Should A Person Living With Dementia Be Involved In Decision Making Regarding Their Healthcare?

Decision Making and Dementia

Making decisions that concern our lives is often vital for all of us. It is considered to be a critical element of individual health as well as wellbeing. Making choices and decisions which are upheld plays central role to self-determination. However, as much as individuals living with a diagnosis of dementia are in great need to control their lives, it is difficult for them to be included in decision-making concerning their health. Recent studies indicate that the ability to make decisions either complex or simple for individual suffering from dementia greatly varies and depends on personality as well as the extent to which the disease has progressed.

People living with a diagnosis of dementia together with their families often find it difficult to decide on healthcare and how the situation should be handled. According to Livingston et al., (2017) individuals with dementia often will bitter because their family members usually fail to consult them when decisions about their care homes that they are going to be taken are made. Therefore, Livingston et al., (2017) claim that health care professional to examine the conversion around decision making concerning people living with the diagnosis of dementia together with their family as well as relatives. People suffering from mild and moderate dementia are capable of participating in decision making concerning their health up to some extent (Livingston et al., 2017). According to this literature, People living with a diagnosis of dementia should not be allowed to make decisions concerning their healthcare such as whether to take them to care home or live with their family members at home because they lack insight concerning problems of what they are doing might cause to their health. Additionally, caregivers also argue that it’s not safe for people with dementia to be included in decision making because they lack a proper understanding of various issue that necessitates a move.

The article entitled “A review of End-of-life issues in advanced dementia” by Arcand, (2015) claims that if patients who have severe dementia are allowed to make decisions, they are always surrogate due to the incapacity to think and loss of memory. Therefore, clinicians are responsible for exploring as well as understand previously goals that the patient state to come up with an appropriate medical decision to ensure that the treatment coincides with the desires of the patient. Therefore, according to this literature, families of patients living with a diagnosis of advanced dementia play an essential role in that decision concerning their health care is made appropriately. Additionally, health care providers should consider dementia in advanced stages as a major terminal illness which requires continuum care. Clarification on goals as well as family education should be prioritized and considered to be of paramount significance to help avoid burdensome intervention. However, Arcand, (2015) fails to mention various kind of response that can be initiated to aid in individuals who have dementia together with their families reach a concrete decision (Arcand, 2015).

Should Individuals with Dementia be Involved in Healthcare Decision Making?

Decision making depends on three vital elementary components; that is the ability to identify an individual needs, making choices as well as exploring options (Wolfs, et al., 2012). Individuals living with a diagnosis of dementia often make decisions that are as a result of emotional choices rather than rational ones. According to Wolfs, et al., (2012), several aspects make decision-making by people suffering from dementia challenging. Such factors include; strong emotion, continuous nature of dementia, difficulty in accepting dementia and patients depending on surrogate decision making. The literature argues that caregivers, as well as health caregivers, have an active role in ensuring that the patient accepts their conditions. Acceptance is essential since it helps patients who have dementia agree with the decision made by their families and caregivers hence providing significant benefits to their recovery. Finally, decision making for people living should be made as a team. The article offers insight concerning complex, emotional and complicated decision making that patients who have dementia, their families together with caregivers often undergo.

The article entitled “Everyday decision-making in dementia” suggests that people living with a diagnosis of dementia should not be allowed to decide on their health status. According to the article, exercising choice as well as control over decision is vital to value and quality of life. (Samsi & Manthorpe, (2013), reveals that 2005 act on the mental capacity of England and wales offers a legal framework of safeguarding the right of individuals living with a diagnosis of dementia to make their own decision related to their health care as long as probable. The caregivers should gradually make the decision-making on health issues affecting the dementia patients. However, there is a lot of stress associated with the making decision on behalf of someone especially if they are suffering from diseases such as loss of memory and inability to think. Additionally, the article also suggests that decision making concerning health of people with dementia should be made collectively (Stein-Parbury, et al., 2012. Healthcare providers together, dementia patients along with their families should be involved when making-decision to ensure that the best interest principle is achieved.

The article on “Healthcare experiences of people with dementia and their caregivers” reveals that decision-making on the health-related issue of a person needs to be carried out with a lot of critical thinking and evaluation of many issues. According to the article, individuals living with a diagnosis of dementia are not capable of identifying a problem, role translation and understanding information on human health. A study conducted by Prorok, Horgan, & Seitz, (2013) that involved 1866 people with dementia together with their caregiver’s claims there has been raising number of people who have dementia. Therefore, is very important to have a better understanding of such people. Review of various researches to examine the characteristic of healthcare experiences among people living with dementia reveals that their health care can only be improved if they are not involved in decision making. People who have dementia often experience a decline in their cognition (Rokstad et al., 2013). Deterioration in cognition often affects the choices and decision that the patients make concerning their health. Therefore, allowing them to decide on their health care exposed them to highest risk of acquiring other diseases that can lead to their death.

