Psychiatrymiddle twist
An 83-year-old man with moderate Alzheimer disease has a large symptomatic inguinal hernia and the surgeon has recommended repair. He lives in a hostel, cannot manage his own money and needs prompting to dress. His daughter says he 'could not possibly understand' and asks to sign the consent form herself. You are asked to assess his capacity to consent to the operation. Which one of the following findings would most strongly indicate that he lacks capacity for this decision?