Mistreatment and abuse of people with dementia

1. Summary

People with dementia may be subject to mistreatment and abuse in the community or in care homes and hospitals. This may include psychological, financial, emotional, sexual or physical abuse, including the inappropriate prescription of anti-psychotics. In most cases of repeated abuse, the abuser is well-known to the older person.

People with dementia are at higher risk of elder abuse (Cooper et al, 2008). People with dementia can be more vulnerable to abuse as they may struggle to discuss their feelings and experiences or remember what happened to them. Dementia can also make it harder to detect abuse. Common reactions to abuse, such as withdrawal from communication, can also be symptoms of dementia.

There is significant public concern about abuse. 70% of UK adults are scared of moving into a care home and 64% believe that care homes are not doing enough to prevent abuse (Alzheimer’s Society, 2008).

The mistreatment and abuse of people with dementia is always unacceptable. The risk of abuse can be reduced through the provision of adequate support, training, ongoing supervision and legal protection.

2. What the Society calls for:

  • Dementia training for staff in care homes and hospitals. Lack of training is an important cause of poor quality care. Staff may be unable to communicate effectively with people with dementia, involve people with dementia in decision-making following the principles of the Mental Capacity Act and care for people with dementia who experience behavioural and psychological symptoms. This can mean that people with dementia do not receive person-centred care, are deprived of their legal rights and receive inappropriate treatments, such as physical restraint and anti-psychotic drugs, that can exacerbate symptoms. Health and social care professionals should receive training to provide high-quality, person-centred care to improve dignity and quality of life even when communication has diminished. For more information, please see our position statement on anti-psychotic drugs and Deprivation of Liberty Safeguards factsheet.
  • Effective and robust enforcement. Abuse and mistreatment are too serious to be considered as part of a general complaints procedure. The Society believes that regulators, not providers, should deal with such complaints. For more information, please see our position statement on the regulation of dementia care.
  • Dementia training and support for carers. People with dementia who experience behavioural and psychological symptoms can behave aggressively. Such behaviour can be highly stressful for carers. Carers who lack support may manage this behaviour inappropriately, for instance by physically restraining a person with dementia. This kind of abuse, despite the fact that it is unintentional, is as unacceptable as intentional abuse. People with dementia can also abuse their carer. This is usually as a result of the behavioural and psychological symptoms of dementia. To prevent abuse, carers must receive support. For more information, please see our position statement on carer support. 
  • Action on financial abuse. Financial abuse is the theft, or the illegal or unauthorised use, of a person's property, money or other valuables. This may be perpetrated by carers or third-parties. People with dementia are at a greater risk of this kind of abuse. In an Alzheimer’s Society survey, 15% of carers said that the person for whom they care had been a victim of financial abuse (Alzheimer’s Society, 2011). To prevent financial abuse, Alzheimer’s Society is calling for: improved financial information, advice and guidance for people with dementia and carers; strengthening of the role of trading standards; councils’ financial assessment and safeguarding teams to work together to investigate cases of suspected financial abuse; improved data-sharing between agencies; and all organisations in the financial services sector to sign-up to the dementia-friendly financial services charter developed by the Alzheimer’s Society and Lloyds Banking Group.    
  • Robust investigation of abuses of power of attorney. The Mental Capacity Act allows another person to take responsibility for making decisions on the behalf of a person with dementia who lacks capacity. Overall, the Society supports the Act’s provision. However, the powers conferred by a power of attorney can be abused and people with dementia who lack capacity are particularly vulnerable.  It is essential that suspected cases of abuse of power of attorney are investigated in order to safeguard people with dementia.

3. References and further information

Alzheimer's Society is a member of the Action on Elder Abuse campaign. You can call their helpline on 0808 808 8141.

Department of Health, No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse

Welsh Assembly Government, In safe hands: protection of vulnerable adults in Wales

Alzheimer's Society (2013), Dementia-friendly financial services charter

Alzheimer's Society (2011), Short changed: Protecting people with dementia from financial abuse

Claudia Cooper, Amber Selwood and Gill Livingstone (2008), The Prevalence of Elder Abuse and Neglect: A systematic review

Last updated: January 2015 by Laurence Thraves 

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