Assessment of competence to complete advance directives: validation of a patient centred approach

Objective To develop a patient centred approach for the assessment of compe tence to complete advance directives ("living wills") of elderly people wit h cognitive impairment Design Semistructured interviews. Setting Oxfordshire. Subjects 50 elderly volunteers living in the community, and 50 patients wit h dementia on first referral from primary care. Main outcome measures Psychometric properties of competence assessment. Results This patient centred approach for assessing competence to complete advance directives can discriminate between elderly persons living in the c ommunity and elderly patients with dementia, The procedure has good interra ter (r = 0.95) and test-retest (r = 0.97) reliability Validity was examined by relating this approach with a global assessment of competence to comple te an advance directive made by two of us (both specialising in old age psy chiatry). The data were also used to determine the best threshold score for discriminating between those competent and those incompetent to complete a n advance directive, Conclusion A patient centred approach to assess competence to complete adva nce directives can be reliably and validly used in routine clinical practic e.