Advance directives, competency evaluation, and surrogate management in elderly patients.

As patients age, their capacities for memory, judgment, reasoning, planning, and decision-making may erode. Preparing for the time when these losses occur involves three important strategies: advance directives, competency evaluation, and surrogate management. Advance directives allow currently competent patients to record the kind of medical procedures they desire if they become incompetent in the future. Competency evaluations determine the mental competence of a patient and require special training for the physician. The need for surrogate management increases as a patient's cognitive deficits worsen and often requires involvement of the legal system. This paper addresses these important strategies in detail.