When someone is living with dementia, one of the most difficult questions families face is not always spoken out loud.
It often comes up in small, everyday moments.
“Should I still be asking them?”
“Do I need to check everything with them?”
“Am I doing the right thing?”
These questions often come up around decisions, particularly things like spending, appointments or day-to-day choices.
And they can be surprisingly hard to answer.
Dementia and decision-making
Dementia is not just a condition that affects memory. It affects how the brain processes information, weighs up options and understands consequences.
This means that over time, decision-making will become more difficult.
From a clinical perspective, these changes are linked to how the brain’s networks communicate. The brain relies on billions of neurons working together to bring information together, compare options and reach a decision. When these connections become disrupted, this process becomes less efficient.
As a result, someone may still understand parts of a situation, but struggle to bring everything together in a clear or consistent way. However, there insight into this impairment will be flawed and so they often still believe they can and should be involved in all decisions.
Why this is difficult for families
For families, this creates a very real tension.
On one hand, there is a strong instinct to:
- include the person
- respect their independence
- continue as things have always been
On the other, there may be moments where:
- decisions don’t feel safe
- things become confusing
- outcomes feel out of character
This can lead to uncertainty.
Should you still be asking? Or should you be stepping in?
It is not about treating someone differently, it’s about responding differently
This is an important distinction.
The person themselves has not changed in terms of who they are. But how their brain is working has.
That means the way decisions are supported often needs to change.
In practice, this might mean:
- simplifying choices
- guiding decisions more actively. Involving them but making the decision yourself on the best outcome
- reducing the number of decisions they need to make
- becoming the primary person in complex areas such as finances
This is not about taking control. It is about adapting support. The careful balance is still ensuring they feel agency (independence) in their world, while recognising that they can’t make logic based decisions only emotional decisions. Which are more likely to be incorrect.
Do you need to check everything with them?
This is one of the most common concerns, particularly around spending.
In the earlier stages, many people can still be involved in everyday decisions. However, as dementia progresses, constantly seeking approval can sometimes create:
- Arguments
- Not accessing treatment
- confusion
- anxiety
- pressure
There are times when it may be more appropriate to:
- make smaller decisions on their behalf
- guide conversations rather than ask open-ended questions
- reduce the number of decisions they need to process
This often leads to a calmer and more manageable experience for the individual. While still making them feel involved.
Knowing when to step in
There is rarely a single moment where everything changes.
More often, families begin to notice:
- Incorrect decisions
- reduced confidence
- hesitation
- difficulty managing more complex decisions
This is usually the point where more support becomes helpful.
Introducing that support gradually tends to work best. It allows the person to remain involved, while reducing stress and risk.
Finding the balance
Supporting someone with dementia is not about removing independence.
It is about finding the right balance between:
- involvement
- guidance
- protection
Many people can still be part of decisions but may need support around how those decisions are made.
Understanding this makes it easier to respond in a way that feels both respectful and appropriate.
Structured support
When these changes are recognised early, it becomes much easier to put the right support in place.
Structured support can help individuals continue to engage, feel more confident and maintain independence for longer.
Find out more about how we support individuals
Final thoughts
Dementia changes how decisions are made.
Adapting how you support someone is not about treating them differently as a person — it is about responding to how their needs are changing.
For many families, this is one of the most important shifts to understand.
If you’re unsure what the right balance looks like, it can help to talk things through.
At The Ness, we support individuals and families to understand what is changing and what may help at each stage.
Get started with a free assessment