Dementia and decision-making

In England and Wales, the Mental Capacity Act 20015 provides the legal framework to support people to make their own decisions wherever possible. It covers all decisions people may make for themselves, however little or big, from deciding whether to have a bath or shower to selling a house. The law says we must start by assuming that people can make their own decisions. This includes people with dementia.

How can you help a person with dementia to make decisions now and for their future? Explore the links below to find out more about this topic.

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Helping people living with dementia make their own decisions

Helping people make their own decisions

Don't assume that people with dementia can't make decisions themselves. People with dementia should be given all practicable support to make their own decisions. Think about what information a person needs, the best time to discuss it, the best person to help to explain things, and the best way to talk about the decision. A translator may be needed 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.

Can a person living with dementia make the decision

Capacity: can the person make the decision?

Decisions cannot be made for a person with dementia unless there is evidence that they can't make the decision themselves. The process of working out whether someone can make a specific decision, at the time it needs to be made, is called a mental capacity assessment. Knowing a person has dementia is not reason in itself to assess a person's capacity; care must have a 'reasonable belief' someone might lack capacity before assessing it. Staff then need a valid assessment that shows someone lacks capacity to make a decision before doing anything in their best interests.

dementia - making decisions in a persons best interests

Making decisions in a person's best interests

When a person with dementia lacks capacity to make a particular decision, care workers must do what's in the person's best interests. The person should still be involved as much as possible. Any decisions made must give a lot of weight to what the person wants. Their known wishes should only be over-ridden if necessary. People who know the person well should be consulted. These decisions are known as 'best interests decisions'. Some people with dementia will have an attorney to make some best interests decisions on their behalf.

Advance care planning - dementia

Advance care planning

Advance care planning refers to people making plans for a time when they might not have the capacity to make some decisions. It covers decisions about care, treatment and money. People in the early stages of dementia should be supported to make advance care plans. Care staff should know about 'Advance Decisions to Refuse Treatment' and Lasting Power of Attorney arrangements.

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  • What the research says: Making decisions