Assessment of older adults' decision-making capacity for independent living: Findings from a nominal group technique meeting in Ireland

Introduction: Occupational therapists are one of the nominated professions who can assess decision- making capacity in according to recent Irish legislation. However, the process of implementing this legislation into practice remains unclear for therapists. The aim of this study was to form a consensus on recommended procedures for occupational therapists when assessing older adults' decision-making capacity for independent living. Methods: A nominal group technique was employed to identify and rank critical dimensions of capacity assessment. Twenty occupational therapists from a range of Irish practice settings participated in a 1-day consensus meeting. Results: Key triggers indicating the need for capacity assessment related to independent living were risk, reduced insight and conflicting stakeholder perspectives on older person's needs (strong consensus). Capacity assessment should consider observations of function, cognitive assessment, and home-based assessment (strong consensus). Strategies to maximise the older person's participation in the capacity assessment and enable occupational therapists to embed will and preference within the capacity assessment process were identified. Conclusion: Findings represent a hierarchical organisation of key components to be considered in capacity assessment of independent living and highlight the role of occupational therapy in assessing and enhancing older adults' decision-making capacity. Consumer and Community Involvement: No consumers/patients of occupational therapists were involved in the study. PLAIN LANGUAGE SUMMARY: Many older people want to stay in their own homes for as long as they can. Occupational therapists assist the person to make this decision. This study looked at how occupational therapists in Ireland help older people make this decision. Twenty therapists agreed on the best way to check if someone can decide to live independently. Sometimes, tests are needed because of safety risks, confusion, or family disagreements. Therapists watch how people do daily tasks, test their thinking, and check their home to help them decide. The study also suggests ways to make sure older people are included in these decisions.