Exploring Dementia Abuse: Best Practices for UK Service Users

This report delves into the critical issue of dementia abuse within the UK healthcare system. It explores the prevalence of abuse, its causes, and the impact on service users. The report examines various theoretical frameworks, including Bowlby's and Erikson's theories, alongside the social and medical models of disability to understand the complexities of dementia care. It analyzes the trends of abuse, identifying key risk factors and proposing practical strategies to minimize the chances of abuse, such as improved caregiver training, implementation of robust policies, and enhanced patient-centered care. The methodology includes literature review, data analysis, and ethical considerations, culminating in recommendations for improved practices within care homes and the wider community. The report aims to understand the trends of abuse towards dementia patients, and identify ways of minimizing the chances of abuse.

Exploring best practice in the UK, different approaches for
keeping service users with Dementia safe from abuse or
minimising the chance for it.

Table of Contents
Introduction ...............................................................................................................................4
Background ...........................................................................................................................4
Reason for studying...............................................................................................................5
Problem statement......................................................................................................................5
Aim-.......................................................................................................................................5
Objectives..............................................................................................................................5
Questions -.............................................................................................................................5
Literature review .......................................................................................................................6
Concept of dementia..............................................................................................................6
Bowlby’s theory....................................................................................................................7
Erikson's Theory....................................................................................................................7
Social model of disability......................................................................................................8
Medical model of disability...................................................................................................9
Caregiver stress theory..........................................................................................................9
Causes of abuse in patients suffering from dementia..........................................................10
Understand trends of abuse towards dementia patients and to understand ways of
minimizing the chances of abuse.........................................................................................11
Methodology ...........................................................................................................................12
Types of investigation.........................................................................................................12
Research Approach..............................................................................................................13
Rationale for the selected approach.....................................................................................13
Data collection ....................................................................................................................14
Trend analysis of dementia .................................................................................................15
Data analysis .......................................................................................................................16
Ethical implications ............................................................................................................16
Resource..............................................................................................................................17
Time Table...........................................................................................................................17
Data Analysis ..........................................................................................................................20
Theme 1: The concept of dementia.....................................................................................20
Theme 2: The causes of abuse in patients suffering from dementia...................................21

Theme 3: Trends of abuse towards dementia patients.........................................................22
Theme 4: Different ways through which chances of abuse can be minimised....................23
Theme 5: Impact of dementia on patients...........................................................................24
Conclusion................................................................................................................................24
Recommendations....................................................................................................................25
Reflective statement.................................................................................................................25
Bath Spa University Research Ethics Approval Form.............................................................31

Introduction
The focus area of this current research proposal would be to explore the best
implementation in UK and minimizing chances of abuse with Dementia patients. It has been
evident that dementia patients in UK are subjected to elder abuse (Cherry and Jacob, 2016).
The general public is not able to understand that how to behave with people having problem
of dementia in order to improve their comfort level. People suffering from dementia get
abused by society and care providers in hospitals which impacts negatively on medical
condition of these individuals. This research will delve into finding best practices that will
successively aid in alleviating such practices. The research will study recent trends, theories,
and models that will successively lead to the formulation of best practices.
Background
Dementia can be described as general term for a decline in mental ability severe
enough to interfere with daily life including memory loss. It is observed that people forget
about their daily routine activities in critical dementia. Dementia patients are at very high risk
of abuse and their struggle to explore their feelings adds fuel to the fire. In UK, one common
reaction regarding abuse is communication withdrawal (Collier, Knifton and Surr, 2015). In
UK, 70% of dementia adults have evidently has been reported to be scared from moving in
care homes. 64% of adults suffering from dementia agree that care homes are unable to look
after them (HEALTHTALK, 2018). In UK, there is a big gap in training for care providers
that must lead to the creation of the aforementioned thought. Staffs are unable to
communicate properly and henceforth are unable to take Mental Capacity Act 2005 into
account. There is also a need for robust enforcement for better care provision for such
patients. The investigation about given topic related to dementia provide support to analyse
the actual cause behind the problem of abuse which facilitate to gain knowledge about
solving it properly.
The investigation regarding abuse with patients with dementia is significant to be
carrying out in order to determine actual causes of this issue in respect to sort out them in
proper manner. It is necessary to identify types of abuse which has been faced by people
having dementia including psychological, financial, emotional, sexual and physical abuse
along with inappropriate prescription of antipsychotics. It has been analysed that in mots of
the causes of repeated abuse, the abuser is well known to the old patient.

