Is the Home a Better Place for People with Dementia to Make Decisions?

Abstract: The UN Convention on the Rights of Persons with Disabilities emphasizes supporting individuals with disabilities, including those with dementia, in making self-determined decisions, as cognitive decline often challenges their capacity to consent. This study explored a new approach to supported decision-making by examining whether conducting decision-making conversations in a familiar home setting, rather than a clinical environment, reduces complexity and strengthens consent capacity. We used a randomized AB/BA crossover design to assess the impact of spatial intervention on capacity to consent in N = 28 individuals with suspected or confirmed dementia. We computed linear mixed models for consent capacity facets and secondary endpoints (e.g., task complexity), including baseline covariates. Overall, the participants scored high on consent capacity subscales and showed low anxiety and uncertainty during decision-making. Regression analyses showed no significant differences in capacity to consent depending on location and period. Descriptively, there was a slight increase at the second time point, which was more distinct for participants first assessed at home. Although we found no significant differences, the descriptive results suggest potential learning effects, with the home environment possibly providing supportive conditions. Limitations included a small sample size, challenges faced by physicians unfamiliar with home visits, and ceiling effects.