When to Make Decisions for Someone with Dementia… and When Not To

It can be tempting to assume that because someone has Alzheimer’s disease or some other form of dementia, they’re not capable of making their own decisions.

The trouble is it’s not always true – perhaps more often than you’d expect. By stepping in to speak for someone else, we may be unintentionally making them feel unheard, ignored, and insignificant.

Of course, there are times when dementia does make it difficult for people to make their own decisions. They may decide to do things that place themselves and others at risk. In situations like those, it would be irresponsible not to intervene on their behalf.

So, how do you know when to step in and when not to?

Allow extra time for them to respond

It’s important to recognize that individuals with dementia often need extra time to process what they’re hearing. If you ask them a question, it may take them longer than usual to consider what you’re saying. Their brain may be slower at formulating an answer and then getting it back out.

The trick is to be patient. Give them extra time to answer.

When you’re not certain whether they understand

But what if their ability to understand fluctuates? People with dementia may be more lucid at certain times than others. How can you gauge whether they’re capable of making their own decisions at any given moment?

Here are some guidelines to follow:

  • Start by assuming they can participate in whatever discussion you’re having and that they can understand.
  • Be concise when you talk. Say one thing at a time. Be patient. Give them extra time to process what you or others are saying.
  • Pay attention to whether they seem to be following along. Do they say things that show they’re aware of what’s being discussed? Are they voicing an opinion?
  • If they appear to be following along, don’t step in and make decisions on their behalf.
  • If they don’t appear to be following along, continue to involve them in the conversation even if they’re not able to make a decision. Give them the chance to express their concerns.

As making their own decisions becomes increasingly difficult

As their dementia progresses, it will be increasingly difficult for them to make decisions. That’s why it’s important to have conversations with them early on in their disease to give them a chance to talk about decisions that may have to be made in the future. It will give you a clearer sense of their preferences should you be called upon to make a decision on their behalf when the time comes.

It’s also important to realize that the state where they live likely has specific rules about who can make important decisions for someone else and when they can do it – decisions like consenting to certain types of treatment or managing personal property.

Other questions?

Looking for more advice on how to support a family member with dementia? We’re experts in dementia care and we’re here to help. Contact us at a community near you, we’ll be happy to assist you.

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