What is harm in safeguarding? The unintended consequences of overprotection

While intended to protect, safeguarding measures, if applied without balance, can lead to significant harm for older adults. This critical but often overlooked aspect of senior care involves considering the unintended consequences of risk-averse policies. Understanding what is harm in safeguarding is essential for promoting true well-being.

Quick Summary

Safeguarding that becomes overly protective can cause harm by eroding an individual's autonomy and dignity, leading to reduced independence, emotional distress, and potential physical decline. It is crucial to balance protection with an older adult's right to make their own choices, accepting a reasonable degree of risk for a better quality of life.

Key Points

• Harm in Overprotection: Excessive safeguarding can cause emotional, psychological, and physical harm by stripping an individual of their autonomy and dignity.

• Dignity of Risk: This concept emphasizes that everyone has a right to make their own decisions and take reasonable risks as part of a fulfilling life.

• Autonomy Erosion: Overprotective practices can lead to reduced independence, feelings of helplessness, and resentment toward caregivers.

• Balancing Act: The key is to balance the caregiver's 'duty of care' with the individual's 'dignity of risk' through a person-centered approach.

• Physical Decline: Limiting physical activity to prevent falls can ironically accelerate muscle loss and reduce mobility, increasing long-term risk.

• Communication is Key: Effective safeguarding relies on open communication and involving the individual in decision-making, rather than making assumptions.

• Unintended Consequences: The psychological harm of being infantilized or isolated can be more damaging than the risks being prevented.

The Core Conflict: Duty of Care vs. Dignity of Risk

Safeguarding is the process of protecting an adult with care and support needs from abuse or neglect. It is rooted in a fundamental "duty of care"—the legal and ethical obligation to ensure another person's safety. However, the drive to eliminate all risk can directly conflict with a person's "dignity of risk." This concept recognizes that living a fulfilling, dignified life requires making one's own choices, which inherently involves some degree of risk. For older adults, this means having the right to pursue meaningful experiences, even if they have a potential for failure or injury.

Erosion of Autonomy and Independence

When safeguarding prioritizes safety to an extreme, it strips individuals of their decision-making power, leading to a profound loss of autonomy. Overprotective actions can inadvertently send the message that a person is no longer capable of managing their own life. This can manifest in many ways:

• Preventing an elderly person from using stairs or walking outdoors, leading to physical decline.
• Taking over financial management without consent, even if the person has the mental capacity to manage their own affairs.
• Dictating diet or social activities, ignoring personal preferences and cultural norms.

This loss of control is not just inconvenient; it can have significant psychological consequences. It can lead to resentment towards caregivers, a feeling of helplessness, and a loss of personal identity. The very act of protecting can become a form of emotional harm.

Psychological and Emotional Distress

The psychological and emotional harm of over-safeguarding is a critical but often unseen consequence. The impacts can include:

• Increased Anxiety and Depression: Feeling infantilized and powerless can lead to or worsen anxiety and depression. When life's small risks are removed, so too are the opportunities for success and mastery that build confidence.
• Low Self-Esteem: Being constantly protected can make a person feel incompetent and incapable, lowering their self-esteem.
• Resentment and Strain on Relationships: The individual may resent those enforcing the restrictions, causing strain on relationships with family members and caregivers.
• Social Isolation: Restricting social interactions to prevent potential exploitation can paradoxically cause the isolation that exacerbates other vulnerabilities.

Physical Consequences of Overprotection

The physical harm of excessive safeguarding is often a slow, insidious process. While trying to prevent falls or other physical injuries, overprotection can inadvertently cause greater long-term harm. A common example is the fear of falls leading to reduced physical activity.

1. Accelerated Muscle and Bone Loss: Less movement leads to a faster decline in muscle mass and bone density, increasing fragility.
2. Reduced Balance and Mobility: Limiting walking or movement results in poorer balance, making future falls more likely and more dangerous.
3. Chronic Conditions: Reduced activity can worsen chronic conditions like heart disease, diabetes, and arthritis.
4. Dependency: The person becomes more dependent on others for basic tasks, which can be difficult to reverse.

