Consent, capacity, and involving families

Dementia can affect decision-making, but a diagnosis of dementia does not automatically mean a person lacks capacity. Many people living with dementia can make some or many decisions, especially if information is explained clearly and they are given enough time and support.

Key points for frontline staff

• Capacity is decision-specific: a person may decide what to wear or eat but struggle with a more complex decision.
• Capacity can fluctuate: tiredness, infection, anxiety, pain, time of day, or medication effects may make decision-making better or worse.
• Support should come first: use simple language, familiar staff, quieter spaces, and extra time before deciding the person cannot decide.
• Refusal still matters: if the person has capacity for the decision, staff must respect that choice even if others dislike it.
• Family involvement is important, but not unlimited: next of kin status alone does not automatically give legal power to consent on the person's behalf.

Nation-specific legal note

For adults in England and Wales, the Mental Capacity Act 2005 provides the broad framework for supported decision-making, best interests, and least restrictive care. Scotland uses the Adults with Incapacity (Scotland) Act 2000, and Northern Ireland uses the Mental Capacity Act (Northern Ireland) 2016. Staff should follow their own local legal framework and employer policy.

Some families or representatives may have formal authority, such as a health and welfare attorney or another lawful decision-maker. Staff should know when to seek senior advice rather than guess.

Dementia does not automatically remove a person's right to decide. Staff should support decision-making first, recognise lawful representatives properly, and seek senior advice when capacity or consent is unclear.