Assessment of Older Adults with Diminished Capacity: A Handbook for Psychologists

Assessment of Older Adults with Diminished Capacity: A Handbook for Psychologists

Book Review by Patricia J. Walz, Ph.D.

This is a book published in 2008 by the American Bar Association Commission on Law and Aging in conjunction with the American Psychological Association. The goal of the book is to review six civil capacities of importance to older adults, namely medical capacity, sexual consent capacity, financial capacity, testamentary capacity, capacity to drive and capacity to live independently.  The handbook also addresses emerging areas of interest such as the capacity to mediate, capacity to participate in research and capacity to vote.   The handbook provides not only insight into the conceptual elements below, but also suggests assessment instruments that may be helpful to the psychologist. It was printed in 2008 so it’s a bit dated, but it’s a great resource for psychologists.


The nine conceptual elements for conducting a capacity assessment are:

  1. Identifying the applicable legal standard(s)
  2. Identifying and evaluating functional elements constituent to the capacity
  3. Determining relevant medical and psychiatric diagnoses contributing to incapacity
  4. Evaluating cognitive functioning
  5. Considering psychiatric and/or emotional factors
  6. Appreciating the individual’s values
  7. Identifying risks related to the individual and the situation
  8. Considering means to enhance the individual’s capacity
  9. Making a clinical judgment of capacity


You may not need to be a forensic psychologist or neuropsychologist to address capacity in an older patient, but you should investigate the referral to determine if you have the professional competence based on education, consulting, or study as required by the APA Ethical Principals of Psychologists and Code of Conduct. With the growing geriatric population, psychologists are more frequently called upon to answer questions of capacity and this handbook can aid in that process.  Psychologists who are new to the assessment of capacity in older adults are encouraged to consult with colleagues or pursue additional education, training and supervision in the area.


Cases involving older adults are complex and challenging because there are often many layers to consider, as older adults are complex.  They consist of a lifetime of psychological, social, cultural, and biological factors that contribute to the individual’s specific strengths, weaknesses, social system, lifestyle and values.


The term capacity if used rather than competency because the term competency should only refer to a legal finding whereas the term capacity refers to clinical findings.  Another distinction is the difference between global and specific capacity.  The term “competency” has been used to refer to a person’s global ability to engage in a range of functions. However, within the global term of competency there is the ability to perform certain functions, intra-individual variability in performance across functional domain, and potential methods of enhancing an individual’s ability to perform functions.


You can obtain this handbook free as an Adobe download by clicking here or by Googling the title.


Review Written by
Patricia J. Walz, Ph.D.
Licensed Psychologist
Ft. Smith, Arkansas