Understanding Safeguarding for People Living with Dementia: A Realist Review of Conceptualization and Practice

Abstract

People living with dementia face a disproportionately high risk of abuse and neglect, yet safeguarding responses remain underexplored, particularly within the context of English legal and care systems. This realist review investigates how safeguarding practices for people with dementia operate in England, examining what works, for whom, in what circumstances, and why. Drawing on 44 studies published between 2014 and 2024, supplemented by extensive stakeholder engagement with individuals with lived experience, carers, practitioners, and community representatives, the review synthesizes evidence through Context–Mechanism–Outcome configurations. Five core domains emerged: stakeholder roles, conceptualization of abuse and neglect, safeguarding processes and diversity, safeguarding law and policy, and partnership working. Findings reveal that effective safeguarding depends not only on statutory frameworks like the Care Act 2014 and Mental Capacity Act 2005, but also on professional judgement, relational dynamics, and inter-agency collaboration. Significant barriers include inconsistent training, conceptual ambiguity, cultural stigma, and systemic under-resourcing. Importantly, safeguarding outcomes improves in environments where legal literacy, trust, and communication are strong, and services are culturally competent and person-centered. The review highlights the need for integrated, rights-based approaches and greater inclusivity in safeguarding systems to better protect diverse populations of people living with dementia.