Reason for studying
Reason behind this study is to explore best practice from UK so that dementia patients
are free from abuses. The purpose of study is to analyse the problem of dementia in people
and cause of abuse take place with them in society as well as care providers. However, it is
necessary to determine this problem in order to gain an idea of establishing appropriate
practices and techniques in order to reduce the abuse of dementia patients because it impacts
negatively their medical condition (Stevenson, McDowell and Taylor, 2018). Moreover, it is
important to find out reasons of problem in respect of using different approaches for to make
such patients secure from abuse along with reducing risk of occurring the same.
Problem statement
The problem statement is “exploring best practice in the UK, different approaches for
keeping service users with Dementia safe from abuse or minimising the chance for it”. It
involves to analyse about problem of abuse with patient suffering from dementia in order to
make more effective as well as efficient practices for reducing the problem properly.
However, abuse of dementia patients impacts ion their condition negatively and results into
complicated situations accordingly.
Aim-
“To understand trends of abuse towards dementia patients and to understand ways of
minimizing the chances of abuse”
Objectives
There are 3 objectives that are as follows:
 To analyse the concept of dementia.
 To determine the causes of abuse in patients suffering from dementia.
 To understand trends of abuse towards dementia patients and to understand ways of
minimizing the chances of abuse.
Questions -
 What is the concept of dementia?
 How to determine the causes of abuse in patients suffering from dementia?

 How to understand trends of abuse towards dementia patients and to understand ways
of minimizing the chances of abuse?
Literature review
Literature review refers to published information certain subject area and at times,
information in particular area of subject within certain time period. Literature review can be
simple summary of sources, it usually has organizational pattern which combines synthesis
and summary. Literature review is a type of evaluation and search of available literature for
the given subject. It gives readers an easy access to the research on specific topic by choosing
high quality articles that are meaningful, valid, important and relevant and also summarising
them in a single report. This also provides excellent starting point for the researchers to start
the research in new area by pressuring them to evaluate, compare and summarize research in
the particular area.
Concept of dementia
Dementia can be described as a kind of mental health problem which consist a group
of symptoms associated with decline in memory and other thinking skills severe enough to
reduce person's ability. As per views of Martin L, Albert and Bracha Mildworf (2019), it
consist several symptoms of dementia such as memory loss, communication & language
difficulty, reduce ability to focus & pay attention, reasoning & judgement and visual
perception respectively. However, Alzheimer's disease can be known as most common cause
of progressive dementia in older adults. The abuse is with patients suffering from dementia is
observed which impacts negatively on condition of them facilitating complications in future.
It involves that abuse of such people is mostly attempt by citizens living in society and care
providers. The effective practices and approaches are required to be implemented for every
person in order to reduce risk of abuse with dementia patients. It consist to make strict legal
rules and policies in care institutions for make such patients secure along with reducing
chance of occurring the same.
In context of selected topic like to understand trends of abuse towards dementia
patients and to understand ways of minimizing the chances of abuse, several investigations
has been carried out. According to the opinion of Mahendra (2018), it is analysed that
researchers already conducted investigation regarding this topic in order to analyse types of
abuse to old people suffering from dementia. It has been evaluated that previous researches
has a gap that they only find out issues related to abuse and people who are responsible for

