Safeguarding Adults with Dementia

1. Adults with Dementia

Factors that can increase risk

Adults with Dementia are likely to have cognitive symptoms that may make them more at risk of abuse or neglect.

These include:

Memory loss;
Difficulty making decisions;
Difficulty problem solving;
Communication issues; and
Problems with orientation and perception.

Mental Capacity

It is important not to make assumptions about mental capacity. Capacity has to be considered separately for each decision at the time it needs to be made, and a person can have capacity to make some decisions but not others. Consideration must also be given to whether there is any support that would help the person to make the decision.

In the early stages of Dementia adults are often able to, either independently or with support:

Be involved in care and support processes;
Provide an insight into their needs;
Make decisions about care or treatment;
Decide how best to manage risk; and
Set their own goals and outcomes.

Even where the adult lacks capacity, it is important to have regard to their wishes and feelings.

Maximising participation in the safeguarding process

The following table sets out some good practice 'rules' to enable an adult with Dementia to be actively involved in the safeguarding process:

Rule	An adult with Dementia can…	Do's	Don'ts
Meet & greet	Forget names and faces Misplace the context of a face	Introduce yourself, your role and the purpose of the conversation each time	Expect the adult to have remembered you
Getting to know you	Feel socially uneasy Find it difficult to start a conversation	Spend time 'getting to know' the adult each time you see them, by inviting them to talk about something that interests them	Go straight into the formal purpose of the conversation
Gain my attention	Not realise you are talking to them unless you are explicit	Routinely use the adult's name and wait for recognition before speaking to them	Provide information to the whole room if it is only meant for the adult
Help me feel at ease	Become anxious, confused, scared, angry or upset by the actions of others	Sit where the adult can see you, do not stand over them, do not appear from behind Use a calm tone, smile, use positive body language and be friendly	Use authoritative body language or verbal tone
Value, Respect & Dignity	Easily feel isolated, ashamed, worthless and devalued by the actions of others	Speak to the adult, not a carer or representative Speak to the adult as an adult Seek their views and listen to what they have to say, even if it doesn't appear to make sense	Talk over the adult, ignore them or whisper to others
Avoid distractions	Find it difficult to focus when there are a lot of things happening around them	Keep distraction to a minimum from TV, radio and other people in the room Avoid late arrivals at meetings	Proceed regardless of any distraction
Help me remember	Find it hard to retain new information	Summarise key information Be prepared to say something more than once or answer the same question several times	Expect the adult to retain information without support
Help me understand	Find it hard to understand the meaning and context of communication Misinterpret information	Use uncomplicated language and break things down Explore alternative communication e.g. pictures and objects of reference Give time to process information	Use inaccessible formats to provide information
Sometimes words are not enough	Struggle to find the right words Forget what they want to say	Be reassuring Offer helpful alternatives-would it be easier to show me? Explore alternative communication e.g. pictures and objects of reference	Assume to know what the adult wants to say Assume a lack of capacity
Work in the here and now	Sometimes find it hard to understand the concept of the 'future', anticipate future needs and advance plan	Set timeframes to achieve outcomes that are meaningful to the adult
Manage my anxiety	Become overwhelmed by information, leading to changes in mood, behaviour or engagement	Rephrase something Take a break Change the environment Change the subject for a while	Exclude the adult from the conversation
Don't challenge my reality	Have a false perception of reality that is very real to them	Accept the adult's reality Use the information to inform the process Consider assessing mental capacity	Correct or challenge as this can cause confusion, anger and anxiety and serves no purpose

2. Informal Carers of adults with Dementia

Carers may be at increased risk of harm from, or of causing harm to, the adult they support.

This is especially the case if they:

Have their own health or care needs;
Are feeling overburdened;
Are isolated;
Are feeling lonely.

Risk can also be increased if the Dementia symptoms experienced by the adult are challenging.

For example if they;

Have fluctuating needs;
Are repetitive;
Do not comply with care routines;
Seek constant reassurance or attention;
Need constant supervision;
Are awake overnight.

Carers deemed at increased risk should always:

Be offered a carers assessment;
Be provided with regular opportunities to talk; and
Receive good information and advice about the support available to them.

3. Herbert Protocol

There is a risk that adults living with dementia can get lost and go missing.

The Herbert Protocol can be a good prevention measure to reduce the risk that harm will occur.

A form is completed by a carer that contains a list of information to help the police if the adult goes missing, including:

Medication required;
Mobile numbers;
Places previously located;
A recent photograph.

In circumstances where an adult with dementia has support from a professional or agency and it is identified they are at risk of going missing, the professional should encourage their carer to complete a form.

If there is no carer, the professional or agency should complete the form with the adult's consent (or in their best interests if they lack capacity).

The local Herbert Protocol form can be found in the Contacts and Practice Resources area.

Also see: Missing Adults.

4. Further Guidance

See Supporting people living with dementia to be involved in adult safeguarding enquiries.