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Decisional Capacity of Depressed Elderly to Consent to Electroconvulsive Therapy

Mayo Clinic Department of Psychiatry and Psychology, 200 First St. SW, Rochester, MN 55905lapid.maria{at}mayo.edu

Teresa A. Rummans, MD

Mayo Clinic Department of Psychiatry, Mayo Medical School, Rochester, Minnesota

V. Shane Pankratz, PhD

the Mayo Graduate School for Biomedical Sciences, Mayo Clinic Division of Biostatistics, Rochester, Minnesota

Paul S. Appelbaum, MD

Law and Psychiatry Program, University of Massachusetts Medical School, Worcester, Massachusetts

The purpose of this article is to determine the abilities of severely depressed elderly to consent to electroconvulsive therapy (ECT) and to investigate the impact of educational intervention on their capacity. Forty severely depressed adults referred for ECT, with Mini-Mental State Examination scores greater than 20, were recruited. Using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), decisional capacities were assessed at baseline and reassessed after education. Between the 2 assessments, all subjects received standard education, and half of the group was subsequently randomized to receive further education. At baseline, the geriatric group scored lower on understanding, reasoning, and choice and higher on appreciation. After education, all MacCAT-T scores increased for both age groups. Depressed elderly in the sample, as a group, had adequate decisional capacities to consent to ECT. They showed greater improvement in decisional capacity with education. The findings highlight the importance of providing education to the elderly to optimize their ability to give informed consent.

Key Words: geriatric depression • electroconvulsive therapy • decisional capacity

Journal of Geriatric Psychiatry and Neurology, Vol. 17, No. 1, 42-46 (2004)
DOI: 10.1177/0891988703261996


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