abusive activities but they did not focus on methods or practices to prevent abuse. However,
it is not much enough to just determine causes of particular problem but is mandatory to
identify actual methods or techniques in order to sort out the issue properly. The present
investigation is going to determine appropriate strategies in respect of solving problem of
abuse with old patients having health issue of dementia.
Bowlby’s theory
According with this theory, Bowlby’s theory describes that there is always a strong
physical and mental attachment towards a caregiver. This attachment is very much important
for a patient, especially dementia patients. These patients suffer from memory loss and have
social and thought related symptoms. This leads these patients to dwell into baseless thoughts
and at this very moment, caregivers are required. Care providers for dementia patients require
them to bond with these patients and win trust. This theory also suggests that care providers
must understand patients’ temperament (Curtis and Burns, 2015).
If they are feeling low or are under abuse related issue, it will the care provider’s job
to understand them. Then there is a need to provide them with requisite ideas for fighting
with those issues. UK has legislation, based on such patients’ betterment, have formulated
multiple laws that will help care providers. Such laws include The Equality Act of 2010 and
Mental Capacity Act of 2005. Both acts provide better suggestions for care services to take
necessary actions against anyone who is abusing their patients.
According to Pasmore (2015), care providers must take this theory in their practices
so that they are able to deal in a much better way. Those patients that are already abused must
also be approached by care providers so that any tendency of death does not occur. If a
patient is not at a service centre, the family members must take this theory into account.
Bonding with dementia patients will shed a better light on their inner thoughts of anger and
despair (Ellis, Winslow and Noble, 2016).
Erikson's Theory
In dementia patients, it is evident that families are the ones that provide most of the
care. Due to acceptance of this strategy, it is evident that such patients become more and
more vulnerable to external abuses (ALZHEIMERS, 2015). This also must lead to the
discussion that dementia patients tend to stay away from commercially available care homes.
Since dementia is not curable, families are required to look for earlier signs. This will lead to

having much better-benefiting chance from treatment. Furthermore, it will aid in learning
about unknown anxieties.
Abuses related to dementia patients have increased so much that caregivers or
families must incorporate this theory so that they are able to understand what is going inside
the patients’ mind (Glasby, 2017). It is evident that with integrity and despair, there is always
a positive outcome and if negative, it is death. It is also seen that if the patient has achieved
life fulfilment related sense, they are less likely to fear death and external abuses.
As suggested by Howieson and Hodges (2014), this is the part where caregivers and
families come into play. Anyone who is in provision of care for the patients must provide
them with a better sense of life. So, even if any external factor tries to abuse them, they will
never take the path of death. This theory also demands the presence of a very close and
trustworthy partner who will train patients in direction.
Social model of disability
This model or framework provides a better way to assess dementia patients' rights.
This framework also underpins legislation based on a nation or global regarding disability.
This framework dwells mostly into The Care Act of 2014 and The Equality Act 2010. Hence,
there is an immense need to understand this model for the ultimate betterment of dementia
patients and alleviating their abuse (Tible et al. 2017).
This model attains its roots from the 1970s movement of disability rights of US.
People gathered at a single place to discuss relevant issues of dementia abuse. They also
shared their own experiences as most of them were suffering from dementia. Their
experiences opened up a new idea that such patients generally stayed out from mainstream
life. Much to its dismay, general population also misbehaved with these people and this led to
creation of a great spark among the dementia community in UK.
In the 1980s, disabled patients and professional care providers came out on the roads,
asking from a framework that will look out for the betterment of such patients. Equality act
came as the answer to the movement that provided a great sigh of relief to patients and
professional caregivers. Now they had Harvarda framework that looks for any abuse
occurring with them. Furthermore, these acts called in for strong punishments for those who
will commit abusive atrocities against dementia patients. According to the concepts of Day
(2013), it is because of the leaders of those times that helped to bring change in this sector.

