Identifying Modifiable Markers of Impaired Decision Making Can Improve Nursing Home Residents’ Ability to Make Decisions Independently

On a daily basis, nursing home residents have opportunities to make many decisions that affect their lives.  These decisions range from important medical considerations to more routine decisions, such as choices regarding social activities and composition of meals.  Even if a resident’s cognitive condition hinders decision-making ability in one area, that resident might have the ability to make other types of decisions.  Residents who actively participate in decision making can strengthen their sense of well-being and improve their quality of life.  Factors that are known to indicate poorer decision-making ability include cognitive impairment (particularly dementia) and older age.  By contrast, depression does not diminish a nursing home resident’s ability to make decisions.

Research is still needed on nursing home resident characteristics that may indicate impaired decision-making ability. It is crucial to identify impaired decision making in order to assess the correct balance in the latitude provided each resident to make certain decisions.

A recent study investigated the association between a range of nursing home resident characteristics and impaired decision making and found that several independent markers included depressed, sad, or anxious mood (independent of depression or anxiety diagnosis); dementia; and greater need for activities of daily living (ADL) assistance. Some of these factors, especially mood, are modifiable and addressing them may help enhance decision-making ability.

Nursing home staff should strive to gain a greater understanding of correlates of impaired decision making in their residents so as to be better able to identify modifiable factors. This can lead to the restoration of independence in decision making for residents.