Can a Person with Dementia Safely Make Decisions?

5 Questions to Figure Out if the Person with Dementia Can Safely Make Decisions (or at least get the conversation going)

In the previous post, I described how decisional ability is more like a dimmer than an on-off light switch. In this post, I will describe some ways to see if the person with dementia understands the decision and has the ability to safely make it–and is not being manipulated by someone. These 5 questions can start the conversation rolling. Caregivers will probably have other related questions for each of the big ones.

  1. Tell me about the decision. (What is the decision? What does it mean to you?)
  2. If you go through with _______, what may happen?
  3. Tell me who your decision may help.
  4. Tell me who your decision may hurt.
  5. Is someone or something “pushing” you to make this decision?

One has to evaluate the responses based on how severe the dementia is. I probably would not ask these questions of someone with moderate to severe dementia. The asking of the questions is a process; we are providing an opportunity to really find out what the other person is thinking. On one hand, we want to protect our loved ones from financial abuse or unsafe conditions. On the other hand, we want to respect their autonomy….their ability to make their own decisions.

Let’s say I have a parent with dementia who is living in his own house. One of the adult children wants that parent to move in with her. The parent steadfastly refuses. Here are his responses to the questions:

“My daughter wants me to move in with her, but I don’t like where she lives. It is not close to where my friends are and I’ll never see them. If I move in with her, I’ll have to sell my house and I will always be a ‘guest.’ I will never have my own place. Moving in would help my daughter, she would not have to drive over here to check on me. True, I’ll be with someone but she works every day so I’ll still be by myself while she is at work. It would be nice to have company every evening. I feel like my children are pushing me to move so that they won’t have to worry about me.”

Now, the reality is that the move is not a question of “if” but a question of “when.” At least the parent is sharing some of his concerns about feeling homeless and becoming a permanent house guest. His daughter may be able to come up with some compromises based on this conversation. Perhaps it would be better if he were to relocate to an apartment in a senior community or to an assisted living environment; this may not have occurred to the adult children as a possibility because they were so focused on one potential “solution” to their concerns about their father’s safety.

These five questions can also be useful in checking to see if the PwD is refusing care, medication, or some other necessary item due to true autonomy or instead, due to refusals based on “this does not make sense to me” or out of fear.

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