Medical model of disability
This model goes in conjunction with model and it takes conditions of patients as
central point of view. Decisions regarding this model are specifically made by healthcare
professionals and patients that are already suffering from disability. This model also
maintains aspects of oppression, exclusion from society and passive form of dependence. If a
person with dementia is found to be suffering from any form of abuse like sexual assault and
fighting will have serious implications to follow. Medical professionals interpret provided
information regarding dementia by patients so that a certain diagnosis is determined (Cabrera
et al. 2015). This also is followed by help from the patient’s care provider and family.
Medical professionals try their best to define normality and successive abnormality.
This is ascertained from the perspectives of biology. This model continues linking diagnosis
with physical conditions of dementia patients. Furthermore, this model also aids in assessing
recent life quality and then formulates requisite plans of actions that will enhance current
situations by biological aid. Medical interventions are thought to be better than usage of
regular theories as it regulates a patient’s internal circumstances. It will lead to chalking out
of plans like exercises, medications, lifestyle change and inclusion of a partner.
According to the words of Tible et al. (2017), patients that have suffered from any
kind of abuse must have clear indications on their body. If no physical harm is present, there
will be marked changes in behaviour and here comes the role of partner. They are to check
correctly that what marked differences have risen and then convey the same message to
healthcare professionals so that they are able to provide necessary steps of actions. It is to be
noted that, unlike social mode, this model will only provide medical aid to alleviate their
stress against any harm or abuse.
Caregiver stress theory
This theory is considered as natural theory for psychological and physiological abuse
in elders that are suffering from dementia. This theory assesses that multiple acts of neglect
and abuse occur due to a much high rate of dementia-related symptoms of behaviour and
stress from caregivers. This theory sheds light on the further inclusion of family provided
care. According to Zabalegui et al. (2014), family provided care is the best form of care since
family members are much more accustomed with change in behaviour of dementia patients.
Caregivers lack necessary amount of patience and training to handle such patients. This leads
to the occurrence of abuse in their lives which is unacceptable by family members. Abuse

from caregivers has led to patients with enraged behaviour and freedom loss. Therefore,
professional care providers must dwell into this theory so that such atrocities are not repeated.
In health care institutions, some of the activities are significantly enough to interfere
individual's working, living, mentally and physically condition in negative manner. Now a
days, most of the patients who are suffering from critical disease faced numerous issues in the
health acre institutions. It can be happen while services provider or any other person uses a
position of authority to engage in unwelcome conducts. These kind of practices can impacts
negatively upon humans in terms of mental disorder, physical disability and so other. In those
unpleasant activities patient's suffers and it will be hard for them to upbringing themselves
from such situations. For this, it is required for health care auditors to analyse situations
behind such unwelcome activities and requires to promote a clear, comprehensive policies
that convey safety, respect, inclusion and equality for each and every individual. These kind
of policy and practices assist in promoting standard of guidelines, institutional response,
abusive practices and so on.
Causes of abuse in patients suffering from dementia
Patients with dementia may have high risk of abuse. Psychological abuse is most
common for the patients who are suffering from dementia. Many individuals experiences
multiple forms of the abuse and also mortality risk from abuse. The patients who are with
dementia can be perpetrators and victims for abuse. Abuse includes physical emotional,
sexual harm and physical which can impact on the dementia patients. Dementia patients are
particularly vulnerable to disturbing trend. Unsurprisingly taking care for patients who have
dementia needs patience and time as well as advanced practice and medical care. Dealing
with intellectual impairments of dementia can be challenging for the unprepared caregiver
and for family members and which frustrate and lead to abuse. As mentioned by Donald
Weaver (2019), dementia patients have violent mood swings, this behaviour can also lead to
violence sometimes and then abuse. In this condition there will be development of anger and
aggression, behaving aggressively with caregivers make them to abuse. In early stages it is
very hard to understand, patient are acutely aware with changes happening to thoughts and
memories & regularly feel overwhelmed. As disease progress, patients help with the every
little work such as bating, dressing and with other activities. It can be devastating for the
individual sense of self or pride, these emotions can also manifest usual hostile and
aggressive behaviour. Dementia can activate outbursts and violent mood swings, these can be
extreme patient can seem perfect at one moment and screaming to the other moment.

