The College of Optometrists

Principles of examining patients with cognitive impairment

A178
When examining a patient with cognitive impairment you should:
  1. record the name of the person who accompanies the patient
  2. record the name of any person that the patient consents to receiving the results of, and recommendations from, the examination.
A179
When examining a patient with cognitive impairment you should:
  1. be flexible and adapt your techniques or use alternative methods appropriate to the patient’s needs
  2. take longer if the patient’s responses are slow
  3. adapt the examination to place emphasis on objective techniques if the patient’s attention span is limited
  4. be aware that a patient’s capacity to consent and understand may vary and that you may need to reassess them on another occasion
  5. record any reasons for limitations on the examination and results obtained.
A180
You should provide advice on the findings of your examination to the patient and/or their relative or carer, as appropriate, and with the patient’s consent. This should be in a way that is easy for the patient to understand. You should reassure the patient about visual function and the absence of abnormal ocular findings. You may need to explain how their condition affects their vision.
A181
Making decisions about treatment and care for patients who lack capacity is governed in:
  1. England and Wales by the Mental Capacity Act 2005.70 The Act is supported by a Code of Practice71 for healthcare workers which you should refer to. A person lacks capacity if, at the time the decision needs to be made, they are unable to make or communicate the decision because of an ‘impairment or disturbance’ that affects the way their mind or brain works.
  2. Scotland by the Adults with Incapacity (Scotland) Act 2000.72 The Act is supported by Codes of Practice for healthcare professionals which you should refer to. A person lacks capacity if they cannot make decisions or communicate them, or understand or remember their decision because of a mental disorder or a physical inability to communicate in any form.73
  3. Northern Ireland by The Mental Capacity Act (Northern Ireland) 2016, which partially commenced in late 2019 (phase one – for deprivation of liberty, offences, research and money and valuables)74. The Act is be supported by Codes of Practice for phase one of the implementation. A person lacks capacity if, at the time the decision needs to be made, they are unable to understand information, retain information, appreciate the relevance of the information or communicate their decision because of an impairment of, or a disturbance in, the function of the mind or brain. The timescales for implementing the remainder of the Act are as yet unclear, so you should seek legal advice if you have concerns about a person’s capacity to make decisions.

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