Decision-Making Processes in Dementia Care
Summary
Decision making in dementia care encompasses a spectrum of interactions, from everyday choices about personal routines to high-stakes decisions concerning health interventions and living arrangements. As cognitive impairment progresses, the locus of decision making often shifts from the individual towards care partners and professionals, yet principles of person-centred care demand that people with dementia remain as actively involved as possible. Research has illuminated how fluctuations in capacity, variations in emotional state and relational dynamics influence the ability to form preferences and communicate them effectively. Approaches such as shared decision-making seek to balance respect for autonomy with the practical need for support, employing tools that scaffold communication and clarify values. Supported decision-making frameworks further stress the role of tailored assistance, enabling individuals to express choices with minimal substitution. Ethical and legal frameworks, including statutory capacity assessments, underpin these practices, ensuring rights are upheld even when decisional abilities are compromised. Globally, multidisciplinary studies have underscored the importance of culturally sensitive adaptations, low-tech communication aids and structured decision pathways to enhance involvement, reduce conflict and improve quality of life across care settings.
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Decision-Making Processes in Dementia Care publication trend
The graph below shows the total number of articles in decision-making processes in dementia care across all publications each year (not limited to Nature Index journals).
Technical terms
Shared decision-making: A collaborative process in which individuals and supporters exchange information, discuss options and reach a healthcare or care plan decision together.
Supported decision-making: A model that provides tailored assistance to individuals with impaired cognitive function to help them understand, deliberate and communicate their choices, without replacing their autonomy.
Mental capacity: The legal and clinical assessment of an individual’s ability to understand, retain and weigh relevant information to make a specific decision at a particular time.
Decisional conflict: The state of uncertainty about which course of action to take, often arising when choices involve risk, trade-offs or equivocal evidence, and can be measured to identify support needs.
References
- Considerations for legal, ethical, and effective practice in dementia research. Brain Communications (2024).
- TalkingMats as a decision aid to promote involvement in choice and decision-making around home care services for older people with mild to moderate dementia – study protocol for a randomized controlled trial. BMC Geriatrics (2023).
- Shared decision-making for people living with dementia in extended care settings: a systematic review. BMJ Open (2018).
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