Forensic psychiatric evaluation of legal capacity and guardianship in hospitalized patients: A retrospective analysis

Assessment of decision-making capacity and guardianship in hospitalized patients represents a critical interface between forensic psychiatry, clinical medicine, and law. In Turkiye, such evaluations are frequently requested by courts or notaries; however, empirical data describing their forensic characteristics remain limited. This study examined hospitalized patients referred for forensic psychiatric evaluation of decision-making capacity and guardianship and identified factors influencing medico-legal outcomes. This retrospective study included all inpatient consultations requested for forensic psychiatric evaluation between January 2018 and June 2025 at a university hospital. Sociodemographic characteristics, referring departments, psychiatric diagnoses, Mini-Mental State Examination (MMSE) scores, and forensic psychiatric opinions were extracted from electronic medical records. Eighty forensic psychiatric evaluations were analyzed, including 51 assessments for addressing decision-making capacity for power of attorney and 29 related to guardianship. The mean age was 70.7 ± 14.1 years, and 56.3% of patients were male. Most referrals originated from Internal Medicine and Intensive Care units. Among capacity evaluations, 74.5% of patients possessed decision-making capacity, while 19.6% lacked capacity. Patients assessed as possessing capacity had significantly higher MMSE scores than those assessed as lacking capacity (25.88 ± 2.37 vs. 19.33 ± 2.34; p < 0.001). Guardianship-related evaluations were mainly associated with mental disorders due to acute brain injury. In this acute hospital setting, lack of decision-making capacity was most commonly associated with delirium and dementia, whereas guardianship considerations primarily involved patients with acute brain injury or severe medical illness. These findings underscore the distinct clinical profiles underlying forensic capacity and guardianship evaluations in hospitalized populations.