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:

  1. Memory loss;
  2. Difficulty making decisions;
  3. Difficulty problem solving;
  4. Communication issues; and
  5. 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:

  1. Be involved in care and support processes;
  2. Provide an insight into their needs;
  3. Make decisions about care or treatment;
  4. Decide how best to manage risk; and
  5. 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:

  1. Have their own health or care needs;
  2. Are feeling overburdened;
  3. Are isolated;
  4. Are feeling lonely.

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

For example if they;

  1. Have fluctuating needs;
  2. Are repetitive;
  3. Do not comply with care routines;
  4. Seek constant reassurance or attention;
  5. Need constant supervision;
  6. Are awake overnight.

Carers deemed at increased risk should always:

  1. Be offered a carers assessment;
  2. Be provided with regular opportunities to talk; and
  3. 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:

  1. Medication required;
  2. Mobile numbers;
  3. Places previously located;
  4. 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

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