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  • Writer's pictureTeam Nellie

Navigating Fluctuating Decision-Making in Individuals: Understanding the Complexities of Capacity

Updated: Sep 22, 2023


When working with individuals, especially those with cognitive impairments, one may notice significant variations in their decision-making abilities from one day to the next. Some individuals might be meticulous in managing their financial matters, yet struggle to remember basic information such as the date or how to take care of their health needs. This phenomenon of fluctuating capacity poses unique challenges for both caregivers and the individuals themselves. In this blog, we delve into the complexities of fluctuating decision-making and its connection to cognitive conditions, emphasising the need for a compassionate and individualised approach to support and care.

The Nature of Fluctuating Capacity

Fluctuating capacity refers to the inconsistency in an individual's ability to make decisions and comprehend information over time. It is particularly prevalent among those with cognitive impairments, such as dementia, Alzheimer's disease, traumatic brain injuries, or certain mental health conditions. The very nature of these conditions affects the brain's functioning, leading to unpredictable variations in cognitive abilities.

Financial Awareness vs. Daily Living Skills

One of the perplexing aspects of fluctuating capacity is the discrepancy between an individual's ability to manage financial matters and their struggles with daily living skills. Some may be highly adept at managing their finances, able to recall precise financial details down to the last penny. However, when it comes to remembering essential daily tasks, such as taking medications, eating regular meals, or maintaining personal hygiene, they might falter. This discrepancy arises due to the variability in the brain's affected areas, with certain cognitive functions remaining relatively intact while others are severely compromised.

Time and Decision-making

Another puzzling aspect of fluctuating capacity is the impact of time on an individual's decision-making abilities. They may be relatively lucid and capable of making sound choices in the morning, but as the day progresses, their cognitive impairments worsen, hindering their ability to reason and make informed decisions. This phenomenon can be distressing for both the individual and their caregivers, as it demands constant vigilance and flexibility in providing appropriate support.

The Role of Individuality

Fluctuating capacity is not a one-size-fits-all phenomenon. It varies greatly from person to person, even among individuals with the same cognitive condition. Each individual's brain is unique, and the affected areas and severity of impairment differ significantly. As a result, the manifestation of fluctuating capacity will be entirely individualised, requiring personalised approaches to care and support.

Challenges Faced by Carers

Carers play a crucial role in supporting individuals with fluctuating capacity. However, they encounter several challenges due to the unpredictable nature of the condition. Carers may find it challenging to strike a balance between promoting autonomy and ensuring the individual's safety. Decisions made by the individual in the morning may become unsafe or impractical by the afternoon, necessitating constant reassessment of their needs and abilities.

Compassionate and Individualised Care

To address the complexities of fluctuating capacity, a compassionate and individualised care approach is essential. Here are some key strategies for carers and healthcare professionals:

  1. Regular Assessment: Periodic evaluation of an individual's cognitive abilities can help identify patterns and adjust care plans accordingly.

  2. Clear Communication: Open and honest communication with the individual and their family members can foster trust and understanding.

  3. Flexibility: Flexibility in caregiving approaches and schedules can accommodate the individual's fluctuating needs and abilities.

  4. Support Networks: Involving support networks, such as family, friends, and support groups, can provide additional assistance and emotional support.

  5. Decision-Making Support: Assisting the individual in decision-making, especially during periods of cognitive decline, can help them make choices aligned with their best interests.


Fluctuating capacity is a challenging aspect of working with individuals affected by cognitive impairments. It highlights the importance of recognising the uniqueness of each individual's condition and tailoring care approaches accordingly. While the fluctuating nature of decision-making may pose challenges, with compassion, understanding, and a person-centred approach, we can provide the support necessary for these individuals to lead meaningful lives despite their cognitive challenges.

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