Ways to Improve Decision Making in Seniors

While some people stay mentally sharp for most of their lives, many seniors start to getting a little, well… fuzzy. Some of this may be a natural result of aging, while medical conditions, medication, and other factors can also play a part.

It can be frustrating to watch an aging parent start to make increasingly bad decisions, like ignoring doctor’s advice, doing too much around the home, or falling prey to scam artists.

Thankfully, there are things you can do to help.

What is Good Decision Making?

Before we talk about how to help with decision making in seniors, we need to talk about good decisions in general.

This is an area adult children often struggle with, as we have our own ideas about what our aging parents should be doing. Often, this involves wanting them to take fewer risks, hire help, and give up some potentially dangerous habits.

But remember, everyone’s decisions are influenced by their own values and desires. For example, some seniors choose to keep doing DIY and similar tasks even when they know the risks, because being independent and productive is incredibly important.

Good decision making doesn’t focus on whether the ultimate decision is ideal or even good. Instead, it focuses on the process of making a decision. Does someone’s decision make sense for who they are? Do they understand the factors involved? Can they weigh up the different variables?

One way of doing this is to consider the model used when examining a person’s capacity for decision making. This model has four elements: understanding, appreciation, reasoning, and expression. This means that the person needs to:

• Understand the decision at hand and the related information.
• Appreciate the situation and consequences of the decision.
• Be able to rationally reason through the various options. Some people may rely heavily on values for this part of the process, but that’s still a form of reasoning.
• Express the chosen decision.

How You Can Encourage Good Decision Making

The approaches we’re discussing here are especially relevant for complex decisions, including those that relate to healthcare, advance care planning, and thoughts about where the senior should live. However, the same principles can also be used for more straightforward decisions.

Ensure They Have All The Facts

In healthcare settings, patients are generally given all the information they need before making a decision. But, this isn’t true elsewhere.

For example, a father insisting on DIY might not realize that:

• His strength and stability may decrease, regardless of how active he stays.
• Age-related changes aren’t always obvious, so he may not notice when his tasks become unsafe.
• There are ways to improve his safety while still giving him the independence and activity that he’s looking for.
• A single fall can cause long-term adverse health effects. Sometimes, this even happens from a relatively minor fall.

Also remember that what’s obvious to one person mightn’t be obvious to someone else. For example, STDs are a surprisingly common issue in nursing homes, partly because that generation didn’t receive much sex education and may have little sexual experience aside from their spouse.

Make Information Clearer

How things are presented makes a huge difference to understanding and decision making.

While medical staff mean well, their descriptions can sometimes be complex and confusing. Family members can help by working with doctors to make information clearer.

Here are some approaches to consider:

• Simplifying information, such as using easier language and including only crucial details.
• Provide summaries. Summaries remind people of the most important points, which can help with retention and understanding.
• Use visual aids. Charts, images, and diagrams can make information much clearer. Medical staff may already have some for particular decisions or you may need to make your own.
• Make crucial information clear. Highlighters, tabs, and specific color coding can help to pull out specific pieces of information, allowing seniors to see what matters the most.
• Use analogies. These are especially valuable for complex medical information that’s difficult to understand.
• Present information in chunks, instead of all at once. Large amounts of information can be overwhelming and confusing, decreasing a person’s ability to understand. It’s often better to present the information in multiple stages, perhaps even on different days. This way, there’s enough time to process and understand all the information.

You can also ask the senior what they’ve heard. This will help you avoid missed information or misunderstandings.

Be Supportive

Trying to push someone into a specific decision often backfires, leading to them becoming even more entrenched in their position.

