How to Determine Competency in the Elderly

Instructor: Laurie Smith
As people age, mental capacity issues may arise, which could interfere with daily functioning. This lesson will discuss how to recognize signs and symptoms of competency issues in the elderly and how competency in the elderly is legally determined. Updated: 05/03/2021


Jim is a physically healthy 75-year-old, who keeps himself busy with golf and the occasional neighborhood card game. Over the past year, his daughter Julie has noted some changes in Jim's behavior. Jim seems to be forgetful and misplaces things like his keys on a regular basis. Last week, Julie noticed that Jim forgot to take his blood pressure medication on two separate occasions and didn't show up for a lunch date they had planned weeks ago. Julie wonders if Jim's behavior is simply related to getting older or might be a warning sign of something more serious.

Competency is a term frequently used in legal matters to describe someone's capability of making sound decisions and interpretations. To be considered competent, individuals need to be able to:

  • Comprehend information that is presented to them
  • Understand the importance of such information
  • Make sound decisions among provided choices
  • Understand the potential impact of their decisions

As such, a person is mentally competent when they are able to react to situations in a way that is seen as socially acceptable and recognized as being of sound judgment. A person who is determined to be unable to make sound decisions and interpretations is deemed as being incompetent.

Determining Competency

It's often very difficult to watch a loved one struggle with memory and competency issues, yet it's important to recognize when a determination regarding competency has to be made in the best interest of the individual. The following steps are usually involved when making a determination of competency:

  1. Visiting the doctor for a complete physical evaluation. While physicians can't make the determination whether or not someone is incompetent or competent, they can conduct a thorough physical exam that can help them determine whether a competency issue might be present. Medications can be prescribed to assist with memory issues as well.

  2. Gathering insight. Interviewing the elderly patient and friends and relatives of the patient can provide substantial information when mental competency is in question.

  3. Utilizing psychological tests or assessments. Assessments can be quite useful in helping someone determine whether or not a competency issue exists and how far it has progressed.

  4. Evaluating current functioning and comparing it to prior functioning.

  5. Requesting a complete mental evaluation. A competency mental health evaluation is commonly referred to as a mental status exam, and it evaluates the mental capacity of a patient based on self-report, observation of behavior and speech, evaluation of mood, and testing memory.

The final determination of whether or not an elderly person is considered to be competent rests with the courts. Obviously, the courts hesitate on declaring incompetence because this often involves taking critical life decision-making power away from the individual and placing it with someone else designated by the court. In essence, it takes away an individual's freedom. It is therefore crucial that a holistic approach, involving all the steps and resources we just discussed, be taken when an elderly person's competence is called into question.

Judicial Declaration of Incompetence

As mentioned, the judicial system is responsible for making the final determination on whether or not someone is competent. In order to judge a person as incompetent, the courts require the petitioning party to present evidence that is clear and convincing. In cases involving competence decisions, it is common for the court to hear evidence from relatives and acquaintances, healthcare providers, and social workers, among others.

The courts usually do everything they can to limit judgments of incompetence to certain tasks. For example, people may be deemed incompetent to manage their finances but can still be ruled competent to care for themselves. When the court rules that an individual is fully or partially incompetent, the court will appoint a guardian to manage these areas for the elderly person.

What Affects Competency?

Mental competency can be impacted by physiological and psychiatric disorders. Anxiety, post-traumatic stress disorder, schizophrenia, brain injuries, and being under the influence of alcohol and/or drugs can all impact competency. Perhaps the greatest causes of concern when assessing competency in the elderly, however, are memory issues.

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