Decision-making capacity and older adults – Part 1

Decision-making and cognitive decline concerns; Michigan legalities.

As our population continues to age in the United States and Tribal Nations, we may notice an increase in the amount of patients who demonstrate a decline in their ability to make well informed decisions. It is vital for health care providers to be aware of signs that demonstrate a change in a person’s cognition. If a change is occurring this may indicate a change in a patient’s ability to make informed decisions.

Michigan State University Extension says that it is important to schedule a thorough assessment to determine to what extent a patient’s decision making capacity has been affected. It must also be stressed by the health care provider that their patients need to designate an individual who is willing and able to carry out their health care wishes, should they become incapacitated. These wishes ought to be included in the patients’ health care records, accessible to the patient, family and/or caregiver.

These conversations can be difficult for anyone to have with their family, friends, loved ones or with a caregiver. A tool that may be useful during this time is Aging with Dignity Five Wishes. This document allows your family and physician know:

  • Who you want to make health care decisions for you if you can't make them.
  • The kind of medical treatment you want or don't want to receive
  • How comfortable you want to be
  • How you want people to treat you
  • What you want your loved ones to know

As health care professionals it is important to be knowledgeable of the legal definition of diminishing cognitive capacity within the state or tribal nation that you are practicing health care. According to Michigan statute, use of the term "legally incapacitated person" which is defined in the Michigan Probate Code as "a person, other than a minor who is impaired by reason of mental illness, mental deficiency, physical illness or disability, chronic use of drugs, chronic intoxication, or other cause, to the extent that the person lacks sufficient understanding or capacity to make or communicate informed decisions concerning his or her person."

If you are concerned about a person you know and their immediate changing mental ability to make decisions contact your nearest emergency room, physician, law enforcement and loved ones. For more on this topic read Decision making capacity and older adults – Part 2. To learn more about health and nutrition programs offered through MSU Extension please contact myself, Emily Proctor, Tribal Extension Educator with questions or comments at (231)-439-8927 or

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