Geographical inequalities in dementia diagnosis and care: A systematic review.

Abstract

Background: People with dementia can be disadvantaged in accessing health and social care services for diagnosis and care depending on where they live (including rural vs suburban vs. urban; postcode; country). Without an existing comprehensive synthesis of the evidence to date, the aim of this systematic review was to explore the evidence on geographical inequalities in accessing services for dementia diagnosis and care.

Methods: Five databases were searched in June 2024, including studies conducted in any country, published from 2010 onwards, and in English or German. Titles and abstracts, and then full texts, were screened by at least two reviewers each. Any discrepancies were resolved in discussion with a third reviewer. Data were extracted by two researchers and synthesised narratively.

Results: From 1321 studies screened and 49 full texts read, 32 studies were included in the final review. Most studies were conducted in the US, followed by the UK. Geographical inequalities in dementia are most often evidenced in relation to availability and suitability of services in different regions within a country, or a lack thereof. People with dementia residing in rural areas often experience challenges in receiving a timely diagnosis and accessing health and social care. No research has addressed geographical inequalities in accessing residential care. Innovative models on improving efficiency and quantity of diagnosis rates in rural Canada and Australia emerged.

Conclusions: Health and social care services in rural areas need to be increased and made more suitable to the needs of people with dementia. More research needs to explore inequalities experienced by people with rarer forms of dementia. National strategies to overhaul the health and social care system need to focus on the rurality issue and recommend strategies to improve service access.