Decisional Capacity of Depressed Elderly to Consent to Electroconvulsive Therapy

Abstract

The purpose of this article is to determine the abilities of severely depressed elderly to consent to electroconvulsive therapy (ECT) and to investigate the impact of educational intervention on their capacity. Forty severely depressed adults referred for ECT, with Mini-Mental State Examination scores greater than 20, were recruited. Using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), decisional capacities were assessed at baseline and reassessed after education. Between the 2 assessments, all subjects received standard education, and half of the group was subsequently randomized to receive further education. At baseline, the geriatric group scored lower on understanding, reasoning, and choice and higher on appreciation. After education, all MacCAT-T scores increased for both age groups. Depressed elderly in the sample, as a group, had adequate decisional capacities to consent to ECT. They showed greater improvement in decisional capacity with education. The findings highlight the importance of providing education to the elderly to optimize their ability to give informed consent.

Keywords

geriatric depression electroconvulsive therapy decisional capacity

Get full access to this article

View all access options for this article.

References

1. Lebowitz BD , Pearson JL , Schneider LS , et al. Diagnosis and treatment of depression in late life: consensus statement update. JAMA 1997; 278:1186-1190.

2. US Census Bureau . Statistical abstract of the United States, 2001. Washington, DC: Government Printing Office.

3. Jeste DV , Alexopoulos GS , Bartels SJ , et al. Consensus statement on the upcoming crisis in geriatric mental health. Arch Gen Psychiatry 1999; 56:848-853.

4. Greenberg L , Fink M. The use of electroconvulsive therapy in geriatric patients. Clin Geriatr Med 1992; 8:349-354.

5. O’Connor MK , Knapp R , Husain M , et al. The influence of age on the response of major depression to electroconvulsive therapy. Am J Geriatr Psychiatry 2001; 9:382-390.

6. Weinstock R , Copelan R , Bagheri A. Competence to give informed consent for medical procedures. Bull Am Acad Psychiatry Law 1984; 12:117-125.

7. Appelbaum PS , Grisso T , Frank E , et al. Competence of depressed patients for consent to research. Am J Psychiatry 1999; 156:1380-1384.

8. Roth LH , Lidz CW , Meisel A , et al. Competency to decide about treatment or research. Int J Law Psychiatry 1982; 5:29-50.

9. Culver CM , Ferrell RB , Green RM . ECT and special problems of informed consent. Am J Psychiatry 1980; 137:586-591.

10.

10. Bean G , Nishisato S , Rector NA , et al. The assessment of competence to make a treatment decision: an empirical approach. Can J Psychiatry 1996; 41:85-92.

11.

11. Martin BA , Glancy GD . Consent to electroconvulsive therapy: investigation of the validity of a competency questionnaire. Convulsive Ther 1994; 10:279-286.

12.

12. Levine SB , Blank K , Schwartz HI , et al. Informed consent in the electroconvulsive treatment of geriatric patients. Bull Am Acad Psychiatry Law 1991; 19:395-403.

13.

13. Kim S , Karlawish J , Caine ED . Current state of research on decision-making competence of cognitively impaired elderly persons. Am J Geriatr Psychiatry 2002; 10:151-165.

14.

14. Kim SY , Caine ED , Currier GW , et al. Assessing the competence of persons with Alzheimer’s disease in providing informed consent for participation in research. Am J Psychiatry 2001; 158:712-717.

15.

15. Kim SY , Cox C , Caine ED . Impaired decision-making ability in subjects with Alzheimer’s disease and willingness to participate in research. Am J Psychiatry 2002; 159:797-802.

16.

16. Dunn LB , Lindamer LA , Palmer BW , et al. Improving understanding of research consent in middle-aged and elderly patients with psychotic disorders. Am J Geriatr Psychiatry 2002; 10:142-150.

17.

17. Palmer BW , Nayak GV , Dunn LB , et al. Treatment-related decision-making capacity in middle-aged and older patients with psychosis: a preliminary study using the MacCAT-T and HCAT. Am J Geriatr Psychiatry 2002; 10:207-211.

18.

18. Lapid MI , Rummans TA , Poole KP , et al. Decisional capacity of severely depressed patients requiring electroconvulsive therapy. J ECT 2003; 19:67-72.

19.

19. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.

20.

20. Folstein MF , Folstein SE , McHugh PR . Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189-198.

21.

21. Hamilton M. Development of a rating scale for primary depressive illness. Brit J Soc Clin Psychol 1967; 6:278-296.

22.

22. Grisso T , Appelbaum PS . MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Sarasota, Fla: Professional Resource Press, 1998.