Consent, capacity, distress, and escalation

A diagnosis of dementia does not mean a person lacks capacity. Many people with dementia can make some or all decisions, particularly when communication is clear and they are given time and support.

Consent and capacity in everyday pharmacy care

• Presume capacity first: do not assume incapacity because of diagnosis, age, or appearance.
• Capacity is decision-specific: a person may be able to consent to one matter but not another; ability can change over time.
• Support decision-making: explain straightforwardly, reduce distractions, allow time, use simple language, and try again later if needed.
• Respect refusal: if a person with capacity refuses a service or medicine intervention, that decision must be respected even if others disagree.
• Know the legal framework: the Mental Capacity Act 2005 applies in England and Wales; follow local law, policy, and service arrangements in Scotland and Northern Ireland.

Carers, attorneys, and distress

A relative, carer, or someone holding Lasting Power of Attorney should not automatically replace the person's own decision-making. If the person is distressed, actively refusing, or appears not to understand, stop and reassess.

A health and welfare LPA can be used only when the person lacks capacity for that particular decision.

Distress in dementia can result from pain, fear, noise, unfamiliar surroundings, infection, constipation, dehydration, medication side effects, or delirium. Start by asking what might be causing the distress rather than trying to proceed regardless.

Escalation points for pharmacists and managers

A diagnosis of dementia requires considered support, not assumptions. Pharmacy teams should prioritise the person's own decision-making and escalate only when capacity, distress, or legal authority are unclear.