Physician input into guardianship cases involving the elderly

The determination of an elderly person's competence in guardianship decisions rests primarily on the written statement of an examining physician. We evaluated this physician input by retrospectively reviewing 40 competency case files of persons over age 60 from the Harris County Probate Courts. Of the 40 physician letters reviewed: 10 (25%) did not include a medical or psychiatric diagnosis; 37 (92.5%) did not include results of a formal mental status exam; 19 (47.5%) of the letters were essentially unsupported statements of incompetence. Finally, 29 (72.5%) of the cases failed to include a statement on prognosis or potential need for reevaluation. The medical information transmitted to the courts in guardianship cases involving the elderly was inadequate for the courts to make informed decisions. Guidelines for evaluation were developed to facilitate the transmission of adequate patient data, and to direct physicians as to what information is needed by the court in making guardianship decisions.