In her blog on Friday, Elaine Blades asked what diminished capacity may look like, providing a natural lead-in to our June series of capacity blogs.    

Capacity can seem a nebulous concept at times.  It is to be presumed unless there is clear evidence to the contrary, and is domain-specific rather than global, so a person may be capable in one area and incapable in another.  Capacity is determined based upon a person’s ability to understand information and appreciate the consequences of a decision, which is not always readily apparent.  Certain “stressors” can impact capacity, including: medications, being worried about something, alcoholism, mood disorders, paranoid disorders, delusional disorders, and paranoid symptoms that are secondary to other ailments. 

As professionals, we need to be alert to signs of incapacity in our clients, and we need to remember that some barriers to communication may look like signs of incapacity, and be able to separate these from true signs of incapacity (which is the subject of next week’s blog). 

If capacity is (or becomes) suspected as an issue, probing, open-ended questions should be asked to confirm understanding and appreciation.  How?  By asking clients to re-state information in their own words and looping back to earlier discussions.  Leading questions may not provide evidence of a client’s ability to understand and give instructions.  The answer “yes” or “no” or “I understand” may not mean that a client actually does understand and appreciate, and recording this type of response in contemporaneous notes may not be of much help.

While the following symptoms are not necessarily determinative of a person’s capacity, they are red flags:

• Intellectual impairment, memory problems
• Disorientation, poor attention
• Cannot readily identify assets or family members
• Lack of awareness of risks to self and others
• Incongruence of belief, feeling, and action
• Irrational behavior
• Reality distortion: delusions
• Lack of responsiveness: inability to implement a decision

From our perspective, we are seeing capacity raised as an issue more and more frequently, and not just with elderly clients.  Stay tuned…

 Lesson Learned: Remember to be alert to the signs of incapacity, and when in doubt, ask probing questions.  People are good at masking incapacity, and as a rule of thumb, generally, they are more impaired than they look.