Safeguarding elderly people with dementia

Understanding safeguarding for elderly people

Older people living with dementia are considered particularly vulnerable due to their diminished cognitive capacity, and therefore require safeguarding to keep them healthy and safe. Here, we are looking at the types of abuse and neglect to watch out for, how to recognise signs of potential abuse, the legal and ethical frameworks you need to know about, and how families and caregivers can protect people with dementia through creating a safe living environment and responding to any incidents or concerns. We will also share the resources and support available in the UK, and how home care professionals could play a key role in safeguarding. 

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about safeguarding a loved one with dementia, we can help.

What is safeguarding? 

Safeguarding refers to the actions, policies, and procedures put in place to protect vulnerable people–such as children and older adults–from abuse, harm, or neglect. Older people with physical, sensory or mental impairments can be vulnerable to mistreatment, so it is important to understand what safeguarding is and how it helps protect those with conditions like dementia. 

In the UK, the Care Act 2014 makes clear that safeguarding helps to protect a person’s right to live their life feeling safe and unaffected by abuse or neglect, and it encourages families, caregivers, GPs, and other social care organisations to work together to address any incidents. The key principles of safeguarding, according to the Care Act, are:

  • Empowerment – Enabling people to choose for themselves
  • Prevention – Taking action to address issues before harm can come to the person
  • Proportionality – Having the appropriate response to the level of risk involved
  • Protection – Offering support and representation to those who need it
  • Partnership – Working alongside local communities to improve safeguarding efforts
  • Accountability – Ensuring those implementing safeguarding practices are transparent and communicate openly 

 

This is the case in England, but Scotland, Wales, and Northern Ireland have similar safeguarding practices of their own:

 

Safeguarding covers physical, emotional, sexual, and/or financial abuse, as well as neglect, and those who work with older people have a duty to speak up about any suspected abuse or exploitation to ensure they keep the person safe and protect their wellbeing.

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In what ways are people with dementia more vulnerable?

Vulnerable people who benefit from safeguarding processes include people with dementia, which is a progressive condition affecting a person’s cognitive abilities. It can cause symptoms like memory loss, communication issues, and behavioural issues that make it more difficult for them to protect themselves, and make them more susceptible to abuse. As the condition progresses over time, people with dementia may struggle to recognise loved ones and familiar places, and will eventually need help managing daily tasks, or making decisions.

With these cognitive issues, people with dementia sadly tend to be more vulnerable to abuse, neglect, and exploitation because: 

  • They typically rely on others for care
  • They may have limited ability to communicate their needs or concerns
  • They may not understand when they are experiencing abuse
  • They may not remember experiencing abuse
  • They can become easily confused and disorientated
  • They may trust strangers too easily 
  • They may become more socially withdrawn, making it easier for abuse to go undetected by those around them 

People with dementia are more likely to experience financial exploitation, emotional abuse, and have their personal care needs neglected, among other issues. Research from 2014 found that dementia patients could be more vulnerable to certain types of abuse, with psychological abuse being the most common, affecting between 27.9% and 62.3%. Physical abuse was also estimated to affect between 3.5% and 23.1% of those with dementia.

It is important for families and regular caregivers to recognise red flags early and take action to ensure adequate safeguarding measures are in place to protect them.

What types of abuse should families watch out for?

Research from the World Health Organization suggests that around 1 in 6 people aged 60 or older experienced some form of abuse in a community setting in the past year, so protecting older, vulnerable people is vital whether they are around others or living alone. There are many different types of abuse and neglect, some that are easy to identify, and others more subtle. These include all types of physical, emotional, and psychological abuse, as well as financial exploitation (scams targeting older people), and neglect. The Social Care Institute for Excellence provides some examples of abuse below. 

Types of physical abuse:

  • Any kind of assault, such as hitting, slapping, punching, pushing, kicking, pulling hair or biting
  • Rough handling
  • Scalding or burning a person 
  • Using physical punishments
  • Inappropriate or unlawful use of restraint, or restricting movement, such as tying them to a chair 
  • Creating discomfort on purpose, such as opening windows or removing blankets
  • Involuntary isolation or confinement
  • Misusing medications by either giving too much or not enough
  • Force feeding the person, or withholding food

Types of psychological or emotional abuse:

  • Intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
  • Enforced social isolation, such as preventing someone from seeing loved ones or accessing services
  • Removing mobility or communication aids to make things more difficult for them
  • Intentionally leaving a person unattended when they need help 
  • Preventing a person from carrying out actions for their religious and cultural needs
  • Preventing a person from expressing their choices or opinions
  • Failure to respect the person’s privacy
  • Preventing the person from taking part in meaningful or stimulating activities
  • Addressing the person in a patronising or infantilising way
  • Threatening the person with harm or abandonment
  • Cyber bullying

Types of financial or material abuse:

  • Stealing money or possessions from the person 
  • Committing fraud against the person, or scamming them 
  • Preventing the person from accessing their own money, benefits or assets
  • Employees taking a loan from the person using the service
  • Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions
  • Arranging inadequate care for the person to save money and maximise inheritance
  • Denying the person assistance to manage or monitor financial affairs
  • Denying the person assistance to access their benefits
  • Misuse of personal allowance in a care home
  • Misuse of benefits or direct payments in the person’s own home
  • Moving into the person’s home for free without their agreement, or under duress
  • False representation, using another person’s bank account, cards or documents
  • Exploitation of the person’s money or assets, such as the unauthorised use of their car
  • Misuse of a power of attorney, deputy, appointeeship or other legal authority
  • Rogue trading, such as overpricing property repairs or failing to carry out agreed repairs

As well as the above, it is important to watch out for common scams (such as fake phone calls or emails), discriminatory abuse, institutional abuse (such as discouraging visits to a care home), sexual abuse (such as inappropriate touching or indecent exposure), neglect (such as inadequate nutrition or poor personal care), and domestic abuse. Data from 2022 found that 1 in 30 older people between the ages of 60 and 74, and around 1 in 50 older people aged 75 and up, have been victims of domestic abuse in the past year, so it is important to also look out for abuse within the person’s own home.

How can families and caregivers recognise the signs of potential abuse? 

It can be difficult and confusing to recognise signs of potential abuse in a loved one with dementia, as often they cannot communicate properly, or rely on their own memory. Families and caregivers must look for certain signs that might indicate any of the above abuse or neglect is taking place. These signs might include: 

  • Physical indications like bruises, burns, cuts, or any unexplained injuries
  • Frequent accidents 
  • Vague explanations for wounds
  • Behavioural changes, for example a formerly calm person becoming withdrawn and anxious or aggressive
  • The person with dementia not wanting to be left alone with certain people, or seeming uneasy when around them
  • Unexplained routine changes
  • Suspicious financial activity 
  • Inadequate living conditions
  • Sudden weight loss or missed meals
  • Poor hygiene
  • Missing possessions
  • Changes to legal documents, wills, or bank accounts that suggest exploitation
  • A decline in the cleanliness of the home

If you have any concerns or notice any of the above, it is important to involve others, investigate where you can, and if necessary, report any signs to safeguarding authorities for further investigation.

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Safeguarding people with dementia is not just about families and caregivers stepping in to protect the person’s wellbeing – often there is legislation in place to help protect these individuals from abuse, neglect, and exploitation.

The Care Act 2014 is the key legislation in the UK to uphold adult safeguarding. This creates a duty of care for local authorities to take appropriate steps to prevent abuse, respond to any concerns from people in contact with the individual, and to promote their wellbeing. Local authorities usually have their own Safeguarding Adults Board (SAB) in place to:

  • Ensure arrangements are made according to recommendations from the Care Act
  • Ensure its practices are person-centred and outcome-focused
  • Work with other organisations or parties (such as the NHS or police) to prevent abuse and neglect
  • Ensure parties involved in cases give timely and proportionate responses to inquiries
  • Continuously improve safeguarding practices to enhance the quality of life of older people in the area

Essentially, the SAB will work to ensure safeguarding processes remain consistent, transparent, and effective.

Ethically, safeguarding should also ensure older people with dementia are respected by giving them autonomy where possible. The Mental Capacity Act is designed to offer protections and empower those who may lack the mental capacity to make decisions for themselves about their care and treatment, such as people with dementia. It assumes that people can make these decisions themselves until there are signs indicating this is no longer the case.

How can family and caregivers best protect their loved ones?

