Abuse of adults with intellectual disabilities can and does occur in many places, and as a result, many countries have instituted policies and enacted laws to address this problem. However, research concerning the impact of such policies on abuse remains largely limited to quantitative studies from the perspective of governmental or other authorities and is generally focused on one area or country. Absent are the views and experiences of people with intellectual disabilities with respect to real or perceived abuse. Given the dearth of research involving primary consumers, there is limited knowledge as to the success or failure of such policies and laws. Though carrying out such research can pose methodological and ethical challenges, not undertaking it can also have ethical and social consequences. An international research agenda that includes participatory research that both facilitates the active involvement of and investment in people with intellectual disabilities and views action as an essential outcome is thus proposed. The authors propose such an agenda and posit that along with the collection and analysis of substantially more robust quantitative data, this should facilitate comparison within and between countries.

Background People with intellectual disabilities are at increased risk of abuse which may not always be responded to appropriately. This study therefore sought to explore how nurses and social workers make decisions when safeguarding adults with intellectual disabilities. Method A situational analysis grounded theory study. Semi‐structured interviews were undertaken with social workers (n = 16) and community nurses (n = 9) working in Community Learning (Intellectual) Disability Teams in Wales. Data were transcribed and analysed thematically and cartographically in keeping with situational analysis. Results Four key themes emerged: The official line; Expectation and perception; Non‐vulnerable adult process options; Confidence and competence. Sites of silence were also identified: not making a decision, not asking further questions, preserving family relationships and the individual with intellectual disabilities. Conclusion Decision making in relation to safeguarding adults with intellectual disabilities is a complex process, influenced by many factors and in which discretion is exercised by professionals.

Purpose This paper aims to reflect upon the usefulness of the word “acopia” as a diagnosis in relation to individuals in hospital. Design/methodology/approach A response to existing literature and consideration of application to practice with adults who may be vulnerable. Findings The term “acopia” is derived from medicine but has gained popularity throughout health and social care. It is a term that has no diagnostic tool or agreed characteristics. Practical implications Practitioners across a number of professional disciplines need to be aware of the individual circumstances, preferences and priorities of individuals to secure the most appropriate care and support for each person. Failure to acknowledge complexity of an individual’s presenting condition at hospital admission may have fatal consequences. Originality/value The importance of language used to refer to adults who are likely to be vulnerable may influence the quality of the care and treatment that they receive.