Dementia Gateway: Making decisions

Helping people make their own decisions

Key messages

Don't assume that people with dementia can't make decisions themselves.
People with dementia should be given all possible support to make their own decisions.
You need to think about the best time, the best person and the best way to talk about the decision.
You may need a translator if the person's first language is not English. You should also check if the person uses a hearing aid.
Pictures can help some people make their own decisions, but they may need their glasses.

Sometimes you have got to make a decision to do something or other and you are not quite sure whether you should, so you need a very good friend to help you to go through it.
Person with dementia quoted in My name is not dementia (Alzheimer's Society 2010)

Explore the links below now to read more about this topic:

1. Don't make decisions for people with dementia that they can make themselves Open

People with dementia may have difficulty making some decisions but will be able to make other decisions themselves. For example, a person might not be able to make decisions about their medical treatment but could make decisions about what they eat or what television programmes to watch.

Different people with dementia will be able to make different decisions. As the dementia progresses the decisions an individual will be able to make will change.

For some people with dementia, there will be times when they could make a particular decision and times when it would be harder for them to do this. For example, many people with dementia finder it harder to concentrate later in the day. If a decision can wait until a person can make it themselves this must happen.
2. Support people to make their own decisions Open
Where possible, people must be supported to make their own decisions. The kinds of support people with dementia may need includes:
- making sure their hearing aid is working, or they have their glasses on
- explaining things in a way that is easy to understand
- using pictures, for example when choosing what meal to have
- having someone who can speak the person's own language to explain the decision to them
- choosing the best time of the day to talk about the decision.
Some decisions are very difficult and people may need time to make them. People might also change their mind several times. This doesn't mean they can't make the decision themselves.
3. What if I disagree with the person's decision? Open

Just because you think a person is not making a sensible decision doesn't mean that they can't make that decision for themselves. For example, a person might choose not to eat any vegetables or fruit. Another person might choose to spend more money on alcohol than you would.

The law says that people can make unwise decisions. For example we all know it is unwise to smoke but the law allows adults to do so.

If you are worried about a decision someone has made you might want to check that they understand what they are doing.

The Social Care TV film, Raymond's Money, looks at the dilemma faced by a home care worker, Wendy, who is asked by Raymond, a man newly diagnosed with dementia, to place a large sum of money on the Lottery. Wendy doesn't think this is a good decision, but Raymond's wishes are clear. Notes accompanying the film discuss the principles of the Mental Capacity Act and how they can be applied to this story.

Over to you!

Click here to do a quick activity that will deepen your understanding of this topic. The activity can be done alone or with colleagues and you can also download a copy. Trainer's notes have also been provided.