Competency issues in dementia: Medical decision making, driving, and independent living

Among the many losses that a patient with dementia inevitably experiences i s loss of competency. The patient with a degenerative dementia experiences gradual and progressive impairment of multiple abilities, which may interfe re with his or her competency in a number of realms, including medical or l egal decision making, driving, and independent living. It is common for con cerns about competency to arise while providing dementia care. Family membe rs, other caregivers, members of the health care team, courts, and other ph ysicians may trigger questions related to competency. The treating physicia n is in a unique position to address these concerns. The challenges of comp etency determination can be met with an understanding of the medical and le gal principles behind the notion of competency. The physician's role in com petency determinations is to assess capacity. Although determination of cap acity often proves to be a demanding challenge for the physician, energy sp ent in this endeavor may result in preservation of the autonomy of the pati ent with dementia and overall improved quality of life at its end stages.