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A collaborative model for research on decisional capacity and informed consent in older patients with schizophrenia: Bioethics unit of a geriatric psychiatry intervention research center

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Abstract

Rationale

The numbers of older persons with psychiatric disorders are expected to rise rapidly in coming decades, yet most studies of the safety and efficacy of treatments for such disorders have focused on younger adults. A substantial expansion in research involving older patients is needed to meet the treatment needs of this fast growing group. A critical issue in intervention research is ensuring a patient's decision-making capacity. Considerable heterogeneity exists in this regard even within diagnostic groups. Cognitive changes as well as increased complexity of medication regimens in elderly patients may make it particularly difficult for some older persons to fully understand, appreciate, and/or reason about the risks and benefits of participating in any particular study.

Objectives

Empirical research into assessing and possibly improving decisional capacity is warranted in older people with severe mental illness. Such research may be accomplished through collaborations among specialists from various related disciplines and, importantly, with active involvement of community partners.

Methods

We present one model of this type of collaboration, the Bioethics Unit of an Intervention Research Center, comprising a multi-disciplinary team along with a Community Advisory Board.

Results

Preliminary studies in our Center suggest that older individuals with psychotic disorders vary considerably in their decisional capacity, and many subjects appear to be fully capable for consenting to research projects. Furthermore, the patients' level of understanding of the consent material can be improved significantly through repetition and clarification of key elements in the consent form.

Conclusions

The decisional capacity for a given research protocol is not necessarily an unmodifiable trait, but can be enhanced with improvements in consenting procedures, even in older persons with psychotic disorders.

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Acknowledgements

This work was supported, in part, by NIMH grants MH49671, MH43693, MH59101, by the National Alliance for Research on Schizophrenia and Depression, and by the Department of Veterans Affairs.

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Authors and Affiliations

  1. Department of Psychiatry and Neurosciences, University of California San Diego and VA San Diego Healthcare System, San Diego, Calif., USA

    Dilip V. Jeste

  2. University of California San Diego and VA San Diego Healthcare System, 116A-1, 3350 La Jolla Village Drive, San Diego, CA 92161, USA

    Laura B. Dunn, Barton W. Palmer & Maureen Halpain

  3. University of Southern California Law School, 699 Exposition Boulevard, Room 303, Los Angeles, CA 90089-0071, USA

    Elyn Saks

  4. Adult Protective Services Inc., 2840 Adams Avenue, Ste 103, San Diego, CA 92116-1404, USA

    Alison Cook

  5. Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA

    Paul Appelbaum

  6. University of California, San Diego (0622), 9500 Gilman Drive, San Diego, CA 92093, USA

    Lawrence Schneiderman

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  1. Dilip V. Jeste
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  2. Laura B. Dunn
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  3. Barton W. Palmer
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  4. Elyn Saks
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  5. Maureen Halpain
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  6. Alison Cook
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  7. Paul Appelbaum
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  8. Lawrence Schneiderman
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Correspondence to Dilip V. Jeste.

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Jeste, D.V., Dunn, L.B., Palmer, B.W. et al. A collaborative model for research on decisional capacity and informed consent in older patients with schizophrenia: Bioethics unit of a geriatric psychiatry intervention research center. Psychopharmacology 171, 68–74 (2003). https://doi.org/10.1007/s00213-003-1507-x

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  • DOI: https://doi.org/10.1007/s00213-003-1507-x

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