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, Louis, Maden, Michelle, Williams, Nefyn, Jacob, Nina, Scott, Sion, Shepherd, Victoria ORCID: https://orcid.org/0000-0002-7687-0817, Gates, Cara, Jones, Liz, Barker, Sandra, Hunter, Marie-Clare, Smith, Grahame, Prout, Hayley ORCID: https://orcid.org/0000-0003-0170-7027, Ingle, Mishel, Curtis, Ffion, Hill, Ruaraidh and Griffiths, Alys Wyn 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) , afaf119. 10.1093/ageing/afaf119

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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
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: https://creativecommons.org/licenses/by/4.0/, Type: cc-by
Publisher:	Oxford University Press
ISSN:	0002-0729
Date of First Compliant Deposit:	19 May 2025
Date of Acceptance:	26 April 2025
Last Modified:	19 May 2025 16:30
URI:	https://orca.cardiff.ac.uk/id/eprint/178355

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