Changes in neurochemistry of brain can destabilize moods that can cause more violent
emotions. There are possibility to get trauma and head injury in such cases. As the patient
behave in strange way that can impact on other people who are around that individual and it
can cause to abuse for dementia patients.
Anxiety, social contacts, depressive symptoms, emotional status and perceived burden
of caregiver can make them violent and which also cause abuse for dementia patients. As per
views given by Lesley Carcary (2012), individual with dementia has different mood swings
those can not be predict and such behaviour can be dangerous sometimes for people who are
providing care and treatment and according to action people react to situations which can
abuse patients. Dementia with the progression can create major problems for the patient.
Dementia have numerous economic and social impose and impacts physiological, financial,
institutionally and physical stress on individual who have dementia and also on their
caregivers. Abuse can seen by people but they do not react and take stand in favour of these
patients.
Understand trends of abuse towards dementia patients and to understand ways of minimizing
the chances of abuse
Abuse for dementia patients has different trends which lead to various abuses. It can
also create mental and health problem in patients who are with dementia. It consist different
types of abuses including psychological, physical, financial, neglect and sexual abuse which
are described here. Initially, psychological abuse include threats of abuse, intimidation,
harassment and verbal assaults. Physiological abuse creates mental anguish by humiliation,
manipulation, other cruel conduct, fear and threats. Threatening an individual who is with
dementia is particularly a type of abuse. Secondly, physical abuse can be described as a type
of abuse can cause physical pain and injury in dementia patients. Sometimes due to
consequences of irrelevant behaviour caregiver can hurt them physically. Thirdly, financial
abuse consist to withholding or misuse of individual's financial resources such as property
and money can be disadvantage or advantage for someone else. In addition to this, Neglect
includes that due to the lack of cognitive and insights changes, individual with dementia may
be not able to adequately and safely provide for every day needs and also can be at risk of
falls, malnutrition, wandering and harm. Moreover, sexual abuse involves abuse such as
fondling, any kind of sexual activity and touching when individual is unable to detect,
unwilling to consent, physically forced or threatened.

With the help of certain ways abuse in dementia patients can be reduced. Many
strategies and approaches have been implemented so that abuse can be prevent in dementia
patients. And certain actions against it that mitigates abuse consequences. Innervations which
have been implemented to prevent the abuse include public & professional awareness
campaigns, school based intergenerational programmes, caregiver training for dementia,
residential care policies to determine and improve the standards of care, caregiver support
interventions and screening of potential abusers & victims. Isolation in such patient can cause
sadness, loneliness and depression which will increase rate of abuse so it should be avoided
isolating patients. Asking about their problem and try to understand their condition can
decrease their aggression and anger which will prevent abuse.
Social welfare sectors with the help of legal provision, housing and financial support
contribute to reduce abuse. In education sector like awareness campaigns & public education
as well as health sector through treatment and detection of victims by the primary health care
workers will help to reduce it. Caregiver support after the abuse has been occurred decrease
likelihood of abuse school based intergeneration and re-occurrence programmes, shown
certain promise as caregiver support to control dementia patients abuse before it takes place
and also professional awareness about problem. With the help of these strategies and
programs abuse for dementia patient can be minimized.
Methodology
In order to conduct a well structured investigation on a particular topic, this section
specifically plays a crucial role. It is being found that, if a researcher picks right approaches,
design, structure of the investigation, it directly helps pulling out favourable outcomes for a
particular topic which has been chosen by investigator. Along with this, a research method is
a systematic plan for conducting research (Stevenson and Taylor, 2017). Sociologists draw on
a variety of both qualitative and quantitative research methods, participant observation,
survey research, including experiments and secondary data. Quantitative methods aim to
classify features, count them, and create statistical models to test hypotheses and explain
observations. Qualitative methods aim for a complete, detailed description of observations,
including the context of events and circumstances.
Types of investigation
The investigation types can be categorised into qualitative and quantitative research in
which more suitable action should be selected by research properly. Initially, quantitative