Dementia is a degenerative illness that makes the patient non-competent and more dependent on others. In modern healthcare systems, empowering the patient to participate in the advanced decision-making process is an essential component for patient wellbeing and quality care (Smebye et al.,2014). Therefore, the therapeutic relationship has changed from a patronizing to more advanced participating decision-making. Patients have all the authority to participate in decision making about their health and the patient with dementia being cognitive incompetent can state their choices concerning their everyday activities but not in financial decisions (Smebye et al.,2014). Caregivers must value the preferences of patients as part of their professional behavior.
Patients living with dementia have all the right to value their needs and choices for their treatment. Allowing patients to involve in decisions making is focused on their self-determination and impart a feeling of worth including their integrity, dignity, and personhood (Hegde & Ellajosyula,2016). Cognitive impaired cannot participate in a task although, can take decisions for self-care and assistance and possess all the controls on reasoning and choices. Autonomy is essential for improved quality of life and encouraging autonomy is an important component during dementia care (Hegde & Ellajosyula,2016). Accepting dependency on others by dementia patients in a healthcare setting will restore their autonomy ethics.
The capability of decision-making is a capacity-based process and depends on time and decision type. Although, dementia patient lacks processing and remembering capacities, however, possess all the capabilities to make decisions for self-care. Dementia is a progressive disorder in which the person's competency gets reduced over time, depending upon the stage of dementia (Alzheimer's Society,2020). A good understanding and strong therapeutic relationship will help to understand the needs and supports them during their decision-making process as long it is possible. Timely care and diagnosis is essential in such conditions where patients get access to timely support and information regarding their illness and advanced care planning.
The care workers are expected to support dementia patients during everyday care including medication and agree to take them on time. The caregivers must share knowledge and ensure that they understand all the treatment options before involving them in advanced decision making (Mitty,2014). Legally and ethically it is always recommended to ascertain a patient
wishes, preferences, and choices for their healthcare decisions rather than to appoint a surrogate decision-maker (Mitty,2014). The ability of the patient to encourage decision consequences is a highly valued standard in dementia patients for decision making between healthcare systems.
Alzheimer's Society. (2020). Alzheimer's Society's view on decision making. Retrieved from https://www.alzheimers.org.uk/about-us/policy-and-influencing/what-we-think/decision-making#:~:text=Dementia%20can%20affect%20a%20person's,is%20time%20and%20decision%20specific
Hegde, S., & Ellajosyula, R. (2016). Capacity issues and decision-making in dementia. Annals of Indian Academy of Neurology, 19(1),34-39.
Mitty, E.L. (2014). Decision-making and dementia. The Hartford Institute for Geriatric Nursing., 9(12). 1-4.
Smebye, K.L., Kirkevold, M., &Engeda, K. (2014). How do persons with dementia participate in decision making related to health and daily care? A multi-case study. BMC Health Services Research, 12(241),1-12.
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