The Role of Caregivers and Health Care Providers

Research by Boyle, Wilson, Gamble, Buchman, & Bennett, (2012) suggests that decision-making is a critical factor of health as well as wellbeing within the entire lifecycle. However, it is essential at old age due to the decline in cognitive function. According to the article, people living with the diagnosis of dementia are prone to making a poor decision due to the Alzheimer’s disease. During the study, data on the decision made by the dementia people more than five years ago were collected. Regression analysis was applied to assess error caused by the dementia individuals are associated with a decline in the cognitive function. Out of the 420 people assessed, it was discovered that dementia individuals are prone to make a poor decision concerning their treatments and hospitalization (Borson, et al., 2013). Therefore, the study concluded that poor choices among the dementia people on their health are as a result of a decline in the cognitive function. Thus dementia patients should not be included in decision-making because of poor judgment which can have adverse effects on their health and lives.

The article entitled “how do persons with dementia participate in decision making related to health and daily care Smebye, Kirkevold & Engedal, (2012)”, claims that individual suffering from dementia should not be assumed as incapable of making decision regarding their diagnosis since their cognitive ability is not entirely affected (Smebye, Kirkevold & Engedal, 2012). When evaluating the ability of dementia to make decisions concerning their healthcare, professional caregivers assessed the mental competence rather than the standard test. According to the findings, individual living with diagnosis dementia inconsistency in how they contributed in decision making. People who have moderate dementia were found to have reduced mental capacity. Additionally, the research founds out that excluding people with dementia from taking part in decision making as a capability of causing depression, anger as well as frustration (Jeon et al., 2012). The article claims that though there is a need to give them a chance to make decisions concerning their health, there is a need for involvement of caregivers and family members to offer guidelines (Rokstad, Vatne, Engedal, & Selbæk, 2015). Shared decision making should be made because dementia is associated with memory loss, a decline in mental competence and communication problems capable of misleading the patients into making a wrong decision.

Dementia is associated with ageing population and age-related condition according to the journal “making sense of dementia”. The journals reveal that the diseases are as a result of neurodegenerative diseases that continuously cause damage to the brain cells (Cruz, Marques, Barbosa, Figueiredo, & Sousa, 2013). Therefore this usually leads to confusion, cognitive decline, and difficulties when it comes to solving a problem, impaired abilities of the person to cope with activities of daily life such as cooking personal hygiene among others. According to the journal, one in every six people who are over 80 years has the dementia (Frazer, Oyebode, & Cleary, 2012). Moreover, the article state that the common type of dementia is referred to as Alzheimer’s illness. Therefore, dementia is a global health issue that requires a lot of attention from different health organization. Despite the need by people with dementia to be allowed to continue with their normal life, there is a need to guide them and offer necessary support. According to the article, the disease is associated with mental hill problems due to the confusion, cognitive decline, and difficulties when it comes to solving a problem as well as impaired abilities, they should not be allowed to decide their current and feature health care.

The Risks of Patient Involvement

Dementia has the probability of inhibiting decision making abilities of the patient from it according to the article “Making Care Decisions in Home-Based Dementia Care” (St-Amant et al., 2012). Therefore, family members with the help of caregivers are required to assist the patients with decision making concerning their health care. The article reveals that some patients who are not able to make decision prefer to be helped supported by their family members to decide their health care. However, the articles claim that family members, as well as relatives, have found difficulties in determining on behalf of the patient due to lack of emotional assistance by health care providers during the early stages of dementia. Additionally, medical as well as legal systems have a massive effect on how decision-making is made for dementia patient in various health cares. Therefore, the journal concludes that dementia patient should not be allowed to make-decision due to legal laws and their cognitive impairment.

“False Information from Patients with Dementia Threatens Safety” journal claims that dementia is now one of the most dangerous diseases which pose serious threats to patient safety in many ways (Wallace et al., 2013). Therefore, there is a need to carry out risk management safety for people who are over 65 years old to determine dementia. According to the journal, dementia patients are prone to giving incorrect information thereby putting their lives in dangers as a result of medical error. Due to fear, agitation and confusion, dementia patients should not be allowed to decide their lives. Therefore, family members and healthcare providers should act on behalf of the patient.

Conclusion

Dementia is increasingly becoming a significant threat to health care and patient safety around the world. Due to the severe effects of the diseases such as impaired cognition, confusion and loss of memory evidenced by most of the article discussed above, it clear that patient living with the diagnosis of dementia should not be allowed to make a decision concerning their healthcare. Family members and healthcare team should take the decision making choices on behalf of the patient to ensure that their life is not at risk of medical errors and wrong diagnosis.

References

Arcand, M. (2015). End-of-life issues in advanced dementia: Part 1: goals of care, decision-making process, and family education. Canadian Family Physician, 61(4), 330-334.

Boyle, P. A., Yu, L., Wilson, R. S., Gamble, K., Buchman, A. S., & Bennett, D. A. (2012). Poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment. PloS one, 7(8), e43647.

Conclusion

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