Diminished Capacity

Diminished Capacity is a complex concept. It is situation specific, meaning it is not an all or nothing concept and it is often related to the specific task or issue in question. For example, an individual may lack the capacity to make financial decisions but may still maintain capacity to make health decisions. Even a diagnosis of dementia does not in itself mean that a person lacks capacity to make decisions. The focus always has to be on the specific context and the facts.

While you may not be able to determine whether an individual lacks mental capacity, there are red-flags to be aware of that may indicate mental capacity issues.

Diminished Capacity Red Flags

Consider the four “C”s

1. Context – Does the person understand their situation?
2. Choices – Does the person understand their choices?
3. Consequences – Does the person understand the ramifications of their choices?
4. Consistency – Does the person make a consistent choice?

Red Flag Examples

• Changes from previous behaviors, thinking, attitudes
• Inconsistent and unusual instructions
• Changes in decision-making (particularly if unusual for that person)
• “Head turning sign” – when client constantly turns head to prompt person they are with for reassurance or to provide response
• Not understanding technical terms despite explanations
• Vague responses; e.g. responds “yes” to complex questions, head nodding but little else
• Forgetfulness
• Difficulty keeping facts straight