Competence and risk in older adults: A social work perspective


  • Mary Farrelly A tutor on the Bachelor of Applied Social Services (BASS) degree at NorthTec, formerly a social worker for older people, in community and health settings.



health social work, older people, ethics of social work, autonomy of older people, capacity of older people,


In more than 15 years of working with older people, in community settings and in health, one of the more common triggers for social work involvement centred around issues of competency – the capacity of the older person to continue to exercise autonomy and self determination in any or all facets of his/her life. Social workers operate within defined ethical guidelines, one of which is to recognise and uphold the dignity of the individual and the individual’s right to autonomy. However, often there is tension between the twin values of upholding this right to autonomy and the duty of care when working with older people where there is a question of impaired cognition and decision-making capacity. This article explores that tension in terms of the social work response.


American Bar Association Commission on Law and Aging & American Psychological Association. (2005). Assessment of older adults with diminished capacity: A handbook for lawyers. Washington, DC: Author.

Aotearoa New Zealand Association of Social Workers. (2008). Code of ethics. Christchurch: Author.

Brock, D.W., & Wartman, S.A. (1990). When competent patients make irrational choices. New England Journal of Medicine, 322, 1595-1599.

Cutter, M. A. G. (1991). Introduction. In M. A. G. Cutter & E.E. Shelp (Eds.). Philosophy and Medicine, Vol. 39: Competency: A study of informal competency determinations in primary care. Dordrecht: Kluwer Academic Publishers.

Darzins, P., Molloy, D.W., & Strang, D. (Eds.). (2000). Who can decide? The six step capacity assessment process. Glenside, SA: Memory Australia Press.

Dong, X., & Gorbien, M. (2005). Decision-making capacity: The core of self-neglect. Journal of Elder Abuse & Neglect, 17(3), 19-36.

Dwyer, S. (2005). Older people and permanent care: Whose decision? British Journal of Social Work, 35, 1081-1092.

Feinberg, L. F. & Whitlatch, C. J. (2001). Are persons with cognitive impairment able to state consistent choices? The Gerontologist, 41(3), 374-382.

Gilmour, H., Gibson, F., & Campbell, J. (2003). Living alone with dementia: A case study approach to understanding risk. Dementia, 2, 403-420.

Kennedy, G. J., & Scalmati, A. (2002). The importance of executive deficits: Assessing the older patient’s capacity to remain at home. Geriatrics, 57, 17:40.

Kobylarz, F.A., Heath, J., & Spike, J. (2005). Cross-cultural aspects of geriatric decision-making capacity. Ethics, Law and Aging Review, 11, 105-113.

Lloyd, L. (2006). A caring profession? The ethics of care and social work with older people. British Journal of Social Work, 36, 1171-1185.

Markson, L., Kern, D., Annas, G., & Glantz, L. (1995). Physician assessment of patient competence. [Letter to the Editor]. Journal of the American Geriatric Society, 43(6), 725-726.

Moye, J., Butz, S., Marson, D.C., Wood, E. et al. (2007). A conceptual model and assessment template for capacity evaluation in adult guardianship. The Gerontologist, 47(5), 591-603.

Nay, R. (2002). The dignity of risk. Australian Nursing Journal, 9(9), 33.

Perkins, C. (2002). Assessing capacity. New Zealand Family Physician, 29(1), 41-43.

Perkins, C. (2006). Dementia: A New Zealand guide (rev. ed.). Auckland: Random House.

Protection of Personal and Property Rights Act (1988). Wellington: New Zealand Government.

Silberfield, M., & Fish, A. (1994). When the mind fails: A guide to dealing with incompetency. Toronto: University of Toronto Press.

Slone, D. G., & Pierini, S. L. (1995). Physician assessment of patient competence. [Letter to the Editor]. Journal of the American Geriatric Society, 43(6), 726.

Stewart, R., Bartlett, P., & Harwood, R.H. (2005). Mental capacity assessments and discharge decisions. Age and Ageing, 34, 549-550.

Taylor, B. J., & Donnelly, M. (2006). Professional perspectives on decision making about the long-term care of older people. British Journal of Social Work, 36, 807-826.

Taylor, B. J. (2006). Risk management paradigms in health and social services for professional decision making on the long-term care of older people. British Journal of Social Work, 36, 1411-1429.

Tyrrell, J., Genin, N., & Myslinski, M. (2006). Freedom of choice and decision-making in health and social care: Views of older patients with early-stage dementia and their carers. Dementia, 5, 479-502.

Young, G. (2004). How to assess a patient’s competence. New Ethicals Journal, 2, 41-45.




How to Cite

Farrelly, M. (2009). Competence and risk in older adults: A social work perspective. Aotearoa New Zealand Social Work, 21(4), 15–24.