THEORETICAL FRAMEWORKS FOR COMPETENCE IN COGNITIVELY IMPAIRED ELDERLYADULTS

Determinations of a cognitively impaired elderly adult's competency to make decisions about self-care, property-care, and medical-care occur in clinical and legal domains, and obligate clinicians or the state t o intervene in the interest of protecting the individual or society. T raditionally, competency assessments utilize expert opinion based on n europsychological testing, functional evaluation, and competency guide lines and scales. These assessments have implications for an individua l's autonomy and present significant challenges to the evaluator. Vali dated construct definitions and assessment techniques are needed to ad vance knowledge and practice. In this article, current methods and pro blems of competency evaluations ale reviewed From this, a construct va lidation approach to the problem is described. Next, three theoretical frameworks related to ontological perspectives for competency constru cts are presented to illustrate different ways of conceptualizing comp etency. These theoretical frameworks can be used to identify assumptio ns and organize approaches to assessment and research, and are present ed as starting points to organize future research and practice.