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Aging and Capacity: What To Think And What to Decide?

Some sobering statistics:(1) • Seniors in the 80+ age group are the second fastest growing age group in Canada • One in 5 of these seniors will die in hospital rather than in their home or a palliative care setting even though they prefer the latter. • 8 in 10 Canadians agree that people should start planning for end of life when they are healthy • 70% of Canadians surveyed have not prepared a Will • 47% of Canadians have not designated a substitute decision-maker to make healthcare decisions for them if they become incapacitated. • Fewer than 44% of Canadians have discussed end-of-life care with a family member • Only about 9% of Canadians have discussed end-of-life care with their physician

What is capacity? How is it relevant to me or my aging parents? Capacity and competency are often used interchangeably, depending on the context. There are many types of capacity, including but not limited to capacity to manage financial affairs, capacity to make personal care decisions (health, nutrition, treatment) capacity to drive, capacity to stand trial, capacity to instruct a lawyer in a legal proceeding (e.g., divorce, criminal or civil case), capacity to enter into a contract, capacity to marry, capacity to make or change a Will, capacity to give/revoke Powers of Attorney (Property and Personal Care), capacity to consent to placement (into a long term care facility), advance care planning (end-of-life decisions), and many more.

Many of us are familiar with those which most directly impact our lives throughout adulthood but, become even more important, as we age. Those are: managing our financial affairs; making a Will; executing Powers of Attorney (deciding who we want to make financial and personal care decisions for us if were are alive but incapacitated); capacity to consent to treatment; and capacity to make end of life decisions.

What should I be doing? Having professionals in place to assist you with these decisions is recommended as a way of guiding you through everything that you need to put your mind to, including:

 A good financial advisor and accountant with training and experience in retirement planning for finances;A lawyer experienced in both estate planning and capacity is recommended to assist you in making or revising a Will, executing Powers of Attorney for Property and Personal Care;Sometimes, when making a Will or Powers of Attorney, your lawyer may ask you to undergo a “Capacity Assessment” if you have a history of neurological conditions (e.g., stroke, Alzheimer’s, memory loss, or other difficulties) which may impact capacity; or if there is intra-familial tension/conflict surrounding estate planning, your lawyer may recommend an assessment to reduce the likelihood that contestation of the Will with be successful.The Capacity Assessment Office in Toronto is a very useful resource to discuss your situation and determine whether you need a capacity assessment; or, to help you figure out what other recourse you may have, including getting legal advice.Capacity assessors are trained by the Capacity Assessment Office to perform assessments of capacity to manage Property and/or Personal Care. They have a roster of Assessors, by region, profession and areas of practice, for your reference.

In addition, it is important that you begin to have conversations with your adult children about your wishes with regard to possible incapacity and end-of-life decisions, so that they are aware of your specific wishes and are able and willing to make decisions on your behalf when the time comes. Tell your children what you would like to do with your home, your cottage, your assets. Explain your reasoning to them so that they understand why you wish to distribute your assets in that manner. You can even put that detail into your Will or attach it as a Codicil to your Will to reduce the likelihood of future disputes.

Helpful Resources: • “Speak up”. Useful resources for families to start this important conversation and to complete their advance directive instructions and provide it to their adult children/attorneys named in their Powers of Attorney for Personal Care. • American Bar Association’s consumer’s toolkit for health care advance planning (downloadable). • Dr. Atul Gawande—various books including “Letting go”. • Dying with Dignity Canada - • Alzheimer Society of Ontario: (416) 967-5900 • Prevention of Elder Abuse Committee of York Region: • Ontario Seniors’ Secretariat (OSS). Seniors’ info line: 1-888-910-1999 • Office of the Public Guardian and Trustee: (416) 314-2800/1-800-366-0335 • Community Care Access Centres (CCAC) Info Line: 1-800-268-1154 • CHATS • Regional Geriatric Programs of Ontario: (416) 480-6026 • Advocacy for the Elderly (ACE): (416) 598-2656 • Capacity Assessment Office: (416) 327-6766


Contributor: Dr. Terri Sands Sands Psychology Professional Corporation

679 Davis Drive, Suite 310 Newmarket, ON L3Y 5G8 Tel: (905) 830-3474 ; E-mail: Website:

Dr. Terri Sands is a registered clinical psychologist based in the heart of Newmarket, Ontario, across from Southlake Regional Health Centre. She is an accredited family mediator, elder mediator and capacity assessor designated by the Office of the Public Guardian and Trustee.  In her practice she specializes in separation issues and family mediation, senior issues & elder mediation, capacity assessments, behavioural consultations, individual therapy and couples therapy.  She also provides public speaking  and training on a variety of topics. Full bio: 


1 Wright, A.A. et al. Associations between end-of-life discussion, health care expenditures, JAMA, 2008, 300 (14) 1665-1673. • Heyland, D.K., Allan, D.E., Rocker, G., Dodek, P, Pichoa, D., & Gafni, A. Discussing prognosis with patients and their families near the end of life: Impact on satisfaction with end of life care. Open Medicine. 2009, 3 (20: 71-80). • Lavoie, M., Blondeau, D., Godin, G. Intentions to select a given level of care when confronted with an ethical issue: The impact of a living will. 1999. 29: 77285). • Baxter, S, Gawande, A., CMAJ, Jan 11, 2011, 183(1)


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