What do we know about the application of the Mental Capacity Act (2005) in healthcare practice regarding decision-making for frail and older people? A systematic literature review

Hinsliff-Smith, Kathryn and Feakes, Ruth and Whitworth, Gillian and Seymour, Jane and Moghaddam, Nima and Dening, Tom and Cox, Karen (2017) What do we know about the application of the Mental Capacity Act (2005) in healthcare practice regarding decision-making for frail and older people? A systematic literature review. Health & Social Care in the Community, 25 (2). pp. 295-308. ISSN 0966-0410

Full content URL: http://dx.doi.org/10.1111/hsc.12310

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Abstract

In England and Wales, decision-making in cases of uncertain mental capacity is regulated by the Mental Capacity Act 2005. The Act provides a legal framework for decision-making for adults (16 and over) who are shown to lack capacity and where best interest decisions need to be made on their behalf. Frail older people with cognitive impairments represent a growing demographic sector across England and Wales for whom the protective principles of the Act have great relevance, as they become increasingly dependent on the care of others. However, while the Act articulates core principles, applying the Act in everyday healthcare contexts raises challenges for care providers in terms of interpretation and application. This paper presents a review of the published evidence documenting the use of the Act in healthcare practice, with particular reference to frail older people. Our aim was to identify, review and critically evaluate published empirical studies concerned with the implementation and application of the Act in healthcare settings. A systematic approach was undertaken with pre-determined exclusion and inclusion criteria applied across five electronic bibliographic databases combined with a manual search of specific journals. This review reports on 38 empirical sources which met the inclusion criteria published between 2005 and 2013. From the 38 sources, three descriptive themes were identified: knowledge and understanding, implementation and tensions in applying the Act, and alternative perspectives of the Act. There is a need for improved knowledge and conceptualisation to enable successful incorporation of the Act into everyday care provision. Inconsistencies in the application of the Act are apparent across a variety of care settings. This review suggest staff need more opportunities to engage, learn and implement the Act, in order for it to have greater resonance to their individual practice and ultimately benefit patient care.

Keywords:mental capacity act, fluctuating capacity, everyday decision-making, frail older people
Subjects:L Social studies > L500 Social Work
B Subjects allied to Medicine > B701 Palliative Care Nursing
L Social studies > L431 Health Policy
B Subjects allied to Medicine > B760 Mental Health Nursing
B Subjects allied to Medicine > B700 Nursing
C Biological Sciences > C840 Clinical Psychology
Divisions:College of Social Science > School of Psychology
ID Code:19692
Deposited On:27 Nov 2015 11:29

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