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Making decisions for people with dementia who lack capacity: qualitative study of family carers in UK
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OBJECTIVE: To identify common difficult decisions made by family carers on behalf of people with dementia, and facilitators of and barriers to such decisions, in order to produce information for family carers about overcoming barriers. DESIGN: Qualitative study to delineate decision areas through focus groups and complexity of decision making in individual interviews. SETTING: Community settings in London. PARTICIPANTS: 43 family carers of people with dementia in focus groups and 46 carers who had already made such decisions in individual interviews. RESULTS: Family carers identified five core problematic areas of decision making: accessing dementia related health and social services; care homes; legal-financial matters; non-dementia related health care; and making plans for the person with dementia if the carer became too ill to care for them. They highlighted the difficulties in making proxy decisions, especially against active resistance, and their altered role of patient manager while still a family member. Families devised strategies to gain agreement in order to ensure that the person with dementia retained dignity. CONCLUSIONS: The following strategies helped with implementation of decisions: introducing change slowly; organising legal changes for the carer as well as the patient; involving a professional to persuade the patient to accept services; and emphasising that services optimised, not impeded, independence. To access services, carers made patients' general practice appointments, accompanied them to the surgery, pointed out symptoms, gained permission to receive confidential information, asked for referral to specialist services, and used professionals' authority to gain patients' agreement. End of life decisions were particularly difficult. They were helped by knowledge of the person with dementia's previous views, clear prognostic information, and family support. Information sheets to help carers to overcome barriers to proxy decision making have been developed; their impact in practice has yet to be evaluated.
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“People with dementia and their relatives find decisions about the person with dementia living in a care home difficult.”
From How people with dementia and their families decide about moving to a care home and support their needs: development of a decision aid, a qualitative study (2016) · cites this paper as [3]
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“In general, when they are well most people do not plan that they or their relatives will move into a care home [3].”
From How people with dementia and their families decide about moving to a care home and support their needs: development of a decision aid, a qualitative study (2016) · cites this paper as [3]
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Metadata
- Authors
- Livingston, G., Leavey, G., Manela, M., Livingston, D., Rait, G., Sampson, E., Bavishi, S., Shahriyarmolki, K., & Cooper, C.
- Affiliations
- University College London (GB)
- University of Ulster (GB)
- Medical Research Council (GB)
- Corresponding author
- Livingston, G.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2010-08-18
- Volume
- 341
- Issue
- aug18 1
- Pages
- c4184-c4184
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2923693
- OpenAlex
- W1996631590
- Cited by
- 239
- References
- 16
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 6 · 2023: 8 · 2022: 11 · 2021: 12 · 2020: 19 · 2019: 23 · 2018: 21 · 2017: 21 · 2016: 18 · 2015: 18 · 2014: 23 · 2013: 18 · 2012: 14
- FWCI
- 13.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion, cc-by-nc)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Alzheimer's Society
- Bupa Foundation
- University College London Hospitals NHS Foundation Trust
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Keywords
- dementia, family caregivers, proxy decision-making, barriers to decision-making, end-of-life decisions, care homes, patient dignity
- MeSH terms
- Automobile Driving, Decision Making, Dementia, Family Relations, Female, Health Education, Humans, Male, Middle Aged, Nursing Homes, Patient Care Planning, Terminal Care, Resuscitation Orders, Mental Competency, Caregivers, Patient Selection
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