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Am J Geriatr Psychiatry 16:693-696, August 2008
© 2008 American Association for Geriatric Psychiatry
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Brief Reports

Everyday Decision-Making Ability in Older Persons With Cognitive Impairment

James M. Lai, M.D., Thomas M. Gill, M.D., Leo M. Cooney, M.D., Elizabeth H. Bradley, Ph.D., Keith A. Hawkins, Psy.D., and Jason H. Karlawish, M.D.

From the Department of Internal Medicine, Section of Geriatric Medicine, (JML, TMG, LMC); The Departments of Epidemiology and Public Health, (EHB); Department of Psychiatry, Yale University, New Haven, CT (KAH); and Department of Medicine, Division of Geriatrics, Leonard Davis Institute of Health Economics, Center for Bioethics, Center for Clinical Epidemiology and Biostatistics, Alzheimer's Disease Center, and Institute on Aging, at the University of Pennsylvania, Philadelphia, PA (JHK).

Objective: To demonstrate the reliability and validity of the Assessment of Capacity for Everyday Decision-Making (ACED), an instrument to evaluate everyday decision-making.

Methods: The authors administered the ACED to 39 persons with very mild to moderate cognitive impairment and 13 cognitively intact caregivers.

Results: Intraclass correlation coefficients showed good reliability for the measures of understanding, appreciation and reasoning, and Cronbach's {alpha} coefficients were ≥0.84 for all three decision-making abilities. The ACED also had a moderate to strong correlation with the MacArthur Competency Assessment Tool for Treatment, a validated measure of decision-making capacity for medical treatment decisions, and measures of overall cognition. Associations with measures of executive function were mixed, with moderate correlations observed only with ACED understanding and reasoning performance.

Conclusion: The ACED is a reliable and valid measure to assess decision-making capacity. It may serve as an important addition to current methods used to assess everyday decision-making.

Key Words: Capacity • decision-making • activities of daily living • cognitive impairment






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