Dementia: Encouraging Individual Choices

Dementia: Encouraging Individual Choices

For a person living with dementia having the ability to make good decisions and to choose clearly what they want can become challenging. It can also become difficult to communicate to others what they need or feel. This can result in feelings of anger and agitation that they no longer have control in their life. It is easy for this to be misinterpreted and result in reducing a person's control even more.

Plan for the future

A diagnosis of Alzheimer's disease does not mean a person can't, or shouldn't, make decisions for themselves. In fact, the early stages of the disease is the time to think through decisions to be made and to have some of the difficult discussions we put off. Planning ahead and finding out your loved one's wishes and opinions will make it easier to make difficult choices on their behalf in the future.

  • Talk about their values and definition of quality of life.
  • Make financial arrangements and complete legal paperwork.
  • Ensure the person's wishes for who will control their welfare and make decisions on their behalf are recorded.

Re-evaluate your Approach as a Person's Abilities Change

An individual living with dementia will generally become more reliant on a carer to help them. In the busyness of the day, it can be easy for this person to quickly make all the decisions, just to get on with the job. This may be the most efficient thing to do, but it really isn’t the best thing for the person living with the condition.

People living with dementia, such as Alzheimer's disease, are adults and as adults, they have been making choices all of their lives. Taking away a person's opportunity to make decisions is robbing them of their independence and dignity. This can result in an individual feeling frustrated and unhappy.

Unfortunately, the problem with this is that a person may struggle with making a decision at all. But if this is the case, the solution is not to completely remove the opportunity to have some control. Choices and options need to be presented in a way the individual can manage.

Here are a few things to keep in mind:

  • Don’t presume that a person is not able to make decisions.
  • Respect people as equals, giving them control over what happens to them as much as possible.
  • Allow extra time for a person to make decisions, be patient and appreciate this is an important part of their wellbeing.
  • Aim to allow the person to choose as much of their lifestyle as feasible - surroundings, entertainment and timetable.
  • Reframe questions to suit the person's ability. For example instead of: “What would you like to drink?”, you could try “Would you like a cup of tea or a glass of juice?
  • Always invite someone to participate in activities. Ask them in a way that encourages them to say yes, but always leave them with the option to say no. “Would you like to join me at the table and help me with this puzzle?
  • Sometimes a question may seem too complex and it is simpler to show the options. For example when dressing, rather than asking them what they would like to wear, present two options and ask them to select which outfit they would prefer.
  • This can also happen when being offered food or drink. Often a person will decline a drink when asked, but happily accept it when it is presented to them. Occasionally it may be because the person asked doesn't want to be a bother. It is important to find out if this is the case, but also to gauge whether the question is being understood.

There are some things a person living with dementia may feel they want or need that are just not possible to indulge. The important thing is a person is not left frustrated at not being listened to or respected. Try to redirect, rather than dismiss ideas out of hand. Always look for ways to nurture a person's confidence by asking for their opinions and input whenever possible.

Below is a short video of a care home, I think it is in Singapore. I think it demonstrates in a very nice way how we humans at any age or stage will take ownership of, and interest in, something we have had input into.

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