University of Sheffield research explores how conversations shape decisions about dementia care

The way healthcare professionals talk about care options could influence whether people living with dementia accept or decline support, new research from the University of Sheffield suggests.

When someone is living with dementia, decisions about their care can have a significant impact on their health and quality of life. But how are these decisions made, particularly when family members or friends are also involved.

Funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme, a research team at the University of Sheffield is exploring how people living with dementia, their companions and healthcare professionals make decisions together during memory clinic consultations.

Led by Principal Investigator Dr Traci Walker, School of Allied Health Professions, Pharmacy, Nursing and Midwifery, the team includes Dr Isabel Windeatt-Harrison, Professor Markus Reuber, Dr Simon Bell, Dr Dan Blackburn, Dr Alistair Wardrope, Dr Jon Dickson and Dr Sara Jones, alongside a dedicated Patient and Public Involvement (PPI) group.

In a recent analysis, the researchers identified a striking difference in how people responded to medication and non-drug interventions. Non-pharmacological management (NPM) includes approaches that do not involve medication, such as cognitive stimulation therapy, dementia cafés, hearing aids and referrals to organisations such as Age UK.

The researchers found that people living with dementia and their companions resisted or declined offers of non-drug interventions in 54 per cent of cases, compared with 19 per cent of offers of medication.

Looking closely at the consultations, the team found that healthcare professionals often presented these options differently. Non-drug interventions were more likely to be offered with less emphasis on their potential benefits, less information about what they involved and less follow-up when someone initially expressed reluctance. Medication, by contrast, was more often accompanied by a stronger recommendation, clearer information and further discussion when someone was hesitant.

Findings showed that when non-drug interventions were presented with a stronger recommendation, more information and an opportunity to discuss concerns, people were more likely to accept them.

Dr Windeatt-Harrison, Research Associate said: "The way we communicate care options can have a real influence on the decisions people make. Non-drug interventions can offer significant benefits to people living with dementia, but if they aren't explained clearly or recommended with confidence, people may miss out on support that could make a positive difference to their lives."

The team uses a research method called Conversation Analysis to examine how decisions unfold during real-life interactions. Researchers look closely at the words people use, how they respond to one another and the verbal and non-verbal cues that shape conversations.

As part of the study, the team video-recorded 64 memory clinic consultations, generating 44 hours of recordings involving people living with dementia, their companions and healthcare professionals, including neurologists and dementia nurses. Detailed transcripts allowed the researchers to explore how care options were introduced, how people responded and how decisions developed.

The findings highlight why communication is so important. Non-drug interventions can provide valuable opportunities for cognitive stimulation, social connection and support with everyday life. They may also help manage some symptoms associated with dementia. For people with certain types of dementia, including frontotemporal dementia, where specific dementia medications are not available, these approaches can be particularly important.

The research suggests that healthcare professionals could help people access these options by clearly explaining what interventions involve, communicating their potential benefits and taking time to explore any concerns. This is not about persuading people to accept care against their wishes, but ensuring they have the information and support to make decisions that reflect their preferences.

The wider project also examines how decision-making in three-way consultations differs from consultations involving people without dementia. Ultimately, the team hopes to develop practical resources, including information leaflets, infographics and training materials, to help patients, companions and healthcare professionals communicate more effectively.

By understanding how conversations shape decisions, the researchers aim to support people living with dementia to maintain a meaningful voice in decisions about their care, including as their condition progresses.