To examine the geographical and temporal distribution of safeguarding concerns and enquiries among older adults living with dementia in England, and to assess variation by sex, age and region.

Population-based, repeated cross-sectional study.

England, using national administrative datasets.

Older adults living with dementia in England, identified using national dementia prevalence estimates; safeguarding activity was analysed at local authority and regional level.

Primary outcomes were the number of safeguarding concerns and Section 42 safeguarding enquiries recorded by local authorities. Secondary outcomes included other safeguarding enquiries and variation by age, sex and geographic region.

Safeguarding concerns more than doubled between 2015 and 2022 across the adult population. Among adults with dementia, safeguarding concerns increased by 55.5% between 2015/2016 and 2019/2020, with a temporary decline during the COVID-19 pandemic. Women with dementia, particularly those aged 85 and older, had higher rates of safeguarding concerns and enquiries than men. Spatial analysis revealed substantial variation across England, with higher safeguarding activity in urban and more deprived regions, such as parts of the North West (eg, Manchester, Liverpool), Yorkshire and the Humber, and the Midlands, while lower activity was observed in more rural and less deprived areas such as the North East and South West.

This study provides the first national analysis of safeguarding patterns for people living with dementia in England. The findings found demographic and geographic disparities in safeguarding activity, highlighting the need for more detailed and individual-level data to inform responsive, dementia-sensitive safeguarding policies.