Dementia and decision-making

In England and Wales a new law about making decisions started in 2007 called the Mental Capacity Act. 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 possible support to make their own decisions. Think about the best time, 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, when it needs to be made, is called a mental capacity assessment. Knowing a person has dementia is not enough reason. Care staff should report why a person can't make a particular decision and must have a 'reasonable belief' about that 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 decision, care workers must do what's in the person's best interests. The person should still be involved. Any decisions made must give a lot of weight to what the person wants. Their 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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Available downloads:

  • What the research says: Making decisions