Decision-making capacity in acute care: a psychiatry of later life perspective

We read with great interest the recent article by Doherty and Matthews, "Challenges in decision-making capacity in the acute hospital setting: two years on from the implementation of the Assisted Decision-Making (Capacity) Act 2015," published in the Irish Journal of Psychological Medicine (2025).As physicians working in an Old Age Liaison Psychiatry service, we share the authors' concerns regarding the continuing legal uncertainty arising from the Assisted Decision-Making (Capacity) Act (ADMCA) 2015 in acute hospitals, and we wish to highlight how these gaps disproportionately affect older adults, particularly those living with dementia, delirium, frailty, or without family supports.The scenarios described, such as unsafe discharges and reliance on the High Court's inherent jurisdiction, are central to our daily practice.In our experience, two interconnected issues warrant further emphasis.