Is Dementia a Risk Factor for Neglect?

By Pamela D Wilson CSA, CG, MS, BS/BA

Nearly 50% of individuals living in assisted living are diagnosed with dementia; one third to one half experience agitated behaviors at least once a week. Research indicates that these behaviors threaten the psychological and physical well-being of individuals diagnosed with dementia and often result in a higher likelihood of being neglected by care staff.1

How do behaviors of self-neglect, while living in the community, translate to behaviors of self-neglect when living in care communities? Is it possible to honor the wishes of individuals with dementia when these include behaviors of poor hygiene, expressions of anger or self-injurious behaviors?

How many of you agree or with the following? “Honoring the wishes of a person with capacity demonstrates respect for the individual. Honoring the wishes of a person without capacity is a form of abandonment. 1

Do structured activities and one-on-one attention reduce behaviors associated with dementia?

Human contact and human touch support positive interactions. Is it possible for individuals living in care communities diagnosed with dementia to meaningfully engage in life? In many care communities, large portions of the day are unstructured meaning that older adults living in care communities spend long periods of time without human contact or interaction.

Staff to resident interaction has the potential to reduce agitated behaviors and to improve resident quality of life. Participating in social activities is important for older adults and is a factor that contributes to successful aging. A diagnosis of dementia should not change the availability of opportunities to participate and to interact with others.

As dementia progresses the interest and ability of individuals to participate in a variety of activities also changes. According to the Dementia Initiative, opportunities for participation might include: games, creation of art, interaction with children and pets, music, social engagement, spiritual practices and experiences related to touch.2 Staff in communities confirm that when residents are left on their own or lack the ability to engage in activities they become bored, restless and try to find something to occupy their time.. Sometimes these activities include opening doors, pushing furniture or engaging in activities that seem like trouble making.1

While too much stimulation can also result in behavioral issues, too little stimulation can result in the opposite, troublesome behaviors that are indicative of negative emotional states or behavioral expressions. When individuals are given the opportunity to engage in meaningful activities, problematic behaviors usually disappear. Much like small children who benefit from supervision and structured activities, older adults with dementia benefit from the same.


1 Caspi, Elion. (2014) Does self- neglect occur among older adults with dementia when unsupervised in assisted living? An exploratory, observational study. Journal of Elder Abuse and Neglect. 26:123-149, doi: 10:1080/08946566.2012.830532.

2 Love Karen & Jackie Pinkowitz. (2012) Dementia initiative: Dementia care the quality chasm. Dr. Lene Levy-Storms and Dementia initiative participants, presented June 29, 2012 Washington D.C.

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©2014 Pamela D. Wilson, All Rights Reserved.

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