Understanding capacity and decision-making issues in dementia care

As the prevalence of dementia continues to rise globally, ensuring that individuals living with the condition are supported in making decisions about their lives is increasingly important. This article explores the legal, ethical and practical dimensions of decision-making capacity in dementia, with a focus on the application of the Mental Capacity Act 2006 in England and Wales. It outlines the principles and processes for assessing capacity, making best-interest decisions and the role of legal instruments such as lasting power of attorney and deprivation of liberty safeguards. The discussion highlights the importance of shared decision making and the need for community nurses to actively involve family, carers and individuals with dementia in conversations about their care and future. Two fictionalised case studies illustrate the complexities of real-life decision-making scenarios, offering insights into how legal frameworks and person-centred approaches can be integrated in practice. The article also considers the potential of decision aids to enhance autonomy and participation for people with dementia. This article aims to support community nurses in delivering compassionate, lawful and inclusive care.