Competency Versus Capacity:
Competency is a term used in forensics and is a legal term can refer to a defendant’s capacity to comprehend allegations against them, such as Competency to Stand Trial, or can refer to a person’s competency to handle their own affairs, such as financial or medical decision making. Competency is a global assessment and a legal determination made in court; it is a judicial decision and is decided by the court, though the court often has a psychologist evaluate the individual to provide information on their abilities and functioning.
Capacity refers to an assessment of an individual’s psychological abilities and has four main dimensions: understanding, appreciation, reasoning, and expression of a choice. Capacity is determined by a psychologist, and is fluid and can change over time. An individual may have impaired capacity for a short, temporary period of time or it may last for longer. For example, individuals with dementia may have fluctuations in their capacity. Additionally, capacity should be related to something specific, for example, you may have the capacity to make medical decisions but not have capacity to make financial decisions.
What Is Dementia?
Dementia is a general umbrella term for loss of memory, language, problem-solving abilities, and other cognitive impairments, that are severe enough to interfere with everyday life. There are many different types of dementia. Alzheimer’s disease is the most common form of dementia; however, other types of dementia include Vascular, Lewy Body, Frontotemporal, and Mixed (a combination of two or more types of dementia).
Signs And Symptoms Of Dementia:
Symptoms of dementia are progressive, which means that signs of cognitive impairment start out slowly and gradually get worse over time. Early symptoms of dementia can include memory loss, difficulties concentrating, difficulties or confusion completing a daily familiar task (i.e., using the microwave or stove), word finding difficulties in conversation, being confused about time and place, or mood changes. Other symptoms can include wandering and getting lost in familiar places, repeating questions, using unusual words to refer to familiar objects, hallucinating or experiencing delusions or paranoia, not caring about other’s feelings, or difficulties with balance and movement.
When Should I Be Evaluated Or Have My Loved One Evaluated?
If you or a loved one are experiencing memory difficulties or cognitive changes, see a doctor to determine the cause. Early diagnosis of dementia allows you or your loved one to get maximum benefit from available treatments and allows you to be provided with recommendations to improve your daily functioning.
What Are The Appropriate Steps To Being Evaluated?
Oftentimes, the first step is to visit your primary care physician and they can help you find a specialist (i.e., psychologist who tests for cognitive issues such as dementia, capacity areas, or competency areas). Or you can research and find a specialist in evaluating in these areas. Your psychologist can then evaluate your symptoms and determine a diagnosis. If you have a court case related to Competency or Capacity, you can use the report in that case.
What Types Of Evaluations Are There?
Cognitive and neurological tests are available and used to evaluate thinking and functioning. These can include capacity and competency evaluations which help in determining an individual’s ability to evidence a choice, ability to understand relevant information, ability to appreciate the situation and consequences, and ability to manipulate information rationally.This can be done by asking individuals to respond to what they have been told about their medical condition and interventions, and asking individuals to disclose and paraphrase their understanding of the proposed treatment intervention or diagnostic procedure, or court processes, in combination with psychological testing. For dementia, brain scans can also be used to identify problems that cause dementia and identify any changes in your brain’s structure and function.
What Does This Mean If I Am Diagnosed With Dementia?
Being diagnosed with dementia does not mean you are losing your freedom and independence. In fact, there are specific things you can do to ensure this. Early diagnosis can provide time to plan for the future. You can appoint a power of attorney (POA), which involves a legal document that allows someone else to act on your behalf when you cannot. You can plan ahead to appoint a POA to be a substitute decision-maker for medical decisions, finances, etc. POAs can be complicated and having the help of a lawyer can protect against potential abuses. Lastly, if you are deemed to not have capacity this does not necessarily mean you will be deemed to not have competency. Competency is determined by the court and differs from capacity. If you are deemed not to have competency in some area, trusted loved ones can act as POAs for you; while that can be stressful, you can also still live a fulfilling life.
Summary:
- Competency is a legal term that is determined in court and capacity is the assessment of an individual’s psychological abilities and has four main dimensions: understanding, appreciation, reasoning, and expression of a choice.
- If it is determined by a doctor (psychologist, neuropsychologist, psychiatrist) through testing (cognitive or neurological) that you do not have capacity, then this may lead to not having competency in court, however, this is not always the case.
- A diagnosis of dementia which is characterized by memory loss and cognitive impairments, that are severe enough to interfere with everyday life, may impact one’s capacity and it is important to be evaluated as early as possible.
- Appointing a power of attorney as early as possible can help minimize stress related to decision making in both legal and personal domains.
- Psychotherapy can help alleviate any stress you may experience related to this topic. Ask for a therapist experienced in health psychology, aging, and/or dementia.