When an elderly patient refuses hospital admission for overnight observation and a family member asserts the patient has dementia and cannot make decisions, what is the appropriate approach?

When an elderly patient refuses hospital admission for overnight observation and a family member asserts the patient has dementia and cannot make decisions, what is the appropriate approach?

• A. Assess the patient’s capacity, discuss risks with the patient and surrogate, and document the decision.
• B. Force admission against the patient's wishes.
• C. Immediately admit the patient to protect safety.
• D. Do nothing and let the patient leave.

Answer: (B)

The main idea is honoring patient autonomy by properly assessing decision-making capacity before any admission decision. If a patient can understand, appreciate, reason about, and communicate a choice regarding hospitalization, that choice should be respected—even if a family member disagrees. Capacity is decision-specific and can vary; dementia does not automatically strip a patient of all decision-making power. So, the appropriate approach is to assess the patient’s capacity for this specific decision. If the patient has capacity, discuss the risks and benefits of overnight observation, include the family surrogate in the conversation, and document the discussion and the patient’s decision. This respects the patient’s right to refuse treatment while ensuring they’re informed and supported. If capacity were lacking, then involve the surrogate to decide based on the patient’s known preferences and best interests, and document the rationale. Involuntary admission or forcing care is not the default and is only considered when there is no capacity and clear imminent risk to safety that justifies such action. Doing nothing or ignoring the patient’s stated wishes would not be appropriate when capacity is present. In short, assess capacity, communicate risks with the patient and surrogate, and document the decision.

The main idea is honoring patient autonomy by properly assessing decision-making capacity before any admission decision. If a patient can understand, appreciate, reason about, and communicate a choice regarding hospitalization, that choice should be respected—even if a family member disagrees. Capacity is decision-specific and can vary; dementia does not automatically strip a patient of all decision-making power.

So, the appropriate approach is to assess the patient’s capacity for this specific decision. If the patient has capacity, discuss the risks and benefits of overnight observation, include the family surrogate in the conversation, and document the discussion and the patient’s decision. This respects the patient’s right to refuse treatment while ensuring they’re informed and supported.

If capacity were lacking, then involve the surrogate to decide based on the patient’s known preferences and best interests, and document the rationale. Involuntary admission or forcing care is not the default and is only considered when there is no capacity and clear imminent risk to safety that justifies such action. Doing nothing or ignoring the patient’s stated wishes would not be appropriate when capacity is present.

In short, assess capacity, communicate risks with the patient and surrogate, and document the decision.