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Special Article
February 23, 2004

Who Can Stay at Home?Assessing the Capacity to Choose to Live in the Community

Author Affiliations

From the Heart Research Follow-up Program, Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY (Drs Narins, Zareba, and Moss); Vascular Medicine Center, Orthopedic Hospital, The David Geffen School of Medicine at UCLA, University of California, Los Angeles (Dr Marder); Center for Cardiovascular Disease Prevention, Division of Cardiology, Brigham and Women's Hospital, Boston, Mass (Dr Ridker); Division of Cardiology, Department of Medicine, Washington University School of Medicine, St Louis, Mo (Dr Krone); and Department of Medicine, Maimonides Medical Center, Brooklyn, NY (Dr Lichstein). The authors have no relevent financial interest in this article.

Arch Intern Med. 2004;164(4):357-360. doi:10.1001/archinte.164.4.357

While the courts have final responsibility, physicians are often asked to evaluate the ability of an older individual to remain living alone in the community. A person's capacity to make this decision can be more difficult to assess than the capacity to make medical decisions. Unsafe actions alone do not restrict the choice of individuals. Inability to understand the implications of these actions may also limit this choice. Decision-making ability is not well measured by global tests of cognitive function. Deficits in executive function resulting in impaired insight, problem-solving ability, and goal-directed planning limit one's ability to make and carry out decisions. Unsafe actions and deficits in executive function, combined with the refusal to accept help from family and social agencies, may indicate that independent living in the community presents unacceptable risks.

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