How to help someone with dementia make a decision?

Studies show that many people living with dementia experience a decline in their ability to make complex decisions over time. However, their capacity for making choices doesn't vanish overnight; it changes. Knowing how to help someone with dementia make a decision is a crucial skill for caregivers, fostering independence and preserving dignity.

Quick Summary

Support someone with dementia in making choices by simplifying options, timing conversations carefully, and respecting their autonomy. Use familiar routines, emotional cues, and past preferences to guide them, ensuring their dignity and involvement in daily life are maintained.

Key Points

• Simplify Choices: Offer limited, clear options (e.g., two choices) to avoid overwhelming the individual with dementia.

• Time It Right: Approach decision-making during the person's peak alertness, and in a calm, quiet setting.

• Use Cues: Utilize visual aids, familiar objects, or consistent routines to help guide their choices.

• Focus on Feelings: Pay attention to non-verbal cues like emotions and body language when verbal communication is difficult.

• Respect Autonomy: Involve them in daily decisions whenever possible to maintain their dignity and self-esteem.

• Plan Ahead: Establish legal documents like Power of Attorney and Advance Directives early on while the person has capacity.

• Adapt Your Role: Change your support level as their dementia progresses, from guiding to eventually deciding based on their best interests.

Understanding the Evolving Challenge

Navigating decision-making with a loved one with dementia requires patience and a deep understanding of their changing cognitive abilities. Dementia is a progressive condition, meaning their capacity will fluctuate and decline over time. Your approach must adapt as their needs change, moving from a supportive role to a more guiding one, and eventually, to making choices for them based on their known preferences.

The Importance of Preserving Autonomy

For people with dementia, retaining a sense of control and independence is vital for their self-esteem and mental well-being. By empowering them to make decisions, even small ones, you validate their worth and keep them engaged with their own life. Every choice, from what to wear to what to eat for lunch, is an opportunity to reinforce their identity.

Strategies for Effective Decision Support

Simplify the Options

When presenting choices, less is always more. A long list of options can be overwhelming and lead to anxiety or frustration. Instead, offer simple, clear, and limited alternatives.

• For clothing: "Do you want to wear the blue shirt or the red one?" instead of "What would you like to wear today?"
• For meals: "Would you prefer soup or a sandwich for lunch?" instead of "What do you feel like eating?"
• For activities: "Would you like to listen to music or sit in the garden?" instead of "What should we do now?"

Choose the Right Time and Environment

The timing and setting can significantly impact a person's ability to focus. Try to engage in conversations about decisions when they are most alert and rested, often earlier in the day. A calm, quiet environment free from distractions will also improve their concentration.

Use Visual and Familiar Cues

Visual prompts can be incredibly helpful for memory recall. Use pictures, familiar objects, or even samples to help them visualize the choice. For example, show them two different sweaters, or the box of cereal they usually eat. Familiarity provides comfort and confidence.

Focus on Feelings and Preferences

Even when the ability to reason declines, emotions often remain intact. Pay attention to body language, tone of voice, and facial expressions. A person with dementia may no longer be able to explain their preference, but their emotional response can be a reliable indicator of their choice.

Making Decisions for Different Stages of Dementia

Decision Type	Early Stage	Mid-Stage	Late Stage
Everyday Choices	Actively involve them in selecting clothes, meals, and activities.	Offer two simple, specific options and observe their emotional response.	Focus on comfort. Choices might be limited to sensory preferences (e.g., warm blanket vs. lighter sheet).
Financial Matters	Handle complex matters like investments, but keep them informed of the budget and household expenses.	Take over management with legal authority. Inform them simply, "The bills are paid."	No longer involved. Legal arrangements are fully in place.
Health Decisions	Engage in discussions about future care plans. Ensure legal documents are in place.	Consult legal proxies based on prior wishes. Use simplified explanations for current care needs.	All decisions made by legal proxy, following the person's advance directives.
Living Arrangements	Discuss wishes for future care, such as staying at home or moving.	Revisit earlier discussions if necessary. Frame changes positively, focusing on safety and comfort.	Decisions are based on best interest and safety, guided by legal documents.

