mental capability in the elderly. case presentation mr max rich
TRANSCRIPT
MENTAL MENTAL CAPABILITYCAPABILITY
in thein the ELDERLYELDERLY
CASE PRESENTATIONCASE PRESENTATION
Mr Max RichMr Max Rich
WHAT IS FRAILTY?WHAT IS FRAILTY?
Irremediable dependenceIrremediable dependence
CAUSESCAUSES
cognitive impairmentcognitive impairment
mobility failuremobility failure
bothboth
DementiaDementia
Memory and other Cognitive Impairment
That Affects Daily Function
7
Causes of DementiaCauses of Dementia
• Common
– Alzheimer’s disease
– Vascular dementia
– Mixed AD and VaD
• Less Common– Frontal temporal dementia
– Dementia with Lewy Bodies
– Parkinson’s disease with dementia
– Normopressure Hydrocephalus
Progression
MILD
• forgets recent events
• trouble with complex tasks
• SLOW to understand and accomplish things
MODERATE
• Doesn’t know year or address
• Word-finding trouble
• Very poor short-term memory
SEVERE
• DoesnDoesn’’t recognize relatives t recognize relatives
• Wanders Wanders
• Needs constant supervisionNeeds constant supervision
Who needs evaluation?
A person may• Want to do an important task• Want to make a will• Apparently need help or protection• Have to make an important health
care decision
General Principles
• Capability is Particular• Capability is Presumed• Is incapability permanent?
Mental Incapability
CAUSESCAUSESEasy and Easy and
HardHard
EasyEasy
DementiaDementia
Mood DisordersMood Disorders
PsychosisPsychosis
HardHard
Disorders of judgementDisorders of judgement
Mental retardationMental retardation
Intermittent incapacityIntermittent incapacity
DeliriumDelirium
MedicationMedication
AlcoholAlcohol
Hardest
• Communication problemsCommunication problems• ““out of practice” at taskout of practice” at task
TESTAMENTARY CAPACITYTESTAMENTARY CAPACITY
The bar is low…
1. Nature and effect2. Assets3. Heirs4. Delusional?5. (Undue influence)
Who MIGHT be Incapable?
• Elderly• Strange• Emotional• Drunk etc
Screening For Dementia
1. MMSE (Folstein)2. Montréal Cognitive Assessment(MoCA)3. Sloan’s shortcut
Who ya gonna call??
• Client’s GP• Psychiatrist• Geriatrician• Neurologist
•GP with special interest
