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Understanding mental capacity
Understanding mental capacity

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2.2 Three common decisions

Some decisions commonly emerge when an older person’s capacity is in question. You will now look at three of them: driving, daily living routines and living alone.

Activity 4 Driving and older people

Timing: Allow about 20 minutes

Read this article from The Conversation about aged drivers. How do you feel about drivers who are elderly?

Driving in old age: why Britons would like more help in deciding when to stop [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]


It would only be natural for anyone who uses public roads to be concerned about drivers aged 100 and over. Safety issues might be raised in terms of eyesight, hearing, mobility, undiagnosed or poorly managed medical conditions, short-term memory, poor awareness of the traffic conditions and personal limitations. The list of risk factors is extensive. However, the drivers in the video clearly have no such concerns and appear to show a reasonable capacity to make the decision as to whether they can drive safely. For more on this, look at the Age Concern webpage Drivers over 70.

In the UK, when a person reaches the age of 70 they have to reapply for their licence every three years. There’s no test or medical examination but the driver does have to make a medical declaration. If this raises concerns, the Driver and Vehicle Licensing Agency (DVLA) make further investigations. Sometimes medical practitioners report drivers about whom they are concerned.

Activity 5 Daily living routines

Timing: Allow about 15 minutes

Visit Eldercare at Home: Problems of Daily Living on the HealthinAging site in the USA. Read about at least two aspects of personal care under the heading ‘What you can do to help’.

Then try to think of some older people who have difficulties with some daily-living tasks. List five examples of when a particularly careful assessment of an older person’s mental capacity would be needed. 

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It is important for older people to have some sense of control over their daily living routines, wherever possible. For people with physical or mental difficulties, this control will be limited. Assessments should be made, reviewed and updated continuously. The review process is often time-consuming, but it is part of the reality of effective mental capacity assessment and empowerment that the detail is important.

Many older people live alone. This is usually in a familiar home that feels comfortable and private. The prospect of surrendering their independence to go into assisted-living or residential care can be unwelcome and is often vigorously resisted. 

Some form of supported accommodation usually needs to be considered when the older person shows signs of forgetfulness, confusion, the early stages of dementia, decreasing standards of personal hygiene, changes in personality or conditions that are hard to self-manage. This decision will usually be considered after a prolonged period of providing support within the home and at a point when such support could no longer guarantee the person’s safety – and when the family was at its limit in the support it could provide. Often a search for alternative accommodation is preceded by a number of falls, hospital admissions and episodes of wandering. 

For the older person, moving into residential care is probably one of the most difficult decisions they have ever had to make. It is at such times that an especially careful assessment of mental capacity is required.

Activity 6 Living alone: Catherine

Timing: Allow about 20 minutes

Imagine that you have a close relative, Catherine, aged 89. She lives alone and has been diagnosed with dementia. You are concerned that she is not coping and is increasingly at risk. You don’t know Catherine very well and don’t see her very often, but as her only surviving relative you feel some responsibility for her.

Yesterday Catherine’s GP telephoned you and asked to talk with you about the possibility of residential care for Catherine. You have made an appointment to meet the GP but before then, you decide to look on the internet for information about dementia care assessment and residential care in your local area, so that you are better informed in advance of your discussion with the GP.

  1. Search online for ‘dementia assessment’ in your local authority area, county, borough, or city.
  2. Explore the search results with Catherine in mind. Look for information about how an accurate appraisal of her situation might be made.
  3. If Catherine were to move into residential care, where might that be in the area you have researched and how much would it cost?


You will have found that a great deal of information, from national organisations, local authorities and local groups. You probably realised that for Catherine, a quick online search is likely to be the beginning of a very long journey. Anyone seeking to help her would need considerable help and advice from a wide range of social care, medial, and financial sources. It is a complicated process when attempting to find the right resources as every person is unique. 

Next, you'll consider more complex decisions that have serious implications for older people and their families.