Guiding Complex and Legal Decisions

As dementia progresses, the decisions become larger and more complex. It is essential to have legal documents prepared in the early stages, while the person still has the capacity to express their wishes.

1. Understand Legal Documents: Familiarize yourself with a Durable Power of Attorney for Finances and a Healthcare Power of Attorney. These documents legally name a person to make decisions on their behalf.
2. Involve Trusted Professionals: Work with a healthcare proxy, elder law attorney, and financial advisor to ensure all legal and financial matters are handled correctly and ethically.
3. Document Their Preferences: In the early stages, create an Advance Directive or Living Will that clearly states their wishes regarding medical treatment, organ donation, and other healthcare preferences.
4. Communicate with Family: Keep family members and other caregivers informed to avoid misunderstandings and conflicts. Shared information and a consensus-driven approach can reduce stress for everyone involved.

Long-Term Planning and Support

Beyond the daily choices, long-term planning is essential. This includes securing the financial and legal aspects of their care. Ensure you have clear legal authority through a Power of Attorney to prevent complications later on. Additionally, engaging with support networks can provide invaluable resources and emotional support for caregivers.

For more detailed information on legal planning and advanced care directives, consult reputable resources like the National Institute on Aging website. This provides expert guidance on navigating the complex legal landscape associated with dementia care.

Conclusion

Knowing how to help someone with dementia make a decision is an act of both compassion and respect. It requires adapting your approach as their abilities change, simplifying choices, and prioritizing their emotional well-being. By focusing on their dignity and involving them in meaningful ways, you can ensure they continue to feel valued and in control of their life for as long as possible. The journey is challenging, but with the right strategies, you can provide the support they need while honoring their past wishes and current preferences.

Frequently Asked Questions

How do I know if a person with dementia still has the capacity to decide?

Capacity is often specific to a particular decision and can fluctuate daily. For simple, everyday choices, you can gauge capacity by how they respond to two clear options. For major decisions, a formal assessment by a medical professional is often required.

What if my loved one with dementia refuses to make a decision?

If they become anxious or refuse, don't force the issue. Gently redirect the conversation or come back to it later. It might also indicate that they are overwhelmed, and you should try simplifying the choice even further or making the decision for them based on their known preferences.

Should I make a decision for them if they can't decide?

Yes, if they are unable to express a clear choice, you should make a decision based on their best interests and what you know of their past wishes and feelings. Involve legal proxies for significant decisions if they exist.

What if my loved one with dementia makes a 'wrong' or bad decision?

If the decision is not harmful, it's often best to respect their choice to maintain their autonomy. If it's a matter of safety (e.g., refusing to take medication), approach the issue with calm, simple explanations, or distract and re-engage later. A medical assessment might be necessary for persistent high-risk behavior.

How can I prepare for future decisions while they are still in the early stages?

In the early stages, talk openly about their wishes for the future. Document their preferences in legal papers like a Power of Attorney and an Advance Directive. This ensures their wishes are respected when they can no longer communicate them.

How should I handle disagreements with family members over decisions?

Open and consistent communication is key. Holding a family meeting to discuss the person's documented wishes and best interests can help. Involving an impartial third party, such as a social worker or mediator, might also be beneficial.

Is it different to help someone make financial versus healthcare decisions?

Yes, they require different considerations and legal documentation. A Durable Power of Attorney for finances covers financial matters, while a Healthcare Power of Attorney deals with medical choices. It's crucial to have both in place.

How can I use routines to help with decision-making?

Establishing daily routines minimizes the number of new decisions needed. A predictable schedule provides comfort and security. Within these routines, offer small, guided choices, such as selecting a snack during their regular afternoon break.