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The nature of decision-making in people living with dementia: a systematic review

The nature of decision-making in people living with dementia: a systematic review

Bhatt, Jem, Walton, Holly, Stoner, Charlotte R. ORCID: 0000-0002-1536-4347, Scior, Katrina and Charlesworth, Georgina (2018) The nature of decision-making in people living with dementia: a systematic review. Aging & Mental Health, 24 (3). pp. 363-373. ISSN 1360-7863 (Print), 1364-6915 (Online) (doi:

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The objectives of this systematic review were to: 1) understand how people living with dementia are involved in making decisions; 2) explore the different decisional styles and domains of decision-making that people living with dementia experience and 3) identify what influences the level of decisional involvement of people living with dementia. A systematic review of literature identified studies from Medline, PsycINFO, HAPI and CINAHL databases. Search terms related to decision-making and dementia. Qualitative and quantitative research designs were included. Appraisal of included studies was done using quality ratings. All studies focused on how decision-making took place. Extracted findings were synthesised narratively with concept mapping, conceptualisation and an exploration of connections between studies to develop an overall model of decision-making involvement Fifteen studies fully met the eligibility criteria (thirteen qualitative and two quantitative). All studies had moderate ( = 10) to high ( = 5) quality ratings. Participants were predominantly people living with dementia ( = 13), Parkinson's disease and stroke. The model of decision-making encompasses four decisional styles (managed autonomy, mutual, reductive and delegated) determined by different degrees of involvement from the person living with dementia and their supporter. The decisional style implemented was influenced by the presence or absence of background (the Freedom of Choice framework) and contextual factors (risk, relationships and resources). Decision-making in dementia is complex and influenced by many factors beyond cognitive impairment alone. This review indicates that decision-making in dementia takes place through decisional styles, determined by unique levels of involvement from people living with dementia and their carers.

Item Type: Article
Uncontrolled Keywords: dementia, autonomy, decision-making, narrative synthesis, systematic review
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Faculty / School / Research Centre / Research Group: Faculty of Education, Health & Human Sciences
Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified: 05 Jun 2020 23:36

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