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Mental incapacity among patients in medical wards more widespread than doctors realise

This release is also available in German.

Doctors working in medical wards with acutely ill and predominantly elderly patients need to be more aware that mental incapacity among their patients-and therefore the inability to give informed consent about treatment-is a potentially widespread problem.

Although patients' mental incapacity is becoming increasingly important in clinical practice, little information is available on its frequency in inpatients. Matthew Hotopf (Institute of Psychiatry, London, UK) and colleagues estimated the prevalence of mental incapacity in acutely admitted medical inpatients; they also determined the frequency that medical teams recognised patients who did not have mental capacity, and sought to identify factors associated with mental incapacity.

Around 300 acute medical inpatients were recruited to the study. The investigators used different assessments to identify whether patients had mental capacity (the ability to make valid judgements about treatment) and to identify individuals with cognitive impairment. 159 patients were interviewed for the study, of whom the researchers judged 31% to lack mental capacity; however, recognition of incapacity by clinical staff was low: only a quarter of patients identified by the investigators as not having mental capacity were identified by clinicians. Increasing age and cognitive impairment were the main factors associated with a lack of mental capacity.

Professor Hotopf comments: "A substantial proportion of inpatients in any general medical ward do not have capacity to make informed treatment decisions, a situation that is rarely recognised by doctors. If a legal approach to solve this problem is too heavy-handed-eg, requiring patients to be more explicitly identified and protected-then people who would be affected by such legislation could be adversely affected. However, to accept the
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
14-Oct-2004


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