Evaluating Capacity for Safe and Independent Living Among Vulnerable Older Adults

Abstract

Decisions regarding capacity for safe and independent living often arise in elders as they develop increasing frailty and recurrent morbidity. Capacity for safe and independent living is based on a two-dimension model of autonomy: decision-making and executive autonomy. Decision-making can be evaluated using the four criteria of understanding, appreciation, reasoning, and choosing. In contrast, executive capacity focuses on the ability of the vulnerable older adult to implement decisions, either by themselves or with assistance from others, regarding safe and independent living. It involves having a plan, adapting the plan as necessary based on changing circumstances, and delegating responsibilities if physical limitations prevent personally carrying out the plan. When clinically assessing an elder’s capacity for safe and independent living, providers should evaluate decision-making and executive capacity across five functional domains: maintaining personal needs and hygiene, condition of home environment, performing activities for independent living, health-care self-management, and managing financial affairs.