"I am happy that our president got a perfect score of 30 out of 30 on his cognitive screen, the Montreal Cognitive Assessment, or MoCA, a tool commonly used to identify mild cognitive impairment. Passing this test means less than most people think. At all levels of our society, I find that the popular understanding of decision-making “capacity” is not nearly adequate for the silver tsunami of elders in the pipeline. MoCA, and other tests used to judge capacity, only roughly approximate an elder’s fitness to manage his or her life. These tests often fail to catch the nuances that can mean the difference between an elder getting the care they need rather than being swindled out of their life savings.