Jason Karlawish, MD, provides an overview of the development and use of the Assessment of Capacity for Everyday Decision-Making (ACED). The ACED is the first tool available with data supporting its reliability and validity to effectively address a common clinical issue: is a patient who refuses an intervention to help manage an instrumental activity of daily living (IADL) disability capable of making this decision?
Jason Karlawish, MD, provides an overview of the development and use of the Assessment of Capacity for Everyday Decision-Making (ACED). The ACED is the first tool available with data supporting its reliability and validity to effectively address a common clinical issue: is a patient who refuses an intervention to help manage an instrumental activity of daily living (IADL) disability capable of making this decision? The ACED is useful for assessing the capacity to solve functional problems of older persons with mild to moderate cognitive impairment from disorders such as Alzheimer’s disease. Common clinical scenarios are the person who has problems performing an IADL, such as cooking, but refuses help to manage that IADL. Is the person capable of refusing this help? The ACED provides patient specific assessments of decisional abilities needed to make that informed refusal. The ACED works well for persons with short term memory impairments since the provided summary sheet can be referred to throughout the interview. The ACED can also help in real-world assessment of a person’s cognitive abilities. It can also inform the assessment of complex cases of the “self-neglect syndrome.” The ACED interview takes 15-20 minutes to administer. At the close of an ACED interview, the interviewer has a set of data that describe the person’s performance on the decision making abilities. (Materials: slide presentation)