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Lesson 3. Supported Decision-Making

How To Support Someone With Dementia To Make Complex Decisions

​How to support someone with dementia to make complex decisions?

There comes a time in the course of dementia when someone may not be able to make complex decisions anymore, such as decisions concerning medical treatment.

Let's look at an example

Muneera has vascular dementia and is taken care of by her daughter Fatima. The doctor advises Muneera to start using medication for her blood pressure. Muneera says that she does not want to take pills because she does not understand why she needs them.
3. Check your understanding
Support for making complex decisions (1).

What should the doctor and Fatima do?




Let's look at another example

Jabar who has dementia lives with his wife, Sara. Jabar’s condition deteriorates. Sara decides to make an appointment with the doctor without Jabar to discuss his medical condition and to make a decision regarding his medication. Sara discusses the issue with Jabar’s sister as well, who asks her what she thinks Jabar would have decided before he was diagnosed with dementia. Sara talks to the doctor and tries to imagine what Jabar would have decided if given all the information.
4. Check your understanding
Support for making complex decisions (2).

What do you think are reasons that Jabar can no longer make the decision himself?
Please check all the responses that you feel are appropriate.

The capacity to make a decision may be affected by the following considerations:

The type of decision being made.

Someone with dementia might still be able to choose what kind of clothes to wear, but perhaps not whether to take medicines.

Change over time.

Imagine that Jabar had a severe infection that made him very confused. After this infection is cured, he might be able again to decide whether or not to take the medication.

Can be difficult to assess.

Sometimes it is not clear, in which case there is no other alternative other than to help the person living with dementia make a decision that is in their best interest

Remember

  • Someone with dementia can be involved in making complex decisions, such as medical decisions, with the right support.
  • Support for making complex decisions should focus on providing correct information to help the person you care for understand what the consequences of the decision are.

Remember

You can make decisions in the best interest of a person living with dementia by taking the following aspects into account.
  • Their past and present wishes and feelings (and, in particular, any relevant statement written when they did not have dementia).
  • Beliefs and values that may have influenced the person’s decision when he or she did not have dementia.
  • The views of anyone named by the person you care for as someone to be confused to help with making decisions.
  • Be aware that the best interest of the person you care for is not always the same as your own best interest or that of other family members. In the end, it is the best interest of the person you care for that counts, since the decision concerns them
  • Take into account that someone’s past wishes can be different from their present ones.
​Preparing for decisions

To prepare for decisions that you might have to make for the person living with dementia it is important to:

Gather the information you need to make informed choices for the person as early in the course of the disease as possible.

Talk about decisions with your family, friends, doctor and any others close to you to help with decisions that are important to you both.

Prepare instructions that accurately reflect the wishes of the person living with dementia and inform each other and your doctor about your preferences and decisions concerning medical treatment.
1.Activity
Think of the following choices when you prepare instructions that accurately reflect the wishes of the person you care for.
Where does the person you care for prefer to live if it is no longer possible to stay at home?


What aspects of home/community/facility care are important to the person you care for?


Who does the person you care for want in charge of their finances when they are no longer capable of doing it?


How does the person you care for want to be treated at the end of their life?


Are there medical treatments that the person you care for wants to receive or refuse?


What does the person you care for want when eating is no longer possible? Would they want to get a feeding tube?


Does the person you care for have any particular fears or concerns about medical treatments?


You finished this lesson, well done!

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