Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key indicators for identifying an adult at risk of abuse or neglect in a primary care setting include a range of physical, behavioural, environmental, and care-related signs. These indicators should prompt healthcare professionals to consider or suspect abuse or neglect and take appropriate safeguarding actions.
- Neglect indicators: Adults may have no agreed care plan or not receive the care outlined in their plan, show deteriorating physical or mental health without appropriate response, live in unhygienic or unsafe environments, have poor personal hygiene or malnutrition, show social withdrawal, have inconsistent contact with health and social care, experience restricted access to food or drink not in their care plan, miss prescribed medication or receive it incorrectly, or be denied communication or independence aids contrary to their care plan NICE NG189.
- Physical abuse indicators: Unexplained injuries such as bruises, cuts, burns, grip marks, fractures, or signs of restraint; behavioural changes like flinching or subdued behaviour in presence of certain individuals; and misuse or covert administration of medication limiting activity NICE NG189.
- Sexual abuse indicators: Although not detailed here, sexual abuse should be considered if there are signs or disclosures consistent with such abuse NICE NG189.
- Psychological and emotional abuse indicators: Changes in behaviour, fearfulness, withdrawal, or signs of being controlled or coerced may indicate abuse NICE NG189.
- Self-neglect indicators: Refusal of support, poor self-care, and behaviours that may harm the individual, requiring assessment of capacity and risk NICE NG189,NICE CKS.
- Domestic abuse indicators: Signs include injuries inconsistent with explanations, fear of partner or family members, and disclosures of abuse; healthcare staff should enquire sensitively and ensure confidentiality while being aware of safeguarding responsibilities NICE CKS.
Healthcare professionals should follow the principles of the Making Safeguarding Personal framework, respect the wishes and feelings of the adult, and consider mental capacity when responding to these indicators. If abuse or neglect is suspected, they must act promptly, report concerns to safeguarding leads or local authorities, and ensure the adult’s safety NICE NG189,NICE CKS.