Barriers and facilitators to implementation of mental capacity legislation in care homes for older adults in the United Kingdom: a mixed-methods systematic review

Stokes, L, Maden, M, Williams, N, Jacob, N, Scott, S, Shepherd, V, Gates, C, Jones, L, Barker, S, Hunter, M-C, Smith, G, Prout, H, Ingle, M, Curtis, F, Hill, R and Griffiths, AW (2025) Barriers and facilitators to implementation of mental capacity legislation in care homes for older adults in the United Kingdom: a mixed-methods systematic review. Age and Ageing, 54 (5). ISSN 0002-0729

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Abstract

Objective Mental Capacity legislation defines when a person lacks capacity and subsequently supports individuals to make as many decisions as possible for themselves. Whilst frameworks exist, care home staff often feel unsupported with insufficient knowledge and training. This review aimed to understand barriers and facilitators of implementing mental capacity legislation in care homes for older adults in the United Kingdom. Methods A systematic review was conducted and 3041 potentially relevant studies identified, with 13 studies eligible for inclusion. 11 focused on the Mental Capacity Act (2005) and two on the Adults with Incapacity (Scotland) Act 2000. Barriers and/or facilitators were extracted and subsequently mapped to the Capability, Opportunity and Motivation model and Theoretical Domains Framework. Results Barriers included poor access to training, low staff confidence and a lack of understanding about using legislation in context. Conversely, staff reported in-person training using real-life examples, robust organisational policies and processes and respecting person-centred care were key facilitators. Sense-checking conversations were conducted with care home staff (n = 18) to interpret findings in the context of current practice. Conclusions This review presents complex and multi-faceted barriers preventing the implementation of mental capacity legislation in care homes for older adults. Whilst care home staff have now started to appreciate the importance of such legislation, insufficient time, resources and an inability to track staff knowledge prevents effective implementation of the law. Future research should explore how staff are trained about legislation and identify best practices.

Item Type:	Article
Uncontrolled Keywords:	1103 Clinical Sciences; 1117 Public Health and Health Services; 1701 Psychology; Geriatrics; 3202 Clinical sciences; 4203 Health services and systems; 5201 Applied and developmental psychology
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice
Publisher:	Oxford University Press (OUP)
Date of acceptance:	26 April 2025
Date of first compliant Open Access:	16 May 2025
Date Deposited:	16 May 2025 09:39
Last Modified:	16 May 2025 09:45
DOI or ID number:	10.1093/ageing/afaf119
URI:	https://researchonline.ljmu.ac.uk/id/eprint/26368

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