Involvement of Hospitalized Persons with Dementia in Everyday Decisions: A Dyadic Study

Background and Objectives: To examine the involvement of persons with dementia (PWDs) in everyday decision making from the perspectives of hospitalized PWDs and their family caregivers, and to identify determinants thereof. Research Design and Methods: Using multilevel modeling, we examined cross-sectional data collected prospectively from 42 family care dyads regarding the care values of the PWD. Results: Both members of the dyad rated the PWD, on average, as being "somewhat involved". There was a signifcant amount of variability around the average perceptions of PWD involvement in decision making for both PWDs (x² = 351.02, p < .001) and family caregivers (x² = 327.01, p < .001). Both PWDs and family caregivers were signifcantly more likely to perceive greater PWD involvement in decision making when the family caregiver reported the PWD as valuing autonomy. Additionally, PWDs were signifcantly more likely to report greater involvement when they had greater cognitive function. Finally, family caregivers perceived signifcantly greater involvement of the patient in decision making when they reported less strain in the relationship. Together, autonomy, relationship strain, cognitive function, and care-related strain accounted for 38% and 46% of the variability in PWDs' and family caregivers' perceptions, respectively, of the PWD's decisionmaking involvement. Discussion and Implications: Although research indicates that decision-making abilities decline with advancing dementia, these results imply that working with families to support PWDs in their value of autonomy and mitigate strain in the dyad's relationship may help prolong PWDs' decision-making involvement.