Considerations of Informed Consent and Decision-Making Competence in Older Adults with Cognitive Impairment

Abstract

Methodological Review Ann M. Mayo, DNSc, RN, CNS; Margaret I. Wallhagen, PhD, GNP-BC, AGSF, FAAN Including older adults with cognitive impairment in research studies is necessary to ensure that interventions designed to improve care are effective for all older adults. However, issues related to capacity to consent raise many difficult questions that nurse researchers must address. Protecting vulnerable participants while simultaneously maintaining autonomy and moving important research forward can be challenging. Assessing the decision-making abilities of understanding, appreciation, reasoning, and expressing a choice is an important aspect of determining decision-making capacity. Yet although this is the prominent rational method for judging decision-making competence, it does not take into consideration the importance of culture, values, and emotions. This article focuses on the assessment of decision-making capacity to consent, recommendations for obtaining informed consent in older adults with cognitive impairment, the use of surrogate decision makers, strategies to maximize research participation, and directions for future research. Dr. Mayo is Professor, Hahn School of Nursing and Health Science, University of San Diego, San Diego, and Dr. Wallhagen is Professor, Department of Physiological Nursing, and Director, John A. Hartford Center of Geriatric Nursing Excellence, University of California, San Francisco, School of Nursing, San Francisco, California. Address correspondence to Ann M. Mayo, DNSc, RN, CNS, Professor, Hahn School of Nursing and Health Science, University of San Diego, 5998 Alcala Park, San Diego, CA 92110-2492; e-mail: amayo@sandiego.edu. 10.3928/19404921-20090401-08 Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. We reserve the right not to post any comments with unsolicited information about medical devices or other products. At no time will Healio be used for medical advice to patients.