Culturally Sensitive Assessment of Decision-Making and Functional Capacity in Older African Americans

This research study has two aims: 1) to understand how factors of culture relate to elements of decision-making capacity and the assessment of decision-making capacity, and 2) to develop culturally sensitive clinical practice guidelines for psychologists and other healthcare professional who conduct capacity assessments.

Capacity refers to “a threshold requirement for persons to retain the power to make decisions for themselves”, and it is often questioned in the context of dementia. Clinical judgments of capacity have significant implications for older adults’ fundamental rights of autonomy and safety, and consequences of capacity evaluations are particularly relevant for older African Americans because there is little known about the assessment of capacity in this population, such as how factors of diversity intersect with capacity, and existing measures used to evaluate capacity are biased. Moreover, there is historic and current systemic oppression of older African Americans’ autonomy, which needs to be considered in training on the conduct of capacity evaluations in older African Americans. This study will use a community-based approach to advance our current understanding of how factors of diversity intersect with capacity and the assessment of capacity in older African Americans living in the Deep South. Additionally, a Delphi study will be used to define practice competencies that are necessary for clinicians to conduct culturally sensitive capacity assessments.

Aim 1: Develop a culturally sensitive capacity assessment framework. A Community Advisory Board (CAB) consisting of six individuals who identify as African American or Black and who have ties to the Deep South will participate in focus groups to provide input on cultural factors relevant to capacity and the assessment of capacity in older African Americans. Data provided by the CAB will inform the development of a culturally sensitive capacity assessment framework.

Aim 2: Obtain consensus from experts in capacity and diversity on cultural competencies specific to capacity assessment. A panel of 10 to 15 experts in the field of capacity and multicultural competency will develop culturally sensitive competencies specific to capacity assessment based on the themes generated by the CAB and existing guidelines on cultural competency and capacity assessment. The CAB will review and provide input on the culturally sensitive competencies developed by the expert panel.

Sponsored by National Institute on Aging, Deep South RCMAR Pilot Grant

For more information reach out to the PI Dr. Lindsey Jacobs, PhD, MSPH, ABPP at