Royal College of Nursing (RCN), 2023. National Early Warning Score 2 (NEWS2): RCN Position Statement. [online] Available at: https://www.rcn.org.uk/professional-development/publications/rcn-news2-position-statement-uk-pub-010-127 [Accessed 24 Jun. 2025].

BNF, 2024. British National Formulary. [online] London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk [Accessed 24 Jun. 2025].

Alan’s mental health and cognitive status also require attention. His anxiety, forgetfulness about medications, and excessive worry may indicate depressive symptoms or emerging cognitive impairment. Under the Mental Capacity Act 2005, a formal assessment of his decision-making capacity regarding his health and treatment is legally required if there is reason to doubt it (Bartlett, 2020). Cognitive screening tools such as the MoCA or MMSE should be employed in a clinical setting to evaluate his needs accurately. If capacity is impaired, best interest decisions must be made in line with statutory guidance.

Another pressing issue is medication non-compliance, which significantly increases Alan’s risk of further vascular events given his history of hypertension and hypercholesterolemia. NICE guidance on medicines optimisation (NICE, 2015) recommends person-centred reviews and support systems to improve adherence. In Alan’s case, involving hospital pharmacy staff and considering post-discharge support—such as dosette boxes or community pharmacy follow-up—can help manage and monitor medication use effectively.

Social isolation is also a key safeguarding concern. Since the death of his wife, Alan has become increasingly withdrawn, which correlates with poorer health outcomes and increased hospital readmission rates in older adults (Victor & Bowling, 2012). Research shows that loneliness and isolation are associated with functional decline, particularly when compounded by bereavement and limited social support (Cattan et al., 2005). Social prescribing or referral to local support services via primary care may help address these issues in a non-stigmatising way.

Finally, Alan’s acute stroke symptoms, such as facial droop, highlight immediate safeguarding needs related to hospital discharge. NICE guidelines on stroke rehabilitation (NICE, 2019) recommend early involvement of multidisciplinary teams (MDTs) to assess post-stroke needs, including physical and cognitive rehabilitation. Given that Alan lives alone, discharge planning must involve occupational therapy assessments and possibly a temporary care package to ensure a safe return home. Without appropriate intervention, Alan faces a significant risk of further deterioration or rehospitalisation.

Together, these factors represent a complex safeguarding situation that requires legal, clinical, and social input. Intervening early and in a person-centred manner is crucial not only for Alan’s recovery but also to uphold his rights, dignity, and autonomy.

Braye, S., Orr, D. and Preston-Shoot, M., 2015. Serious case review findings on the challenges of self-neglect: Indicators for good practice. The Journal of Adult Protection, 17(2), pp.75–87. https://doi.org/10.1108/JAP-03-2015-0009

Cattan, M., White, M., Bond, J. and Learmouth, A., 2005. Preventing social isolation and loneliness among older people: A systematic review of health promotion interventions. Ageing and Society, 25(1), pp.41–67. https://doi.org/10.1017/S0144686X04002594

National Institute for Health and Care Excellence (NICE), 2015. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes (NG5). London: NICE.

National Institute for Health and Care Excellence (NICE), 2019. Stroke rehabilitation in adults (NG128). London: NICE.

Victor, C.R. and Bowling, A., 2012. A longitudinal analysis of loneliness among older people in Great Britain. The Journal of Psychology, 146(3), pp.313–331. https://doi.org/10.1080/00223980.2011.609572

Relevant guidance:

• NICE NG128 – Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

2. NICE CG90 – Depression in adults: recognition and management

NICE QS50 – Mental wellbeing in older people in care homes (relevant for social care interface)

Key Points:

• Alan is on Amitriptyline, which is not first-line due to:

• Anticholinergic burden (risk of confusion, falls, cognitive issues post-stroke)

• Poor tolerability in older adults

• Switch to SSRI (e.g. sertraline or citalopram) under supervision

• Psychological therapies should be offered in conjunction: CBT, bereavement support, or referral to IAPT