Advances and Challenges in the Assessment of Decision-Making Capacity in Older Adults

Older adults are more susceptible to impaired decision-making capacity, due to the impact of aging and neurodegenerative diseases on cognitive processes involved in decision-making. Cognitive impairments do not necessarily preclude decision-making capacity, which varies by the complexity of decision. For voluntary assisted dying (VAD), assessments involve understanding VAD principles, alternatives, and potential influences, requiring rigorous, multidimensional approaches informed by legal, ethical, and cultural standards. Similarly, evaluating fitness to stand trial focuses on cognitive abilities essential for engaging in legal proceedings. Both areas demand ongoing research, interdisciplinary collaboration, and adherence to ethical principles to protect rights and autonomy.