Occupational Therapy Practice In Assessment Of Older Person’s Decision Making Capacity To Return Home-An Exploratory Study

Introduction

Decision Making Capacity (DMC) refers to an individual’s ability to make a reasoned and informed decision. In Ireland the older population is increasing and associated with ageing are functional and cognitive decline which are linked to reduced decision making abilities. In an acute hospital an individual’s DMC is often questioned and a DMC assessment takes place. Occupational therapists are involved in this process and evaluate an individual’s cognitive and functional abilities. This study sought to explore the practices of occupational therapists in this process.

Aims and Objectives

Aim: To explore occupational therapists assessment practices in DMC of the older person to live independently.
Objectives: To examine occupational therapists understanding of DMC, assessments used in process and to explore the outcomes of assessment findings.

Methods

The study employed a qualitative description design using semi-structured interviews with ten hospital occupational therapists from seven hospitals. Key themes emerged from analysing the data using thematic analysis.

Results

Three themes emerged from the data; Pre-assessment, Assessment and Post Assessment. Pre-assessment, participants formed their understanding of DMC and sought to build a detailed picture of the individual prior to their hospital admission. The assessment phase consisted of standardised and non-standardised assessments. Standardised assessments were used to evaluate cognitive performance while non- standardised assessments evaluated an individual’s Instrument Activities of Daily Living (IADL’s). Assessments focussed on IADL performance and if possible were completed in the home environment. Post Assessment all results were documented in the medical chart and verbally to the multidisciplinary team and focussed on the level of assistance an individual would require for independent living.

Conclusion

Observational assessments of IADL’s in particular in the individual’s home were considered the most pertinent part of the occupational therapy assessment.

Implications

Occupational therapists require practice guidelines and further training to support their involvement in this process.