the patient likely affects the likelihood of underestimation of decision-making ability, although this study was not large enough to confirm these results.

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