Mental incapacity in a hospitalized patient may go unrecognized, especially if the patient was competent prior to being admitted.
Risk factors for transient mental incapacity during a hospitalization:
(1) older age
(2) delirium
(3) drug-induced cognitive impairment
(4) other adverse drug effects
(5) disorders affecting the brain (stroke, cardiac arrest, head injury, etc)
(6) acute illness
(7) metabolic disorders
(8) hypoxemia and/or hypercarbia
(9) borderline mental competence prior to the admission
(10) sleep deprivation
(11) withdrawal reaction
(12) adverse psychiatric response to illness
(13) severe chronic illness
A close family member may be the first person to recognize that there may be a problem.
A patient in the hospital should be evaluated for mental competence prior to making an important decision.
Differential diagnosis:
(1) inability to speak the local language well
(2) limited intellectual capacity
(3) disagreeing with what a healthcare provider wants to do
