Dementia, Decision Making and Family Dynamics


Families who are helping older adults with dementia face many stresses, like:

  • Seeing the condition get worse over time

  • Helping the person with dementia more and more

  • Disagreeing about what the person with dementia can or should do

  • Disagreeing about the wishes of the person with dementia

Early diagnosis of dementia gives the person more time to discuss and make legal, financial and other arrangements with family members.


Many people living with dementia, especially in the early to middle stages, can take part in family discussions and decisions.


Honoring an older adult with dementia's needs, wishes and priorities can include asking them:

  • About their feelings, needs and wishes

  • About the pros and cons of different options

  • About the risks they're willing to take

  • To choose between options

  • About what is most important to them

  • About past similar decisions or situations they faced

People living with dementia tend to be happier if they are included in family discussions and decisions at some level. It can help to keep discussions short, take breaks and focus on one question or topic at a time.


Family members of older adults with more advanced dementia can still consider the person's:

  • Values and preferences, such as connecting with others, enjoying favorite activities or following religious, spiritual or cultural practices

  • Personality, whether it's adventurous or cautious, outgoing or reserved

  • Relationships, including with family, friends, neighbors and community groups

  • Physical and emotional condition, including how stable it is and likely changes

  • Finances and other resources, including how they managed finances

  • Past decisions, including who they asked for advice and whether independence, cost, quality, convenience or something else was more important

Family members of older adults with dementia can support good family dynamics by:

  • Focusing on the strengths and goals of the person living with dementia

  • Being aware of how family members respond to stress

  • Managing stress by taking care of themselves

  • Trying not to take things personally

  • Seeking to understand others' points of view

  • Building on others' views and information to suggest solutions