Being supportive and encouraging can work much better. For example:

• Focus on the desired outcomes first, then look at how to achieve them. With a father who loves DIY, these outcomes might include independence and having tasks to complete. Are there safer ways to meet those same goals?
• Emphasize collaborative problem solving. You’re not there to force them to make a particular decision. You want the best for them, so why not work together to find solutions?
• Respect their decision. Make it clear that you’ll respect whatever decision they make – and stick to this promise. If you try to bully someone into a particular choice, they may not involve you in future decisions.
• Ask if there’s extra information they want. Some seniors may want more resources or wish to talk to someone else before deciding. Such extra perspectives are often helpful. Plus, the senior may be more responsive to advice from someone else.
• Recognize the emotional challenges. Many decisions have emotional effects, especially those related to end-of-life or loss of autonomy. 

Improve the Environment

Environmental factors are relevant too, especially if you’re trying to have a difficult conversation or if there are various medical aspects to consider.

The following approaches can make things better:

• Remove distractions. Televisions, music, and even people talking in other rooms can all be distracting, making it more difficult to focus on the information at hand.
• Ensure adequate lighting. Good lighting makes it easier to read written information and may also increase alertness in general.
• Make things more home-like. If the senior is in a facility or a hospital, anything that makes their room feel more familiar and home-like may help.
• Promote comfort. This includes having comfortable seating, a suitable temperature, and the right lighting. Being comfortable increases ease, which can then improve decision making.

Be Mindful of the Time of Day

Most of us concentrate better at some times of the day than others. Mid-morning is often a good time, as people have woken up fully and have a decent amount of energy. In contrast, complex conversations and decisions are often more difficult in the evening, as people are tired and may be overloaded from the day’s events. 

Of course, those are just generalizations. You’ll need to think about the individual and their patterns to find the best time for them.

Treat Underlying Conditions First

If cognition is being influenced by a treatable health condition, then addressing the condition first may help. For example, UTIs in seniors sometimes cause confusion and dramatically impact decision making. Treating the UTI first will often improve cognition and restore decision making capacity.

Wait

If possible, it may simply be best to wait a little for highly significant decisions. Doing so decreases the stress and urgency of the decision, while also giving the senior time to adjust to their current situation.

This is particularly relevant if the senior has just been admitted to an emergency room or healthcare facility. Such situations involve considerable changes that the senior needs to adjust to. It may be too much for them to also try and make a decision that impacts their long-term health.

Conversations about moving to a facility may require more time than you expect, as there are multiple areas that the senior needs to consider and adjust to. Being patient and giving them enough space makes the process better for everyone.

Promote a Healthy Diet and Lifestyle

Finally, anything that helps to promote cognition can also improve decision-making. This includes strategies like eating a balanced diet, getting plenty of antioxidants, and engaging in physical activity.

Keeping the brain engaged can be relevant too, like with memory game apps or crossword puzzles.

These diet and lifestyle strategies are a long-term approach. This makes them highly relevant for seniors who are still relatively independent with no serious cognitive issues – and not that relevant in a hospital setting where there are immediate decisions to be made. 

How to Identify Problems

The approaches we’ve discussed are all important ways to improve decision making. Even so, they won’t work in all situations. Sometimes a person no longer has the capacity to make some decisions (particularly complex ones).

This is especially obvious in the later stages of dementia. Here, a person may not understand the world around them well. Even simple decisions can be difficult and complex ones are entirely unrealistic. Challenges with decision making can happen in many other situations. Here are some signs to look out for:

• Confusion. This is often the result of difficulty in understanding or processing information. It could mean that a person gets confused about where they are or who someone is. 
• Inconsistent Decisions, like when someone decides they want surgery, then don’t, then do, there’s probably something else at play.   
• Surprising Decisions. For example, someone may refuse a low risk and high reward treatment, with no apparent reason. 

Crucially, these signs simply mean that it’s time to investigate – they don’t prove a lack of capacity.

After all, we all make inconsistent or surprising decisions sometimes. Such decisions might be driven by personal values, fear, or other factors. It’s unfair to assume that someone can’t make decisions simply because we don’t like what they decide.

If you’re worried about the loss of decision making ability, talk to the person’s physician, as their physician is often the person assessing decision making ability. You can also check out our post on capacity and how it relates to advance care planning.