As with all nursing home residents, it should not be assumed that residents with dementia no longer have decisional capacity and/or that they have a reduced quality of life. In addition to end-of-life ethical concerns with older adults with dementia, daily ethical issues can arise in the care of these individuals. Ethical decisions arise simply related to providing information around the diagnosis of dementia. For some individuals, it may be devastating to be given this diagnosis, while others want the information so as to optimize treatment and make plans for the future. The decision of how to proceed in these situations may be best made by taking the lead from the older adult. For example, if the individual is asking about cognitive changes and expressing concern about these changes, then information around a diagnosis will more likely be heard and appreciated. Conversely, if an individual is denying changes and does not want to hear about his or her impairment, then it may be futile to provide the information. Other care-related issues that commonly create ethical challenges in older adults include such things as refusal of care, wandering, disinhibited speech or behavior that is upsetting to staff and other residents, or aggressive behavior. Wandering, either deliberate or aimless, can be intrusive for other residents or neighbors if the individual is living in the community and a significant clinical problem. Ethical issues arise when a resident with dementia invades the privacy and space of another resident, who does not consent to the visit. The balance between the autonomy of the individual who is wandering versus the greater good of the community must be resolved. Ethically based options to manage these situations include such things as moving the resident who wanders or putting up a stop sign on the door to prevent entry. Alternatively, a resident with dementia may refuse to engage in any type of care activity, just wanting to lie in bed. If allowed to make this decision, the individual will be at risk for pressure ulcers, deconditioning, falling, and contractures and will ultimately require higher level nursing interventions and resources. Preventing these problems would benefit not only the individual in terms of preventing pain and suffering but the community at large. Ethical choices need to be made to resolve the discrepancies between individual choice versus allowing harm to occur. In this situation, ongoing motivational interventions and capturing the individual at the opportune moment to engage him or her in activities would help to resolve the ethical dilemma.