When Major Decisions Need to Be Made

When Major Decisions Need to Be Made

One of the most difficult parts of dementia is losing the ability to make decisions. Not only is there confusion but often, decision-making opportunities are taken away from the individual when they receive a dementia diagnosis.

Loss of decision-making impacts self-esteem and self-confidence. A lack of self-confidence can lead to withdrawal and a downward spiral for the individual. Thus, it is important to try and include the individual in as many decisions as possible for as long as possible.


Understand Their Values

When making decisions for another, it is important to understand their underlying value system. Discuss with them what is important for them for quality of life and end of life care. You may need to do some digging here to get a good sense of what is important. Try and record as much as possible so that you will have a reference when their ability to communicate diminishes.


Discuss Treatment Options

Talk about the different types of care that will become options for them. You may want to discuss the types of treatment open to them as the disease progresses. Remember, you do not need to discuss this all at one time. It may be too overwhelming for them and for you. As well, over time their acceptance of certain types of treatments may change.

I had a friend who initially did not want a tracheotomy to help her breathe. However, when it became the time to make that choice, she chose to have one. It certainly added to her quality of life, though it was a choice she initially rejected.

Sometimes the shock of the diagnosis creates a paralysis that makes the mind recoil against some treatment options. Discussions about treatment should be ongoing, giving the individual the option to change their mind or even come to a decision over time.


Give Them Choices

Try and maximize the number of choices the individual has in their day. At the beginning, decision-making may be straightforward, however as the disease progresses that will change. Continuing to have decisions to make reinforces self-esteem and helps them retain their dignity.

As decision-making becomes more difficult, change the way decisions are presented. Take the abstract decision and make it more concrete. Limit the decision to two choices. For exa