Why do individuals with dementia have difficulty making sound decisions?
As dementia progresses, damage occurs to the front portion of the brain, which manages complex cognitive processes such as memory, planning, reasoning, and problem solving. When this area becomes damaged, an individual begins to lose decisional capacity to understand the benefits and risks to make a fit decision.
As a result, individuals suffering from dementia often need someone else to assume decision-making responsibility on their behalf. This primary caregiver will be required to decide and execute decisions in order to:
- Uphold the individual’s best interest at the forefront, including but not limited to daily routines (i.e. when to shower, change clothes, etc.)
- Keep him/her well by planning and arranging social, cultural and religious activities
- Keep him/her healthy by offering nutritious meals, continuous hydration, and encouraging exercising
- Protect him/her from harm to others and themselves (i.e. taking away the car keys, etc.)
- Make medical and end of life decisions in their best interest
It is common for caregivers to experience challenges and difficulties making decisions for an individual with dementia. What are some of the leading challenges for caregivers?
- Role reversal and needing to “parent” an older adult
- Emotional feelings of loss or resentment towards that person who had been capable
- Family disagreements as to what is in the individual’s best interest
- The need to be decisive, strong and confident in ones’ decisions on behalf of the individual
What are tips to help caregivers with decision-making?
- Understand and accept that the person no longer has the capacity to make good decisions
- Dedicate time to identify and understand what the person with dementia would want for themselves if they had capacity
- Weigh the benefits and risks in taking the action. It is important to recognize some decisions are non-negotiable, while others are negotiable such as:
Non-Negotiable Decisions
- Taking medication
- Wearing proper clothing for the weather
- Hydrating often
- Taking away the car keys
- Medical life sustaining care
Negotiable Decisions
- Time and frequency of showering
- Time of day to change clothing
- Rescheduling a non-urgent appointment
- Accommodating a change in sleep patterns
Seek the input of others you trust to help you to make a good decision. Consider the advice and guidance of trained professionals for assistance.
Keep in mind that you are making the decision for the right reason
If you need assistance with decision-making issues or help with other caregiving concerns contact me