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Assessing whether a person with dementia can still make choices

Key points

  • Decision-making capacity is specific to each choice—don't assume they can't decide anything just because they have dementia.
  • Offer only two clear, concrete options at a time to reduce overwhelm and support their ability to choose.
  • Adapt activities they used to love rather than giving them up entirely; break tasks into steps they can still do.
  • Use simple language, visual cues, and plenty of time for them to respond.
  • Document their preferences early and reassess regularly as their abilities change.
  • When in doubt, consult a clinician for formal capacity assessment, especially for high-stakes decisions.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Start by quietly observing what they can still do during a familiar task like making tea. Note where they hesitate or get confused—this gives a real-world baseline for what choices are within reach.

  2. Offer just two clear options at a time, using simple words and showing the actual items. For example, hold up a blue and red shirt and ask, 'Would you like this one or this one?' Skip open-ended questions like 'What do you want to wear?'

  3. Give them at least 10 to 15 seconds to respond. People with dementia process language more slowly, and rushing can make them shut down.

  4. If they seem stuck or say 'I don't know,' choose gently for them: 'Let's try this one first,' and guide them into the activity.

  5. Adapt activities they once loved instead of dropping them. A former cook can still wash vegetables or set the table; a golfer might enjoy putting practice. Keep the feeling of the activity alive, not their old skill level.

  6. Track changes over time using the IQCODE (Informant Questionnaire on Cognitive Decline in the Elderly), available online. Rate their ability on everyday tasks every few months to spot patterns.

  7. For major decisions—medical treatments, finances, moving to care—ask a doctor or geriatric care manager to formally assess capacity. They can clarify what the person can still decide independently.

  8. Capture their preferences while they can still share them: favorite foods, music, routines, and wishes for future care. Write it down or record a short video.

What not to do

  • Don't assume they can't decide just because they have dementia. Always offer a simple choice first and see what they can do.

  • Don't correct a harmless 'wrong' choice—mismatched socks, a sweater on a warm day. If it won't hurt them, let it go.

  • Don't push an activity they're clearly resisting. If they say no or turn away, stop and try again later.

  • Don't overlook what their body and mood are telling you. A relaxed face or smile is a real answer; restlessness or turning away is a real 'no.'

Practical tools

  • Two-Option Choice Script

    Keep this phrase ready: 'Would you like [Option A] or [Option B]?' Hold up each option as you name it, wait 10 seconds, and if no response, say warmly, 'Let's try this one,' and guide them.

  • Activity Adaptation Checklist

    Pick an activity they used to enjoy and list every sub-step on paper. Check off which steps they can still do, which need help, and which to skip. Keep the steps that work; reshape or drop the rest.

  • Daily Preference Log

    Keep a small notebook or phone note. Each day, jot down one or two choices they made—'chose apple over banana,' 'sat by the window again.' Over weeks, these entries reveal a clear map of their tastes.

  • Visual Choice Board

    Make a simple board with 2 to 4 pictures of activities or items—a walk, a puzzle, a cup of tea. Point to each and say its name, then let them point or tap.

  • 'Can They Still?' Quick Observation Guide

    Before a decision, mentally run through three questions: (1) Can they understand the basic information? (2) Can they weigh the options? (3) Can they communicate a choice, even with a nod? If yes to all, they likely can decide; if no to any, simplify or decide for them. For legal or major decisions, defer to a professional evaluation.

  • Routine Activity Menu

    Write a short menu of 3 to 5 familiar, low-effort activities—folding towels, sorting socks, watering a plant, flipping through a magazine. Offer it each morning and let them pick one.

Discuss with your clinician

Ask their doctor or neurologist: 'Can you formally assess my loved one's decision-making capacity for [specific decision, e.g., living alone, surgery, financial management]?'

If you notice a sudden change in their ability to make choices (e.g., they were managing fine last week and now can't decide anything), discuss with their doctor to rule out delirium, infection, or medication side effects.

For decisions about driving, discuss with their doctor or an occupational therapist who can do a driving assessment. Do not rely solely on your own judgment.

If you are considering a move to a care facility or a major medical treatment, ask the doctor or a social worker to help you understand what the person can still decide and what you must decide for them.

If the person has no advance directives, discuss with their doctor or a lawyer how to make decisions that align with their values and wishes.

Ask your doctor: 'Is there a formal capacity evaluation tool you recommend for important decisions, and how can I access it?'

Ask your doctor: 'What are the signs that I should stop using informal observation and seek a professional capacity assessment?'

Related guides

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