Emotion regulation and decision-making in persons with dementia: A scoping review

Abstract

Background and Objectives Emotion is integral to decision-making, and emotion regulation is associated with improved well-being in older age. Persons with dementia are likely to experience impairments in emotion regulation processes that can potentially contribute to differential decision-making and well-being outcomes. To promote the development of theoretical models of well-being in dementia, we review the quantitative evidence concerning the associations between emotion regulation and decision-making in dementia. Methods Scoping review. Results Seven studies of persons with dementia met our criteria. In persons with frontotemporal lobar degeneration, emotion regulation processes that precede the emotional experience were associated with decision-making in a moral (but not uncertainty) context. Independent of type of dementia, evidence concerning the associations between emotion regulation processes that occur after emotion is experienced and decision-making was mixed and drew on different methodologies. No studies relating to the associations between decision-making in dementia and several emotion regulation processes and strategies were found. Conclusions In this review, we sought to clarify the concept of everyday decision-making in dementia and map the current state of evidence concerning its associations with emotion regulation. Our findings show that emotion regulation processes are associated with decision-making in dementia, depending on type of decision-making assessment and emotional experience. We outline the gaps in the literature to set a research agenda for promoting our understanding of how emotion regulation processes can shape the various decisions that are made by persons with dementia on a daily basis.

Development of a Daily Living Self-Efficacy Scale for Older Adults in Japan

“…Factor 5, “Valuing enjoyment and relationships with others”, included various items, such as “Doing what I love and having fun” and “Being energetic and feeling good”. Yamamoto-Mitani et al raised control of emotion as a subscale of the QOL scale for older patients suffering from dementia [ 19 ], and Perach et al pointed out that the control of emotions is crucial in decision making among older patients suffering from dementia [ 20 ]. These findings suggest that among older adults with declining cognitive functions, it is crucial to maintain a good emotional status by valuing enjoyment and relationships with others to ensure the maintenance of self-efficacy.…”

Care Staff’s Daily Living Decision-Making Support Scale for Older Adults with Dementia in Japan: Development of Validity and Reliability

“…Factor 2 has four items that reflect actions taken by care staff to assist OwDs with communication (e.g., “we wait for the OwD to respond, even if their communication takes time, to draw the terms for their daily living” and “to form a will, we support them to make their choices independently and show concrete choices in their daily living according to their pace”). For ACP, individuals with moderate and severe dementia, especially OwDs, may have difficulty with verbal communication; thus, it is important to better understand their current quality of life, fears, and desires by responding to their emotions, paying attention to nonverbal communication, and observing their behavior [ 13 ]. It has also been reported that emotional control is important for decision-making in OwDs [ 14 ], and the communication of care preferences and assisting with communication correspond to Factors 1 and 2.…”

Broadening and deepening the understanding of agency in dementia

“…They argue for 'an approach to emotion that conceives of emotional processes as intimately tied up with agency' (Slaby, Paskaleva, and Stephan 2013, 34) but explore how this relationship can result in an 'impairment of agency' in conditions such as depression (ibid, 42). This understanding could inform discussions around agency in dementia as agency is seen as something that can fluctuate and be affected by emotional states as well as cognitive impairment 2,3 Perach et al have demonstrated how emotions and our ability to regulate them play an important role in decision-making (Perach et al 2021)…”