Pitfalls in the Safeguarding Process Itself

Safeguarding processes, while necessary, are not infallible and can have their own inherent flaws. Mistakes in judgment and application can cause unintended harm. Research has highlighted several common pitfalls:

• Over-precipitate Action: Rushing to intervene without a full assessment of the situation.
• Focusing on Visible Problems: Addressing only the most obvious risks while ignoring underlying issues or the person's own perspective.
• Making Assumptions: Acting on preconceptions without adequately consulting the individual, their family, or neighbors.
• Inadequate Triangulation of Evidence: Failing to gather information from multiple sources, such as the individual, family, and other professionals, leading to a biased or incomplete picture.

Balancing Risk and Autonomy: A Comparison

To understand the difference, consider the table below, which contrasts an overly cautious approach with a person-centered, risk-balanced one.

Aspect	Overly Cautious Safeguarding	Person-Centered, Balanced Approach
Core Motivation	To prevent all harm and liability.	To empower the individual for a better quality of life.
Focus	On deficits and potential negative outcomes.	On strengths, preferences, and individual goals.
Decision-Making	Made by caregivers or professionals.	Shared between the individual and their support team.
Outcome of Risk	Sees any negative outcome as a failure.	Sees negative outcomes as learning opportunities.
Impact on Autonomy	Reduces or removes independence.	Preserves and promotes maximum autonomy.

Conclusion: The Path Forward

Recognizing the potential for harm in safeguarding is the first step toward a more ethical and effective care model. By embracing the principle of dignity of risk, we can shift from an instinct to overprotect to a commitment to empower. This requires open communication, individualized care plans, and a willingness to accept that a life lived with purpose is a life with some degree of risk. The goal is not to eliminate all risk but to manage it in a way that respects the individual's rights, preferences, and well-being. Ultimately, true safeguarding enables an individual to live as safely and independently as possible, not to be merely kept alive within the confines of someone else's risk tolerance. To achieve this, it is vital to keep the individual at the center of all care decisions, respecting their voice and their capacity for self-determination.

For more information on balancing safety and independence, see the Virginia Department of Behavioral Health and Developmental Services' Dignity of Risk resources: https://dbhds.virginia.gov/wp-content/uploads/2024/10/About-Dignity-of-Risk-FINAL.pdf

Frequently Asked Questions

What does 'harm in safeguarding' mean for an elderly person?

For an elderly person, 'harm in safeguarding' refers to the unintended negative consequences of well-intentioned but overly cautious protective measures. This can include loss of personal freedom, erosion of self-esteem, physical deconditioning from inactivity, and social isolation due to restricted contact.

How can overprotective safeguarding lead to emotional harm?

Overprotective safeguarding can lead to emotional harm by making an individual feel helpless, worthless, and infantilized. It creates resentment toward caregivers and can trigger anxiety, depression, and social withdrawal, as the person feels their independence and life choices are being taken away.

What is the difference between safeguarding and overprotection?

Safeguarding is about protecting vulnerable individuals from abuse or neglect while respecting their autonomy and dignity. Overprotection, however, goes beyond this, seeking to eliminate all risk. This removes an individual's right to make choices and takes away their ability to live a full life, even if it carries some level of risk.

How do I know if I'm being overprotective with a loved one?

Consider whether you are making decisions for your loved one that they are capable of making for themselves. Are you limiting their social interaction, activities, or movement out of fear, rather than based on their actual capacity? Reflect on whether your actions are prioritizing your own anxieties over their desire for independence and a fulfilling life.

Can excessive safeguarding lead to physical health problems?

Yes. A common example is restricting an older adult's movement to prevent falls. While well-intentioned, this can lead to decreased muscle strength, poorer balance, and accelerated physical decline, ultimately increasing their vulnerability to injury in the long run.

What is 'dignity of risk' in the context of senior care?

'Dignity of risk' is the principle that individuals have the right to make informed choices and take reasonable risks to learn, grow, and have a better quality of life. It suggests that a life without any risk is a life without dignity and that overprotectiveness can be detrimental.

How can families balance safety with a senior's independence?

Families can balance safety and independence by involving the senior in all decisions about their care. Implement supportive, not restrictive, measures, like installing grab bars rather than confining them to a room. Focus on open communication, understand their risk tolerance, and create individualized plans that empower, not restrict.