Synopsis
Recognise possible abuse, neglect or exploitation of an adult, establish immediate safety and decision-making ability, and make a proportionate, person-centred referral or disclosure under the framework for the relevant UK nation.
- Treat safeguarding as a clinical safety process: address urgent injury or danger first, then gather enough information to make a defensible referral without trying to prove abuse yourself.
- Speak with the adult alone where safe, use an independent interpreter, ask open questions and record their account in their own words. Do not confront a suspected perpetrator if that could increase risk.
- Capacity is decision-specific. A capacitous adult may choose to live with risk, but refusal does not end the analysis where others may be harmed, coercion is suspected, or disclosure is required by law.
Reasoning priorities
Understand the adult’s experience, wishes and immediate fears without interference.
Use open questions, communication aids and an independent interpreter. Record exact words, observed demeanour and who was present; avoid leading questions or repeated quasi-investigative interviewing.
Worked reasoning
An older adult in an English emergency department has bruising of different ages, missed medicines and says a nephew controls the bank card. In private the adult asks to go home and says, “Do not tell anyone.”
- Stabilise pain and injury, speak privately with communication support, establish whether the nephew is nearby and ask what the adult fears would happen after discharge. The clinical priority is immediate safety, not proving who caused each bruise.
- Assess capacity separately for treatment, discharge destination and sharing the safeguarding concern. Explore coercion and explain that confidentiality may be overridden if serious harm or risk to others justifies it.
- Map the England section 42 indicators: possible care-and-support needs, abuse or neglect, and inability to protect because of those needs. Seek consent to refer; if refused, consult the safeguarding lead and weigh serious-harm and other-person risks.
- Final action: make a prompt, proportionate adult-safeguarding referral and arrange a safe clinical disposition if the public-interest threshold is met; contact police urgently if there is immediate danger. Share the adult’s wishes as well as the risk evidence.
- Verification: document the adult’s words, capacity conclusions, information shared and justification; confirm receipt and ownership of the referral, and escalate if no protective response occurs while risk continues.