For an individual to make an informed consent decision, capacity or competence is a prerequisite. This is a growing concern with an aging population as older adults can exhibit a wide range of cognitive function. Older individuals are not only becoming a larger percentage of the populations but they are also living longer. It is essential for the clinician to determine the cognitive status of the patient he/she is planning to treat.
The elements of capacity include understanding, appreciation and reasoning. These elements are measured by a person’s ability to express their wishes, understand information, reason and arrive at a decision. Questioning the patient as to how he or she is understands the risks to treatment or why they are declining treatment are among the ways to explore the capacity of a patient. There are objective assessment instruments that can be utilized to help with this determination and routinely used by primary health care providers. Treating a person with a cognitive impairment can present a range of ethical dilemmas. In the dental setting, assuring that a patient has capacity may often require reaching out to the family, the primary care physician or surrogate decision maker. It is not uncommon for an individual have transient or diminished capacity which is the ability to express their wishes on one day and not the next. Being aware of the issues of capacity will assist the clinician in providing ethical and legal oral health treatment to geriatric and special need populations.