Psychosocial Predictors of Healthcare Decision-Making Capacity in Older Adults: The Role of Cognitive Functioning and Affective Symptoms

Background/Objectives: Healthcare decision-making capacity is a critical component of autonomy in later life, yet its psychosocial determinants remain insufficiently understood. This study aimed to examine the relationship between healthcare decision-making capacity, cognitive functioning, depressive and anxiety symptoms, and sociodemographic factors in cognitively healthy older adults, as well as to identify psychosocial predictors of decisional capacity. Methods: A cross-sectional study was conducted with 60 community-dwelling older adults. Participants completed measures of healthcare decision-making capacity, cognitive performance, depressive symptoms, and anxiety symptoms. Spearman correlations and multiple linear regression analyses were performed to examine associations and predictors. Results: Healthcare decision-making capacity was positively associated with cognitive performance, but not significantly correlated with depressive or anxiety symptoms. However, regression analyses revealed that depressive symptomatology and age were significant negative predictors, with the overall model explaining 44.9% of the variance. Anxiety symptoms were not significant predictors. A strong positive association was observed between depressive and anxiety symptoms. Conclusions: These findings support a multidimensional model of healthcare decision-making capacity, highlighting the central role of cognitive functioning and the clinically relevant influence of depressive symptoms, even in cognitively healthy older adults. The results underscore the importance of integrating cognitive and emotional assessment in capacity evaluations and suggest that addressing depressive symptoms may contribute to preserving decisional autonomy. Future research should adopt longitudinal and clinically diverse samples to further elucidate these relationships.