Before you begin, have you completed the first four modules in this series about dementia?
Part one: Understanding dementia
Part two: Risk factors and diagnosis
Part three: Managing dementia
Part four: Living with dementia

As dementia is a progressive disease, it is important for people with the condition to be able to make decisions about their future care early on, before they find it difficult to communicate or they lack the capacity to do so. This is known as advance care planning. 

It is important that there are opportunities to review and change the plan as the dementia progresses and if the preferences or needs of the person change. Having an advance care plan ensures that the person with dementia can receive treatment and care according to their preferences, even when they can no longer express them.

It’s important to remember that people living with dementia can still have the capacity to make decisions about their health and medicines. You need to consider patient confidentiality when discussing their health with carers and family members. There may come a point at which the person is no longer said to have the capacity to make informed decisions. A person is thought to be unable to make an informed decision if they cannot do all four of the following: 

• Understand information being given to them 
• Retain information long enough to be able to make a decision 
• Weigh up the information necessary to make a decision 
• Communicate their decision by any possible means, e.g. blinking or squeezing a hand. 

The Mental Capacity Act 2005, which was fully implemented in 2007, provides a statutory framework to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. 

The Alzheimer’s Society offers detailed information covering the Mental Capacity Act and other important legal issues, such as lasting power of attorney (LPA), which gives an appointed person the power to make decisions about the patient’s welfare, including medical treatment.

NICE has also produced a guideline on Decision making and mental capacity to be read in conjunction with the Mental Capacity Act 2005.