If you have a loved one with dementia or you are a caregiver for someone with this condition, you may be wondering how you can ensure their safety and wellbeing, and understanding safeguarding is a great place to start. There are many steps you can take to protect them, including: 

  • Maintaining open communication with your loved one so they feel they can trust you
  • Encouraging them to share any worries, concerns or feelings to help identify potential issues before they get out of hand
  • Listen patiently and always validate their experiences to ensure they feel believed and supported
  • Monitor care providers and support services to check they are providing adequate care
  • Check in with professional carers to observe interactions and regularly review their care plan
  • Help them to manage their finances to identify any issues, such as arranging direct debits or joint accounts to prevent exploitation, and monitoring unusual transactions (if you are concerned that you should not have access to the person’s finances either, involve a neutral third party or a close family member of the person)
  • Supervise medication management to avoid errors
  • Check in on their personal care routines, such as personal hygiene, preparing meals, and mobility support for getting around the home, to ensure it is safe, dignified, and in accordance with the person’s wishes

Ultimately, spending time with and around the person to observe their daily life and the people in it can help you become more familiar with their routines and day-to-day life, which should make it easier for you to identify any changes if they arise. By clearly communicating with your loved one and structuring safeguards, you can help to protect their wellbeing.

How can families create a safe living environment for people with dementia? 

Part of arranging safeguarding for older people with dementia is ensuring their home environment is safe and comfortable for them. This usually involves adaptations, frequent monitoring, and encouragement to create a routine that works for them. 

Home adaptations can help to minimise fall risk for older adults, and since around 30% of people aged 65 and over fall each year in the UK, this is extremely important. You can make the home safer by installing grab rails, non-slip mats, removing loose rugs or cables, and improving lighting to increase visibility. You may also need to install a stairlift to make ascending the stairs safer, add clear signage for people with dementia who may forget where certain rooms are, or install personal alarms so they can seek help quickly if needed.

There are steps you can take to protect the person’s personal information and finances, such as storing important documents, passwords and bank details securely, and monitoring any accounts for unusual activity on a regular basis. It can help to set up direct debits, pre-paid cards, or joint accounts so you have more oversight and can prevent financial exploitation from occurring. 

Encouraging social engagement can also be helpful in protecting an older person with dementia, as isolation can increase vulnerability. Having regular visits with others, participating in community activities, and attending appointments and gatherings can ensure individuals living alone feel connected, and that anything suspicious or alarming does not go unnoticed due to lack of social engagement. While this is important, families may still wish to check in on their social interactions, online activity, and new service providers to ensure they can be trusted.

How should families or caregivers address any incidents or concerns?

If you are worried about someone with dementia that you fear might be being abused, neglected or exploited, it is important to act immediately to help them. You can either call the police if you believe there is immediate danger, or reach out to your Local Authority Safeguarding team to bring up these concerns with trained professionals who can step in to help. Other organisations that may be relevant to contact include domestic abuse services, community and support groups, and the person’s GP. 

Remember, your local authority has a duty to assess anyone who you have concerns about, even if the person in question is resisting help. Identifying problems often requires a collaborative approach from healthcare professionals who can identify signs of abuse, social workers who can provide guidance, and families or caregivers who can monitor the situation and keep detailed records of observations.

What safeguarding resources and support is available in the UK for people with dementia?

If you would like assistance with a safeguarding concern, there are many resources and organisations in the UK to help. Depending on the issues, these may include: 

Professional carers can assist with dementia care and maintaining safety and dignity, and many agencies are regulated by the Care Quality Commission (CQC) to ensure safeguarding standards are in place and adhered to. 

How can home care help with safeguarding?

Home care plays a vital role in keeping people with dementia safe at home, with professional caregivers trained to recognise the signs of abuse, neglect, or exploitation. Home care can: 

  • Report any concerns to the family, local social services, or the safeguarding authorities straight away, which they are legally and ethically obligated to do
  • Provide consistent care so they know the ins and outs of the person’s routine and the people they spend time with, and will know if anything changes 
  • Reduce the older person’s daily risk by assisting with mobility, personal care needs, medication management, and more
  • Ensure the environment remains safe and free from any hazards
  • Support their daily routines and independence so they can maintain familiar habits and a sense of control
  • Create an environment of open communication and trust, so older people with dementia always feel they can share their concerns 
  • Adhere to safeguarding policies to ensure their practical needs while also protecting their emotional wellbeing

At Home Instead, our Care Professionals can become familiar with your family’s individual situation and support you with any concerns you may have over your loved one’s wellbeing. We take the time to match each client with a caregiver who complements their personality, interests and specific care needs, which helps to ensure they feel safe with their caregiver at all times, and can bring up any issues they have. Whether your loved one needs occasional support with personal care, simple companionship to reduce loneliness, or more intensive dementia care, our friendly, supportive Care Professionals can help – you can reach out to your local Home Instead office to discuss your options.

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.