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.
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.
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.
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
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.
All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:
- What the research says: Making decisions
Useful links Open
Dementia: Making decisions
This 2012 guide from Alzheimer Scotland offers practical advice and information on decision-making for people appointed to make decisions on behalf of someone with dementia either as an attorney or guardian (in Scotland) or deputy (in England and Wales).
Making decisions: a guide for people who work in health and social care
This 60-page guide prepared by the Mental Capacity Implementation Programme in 2009 gives a broad overview of the Mental Capacity Act and is aimed at professionals who are supporting people who are unable to make some decisions for themselves.
Nothing ventured, nothing gained: risk guidance for people with dementia
This 2010 Department of Health guidance presents a risk enablement framework for assessing, enabling and managing risk collaboratively with people with dementia and their carers.
SCIE Mental Capacity Act resource
This web-based hub contains extensive information about the Mental Capacity Act, including introductory materials, training and specialist resources, audit tools, and links to research reports and short films about mental capacity.