The Assessment of Capacity for Everyday Decisionmaking (the ACED). An instrument that puts assessment into our ethics and ethics into our assessments.

The Assessment of Capacity for Everyday Decisionmaking (the ACED). An instrument that puts assessment into our ethics and ethics into our assessments.

Developed by James Lai and Jason Karlawish, the ACED is useful for assessing an adult’s capacity to solve functional problems. It is especially helpful to sort out whether to respect a disabled adult’s refusal of assistance to manage their disability. You can read more about why assessing capacity matters in this Huffington Post blog post by Dr. Mark Lachs of Cornell University.

To obtain copies of the ACED and SPACED, please contact Jason Karlawish using the "Contact Jason Karlawish" section on the lower right hand column of the home page.

The following is a summary of the ACED and its companion instrument, the SPACED.

What is the ACED?  The ACED is the first tool available with data supporting its reliability and validity to effectively address a common clinical issue: is a patient who refuses an intervention to help manage an instrumental activity of daily living (IADL) disability capable of making this decision?

How can the ACED help my clinical practice? The ACED is useful for assessing the capacity to solve functional problems of older persons with mild to moderate cognitive impairment from disorders such as Alzheimer’s disease. Common clinical scenarios are the person who has problems performing an IADL, such as cooking, but refuses help to manage that IADL. Is the person capable of refusing this help? The ACED provides patient specific assessments of decisional abilities needed to make that informed refusal. The ACED works well for persons with short term memory impairments since the provided summary sheet can be referred to throughout the interview.

The ACED can also help in real-world assessment of a person’s cognitive abilities. It can also inform the assessment of complex cases of the “self-neglect syndrome.”

How do I administer the ACED? Prior to administering the ACED interview, the interviewer collects information from a knowledgeable informant regarding functional deficits. Realizing each patient has unique living situations and IADL deficits, the ACED instrument content was designed to be tailored to each patient.

How do I interpret the results of an ACED interview? At the close of an ACED interview, the interviewer has a set of data that describe the person’s performance on the decision making abilities. The interviewer has to decide which abilities he or she will use to inform the judgment that the person has adequate ability to make his or her own decision about how to manage an IADL impairment. To inform this judgment, the interviewer can use the scores on the abilities. Or, the interviewer can use an overall judgment on how the person did on the interview. For example, the interviewer could require a person to score at least a 5 on the ability to appreciate, or the interviewer could decide that his or her overall judgment of how the person performed on the ability to appreciate is acceptable.

What is the SPACED? The SPACED is the Short Portable ACED, the latest update of the ACED (the Assessment of Capacity for Everyday Decisionmaking).

The Short Portable ACED is a two page version of the original instrument. The SPACED adapts the ACED structure into a shorter and simpler interview. This is an ideal instrument to structure a clinical assessment.

Building on the ACED format, this shorter version allows the examiner to interview a person with a functional problem that has at least one possible solution (for example, an older adult is forgetting to take his medication and home care can provide a weekly pill box). This version of the ACED maintains the step-by-step flow through the decisional abilities in a logical and problem centered format.

It retains the ACED key features of assessing how well a person understands and appreciates his or her problem, its solution and can reason through the options to manage the problem.

Unlike the longer ACED interview, this version -- while adhering to the scoring criteria or adequate, marginal or inadequate -- does not require a question by question scoring. Instead, the examiner is charged with making the judgment whether a patient’s answer is adequate, marginal or inadequate and whether the patient’s overall performance suggests that the patient is capable or is not capable of making his or her own decision about how to manage the functional problem.

 

To obtain copies of the ACED and SPACED, please contact Jason Karlawish using the "Contact Jason Karlawish" section on the lower right hand column of the home page.