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Solutions to reduce inequities in dementia diagnosis and care

A systematic review examining interventions designed to reduce inequities in dementia diagnosis and post-diagnostic care across multiple countries, focusing on individual, community and health system solutions.

This paper uses the term inequalities. In this Evidence Hub, inequities is used where differences in access or outcomes reflect avoidable and unfair structural barriers in health and social care. 

Key messages 

  • people living with dementia and their carers face barriers to diagnosis and care that lead to avoidable inequities in health and social care outcomes 
  • solutions identified in the literature operate at three levels: individual factors, community support, and health and social care system infrastructure 
  • system-level interventions, such as dementia link workers, integrated care networks and memory clinic networks, show the strongest evidence for improving access to care 
  • culturally and linguistically tailored interventions can improve dementia awareness, service navigation and carer confidence in underserved communities 
  • community-based initiatives, including dementia-friendly communities and peer networks, can help reduce stigma and improve understanding of dementia 
  • digital tools and telehealth services may improve access to support but can also create barriers for people with limited digital literacy or access to technology 
  • evidence on cost-effectiveness and long-term impact of interventions remains limited 

Policy implications 

  • develop dementia link worker or care navigator roles to help individuals and carers access services following diagnosis 
  • strengthen integration between health and social care services to improve coordination of dementia care 
  • invest in culturally appropriate information and support programmes for underserved communities 
  • support community-based initiatives that raise awareness and reduce stigma around dementia 
  • improve workforce training to increase knowledge and confidence in dementia care across health and social care settings 
  • ensure digital dementia support services are accessible and accompanied by non-digital alternatives 
    • increase research and policy attention on dementia care in lower- and middle-income countries 

Gaps 

  • the majority of studies were conducted in high-income countries, with very limited evidence from lower- and middle-income settings 
  • many interventions were evaluated only once, limiting the strength of evidence for their effectiveness 
  • there is limited evidence on the cost-effectiveness of interventions designed to reduce inequities in dementia care 
  • few studies examine long-term outcomes or large-scale implementation of interventions 
  • more research is needed on how different interventions affect health and social care utilisation and outcomes 

Commentary 
This systematic review examines interventions designed to reduce inequalities in dementia diagnosis and care. The review highlights that people living with dementia and their carers often face barriers when trying to access services, which can lead to avoidable differences in health outcomes. 

Many of these barriers occur at several levels. Some relate to individual circumstances such as language, cultural background or socioeconomic status. Others occur at community level, for example where stigma around dementia discourages people from seeking help. Structural barriers within health and social care systems also play an important role, particularly where services are fragmented or poorly coordinated. 

The review finds that system-level solutions appear to have the strongest evidence. These include models such as dementia link workers, integrated care networks and memory clinic collaborations. These approaches can improve coordination between services and help individuals and carers access appropriate support more easily. In some studies, link worker roles also improved quality of life for people living with dementia and reduced pressure on carers. 

Community-level initiatives can also play an important role. Programmes that raise awareness about dementia, reduce stigma and build dementia-friendly communities may encourage earlier help-seeking and improve understanding of the condition. Culturally tailored information and support programmes can also help address barriers faced by minority ethnic communities. 

The review also identifies increasing use of digital tools to support dementia care. Online information platforms, telehealth services and digital care planning tools can help some people access support more easily. However, the authors note that digital solutions can also create new barriers where people lack digital skills, access to technology or reliable internet connections. 

From a health and social care equity perspective, the findings show that inequities in dementia care often arise from structural barriers within systems rather than individual choices. Access to diagnosis, information and support can vary depending on geography, service availability and socioeconomic circumstances.

Identity and experiences of minority ethnic dementia care workers during COVID-19

A qualitative study exploring how identity shaped the experiences of dementia care workers from minority ethnic backgrounds during the COVID-19 pandemic.

Key messages 

  • participants described experiences of racism and discrimination in the workplace 
  • care workers reported feelings of injustice and being undervalued 
  • strong senses of personal and collective responsibility shaped care delivery during the pandemic 
  • workplace support structures influenced how workers coped with pressures 
  • identity intersected with pandemic conditions to shape everyday working experiences. 

Policy implications 

  • employers need to address racism and discrimination within dementia care settings 
  • culturally responsive support structures are needed for minority ethnic staff 
  • recognition and valuing of care work are central to workforce wellbeing 
  • inclusive leadership and clear reporting mechanisms may improve staff experiences. 

Gaps 

  • online recruitment may have excluded workers with limited access to technology 
  • participants had limited exposure to COVID-related deaths, affecting transferability 
  • findings are based on self-selected qualitative accounts 
  • future research should include randomly selected samples. 

Commentary 

This study highlights how identity influenced the working lives of minority ethnic dementia care workers during the COVID-19 pandemic. Participants’ accounts show how experiences of racism and exclusion sat alongside strong professional commitment and a sense of responsibility to those they supported. 

The findings underline the emotional labour involved in dementia care, particularly under crisis conditions. Where workplace support was limited or inconsistent, feelings of being undervalued were intensified, shaping how workers understood their role and status within care settings. 

From a care equity perspective, the study exposes how structural inequities within the workforce affect both staff wellbeing and the delivery of care. Minority ethnic workers faced additional burdens linked to discrimination and lack of recognition, reflecting wider inequities in the social care sector. These conditions risk reinforcing disparities in retention, progression and workforce stability. 

Overall, the paper demonstrates that equitable dementia care depends on equitable treatment of the workforce. Addressing racism, strengthening support structures and recognising the contributions of minority ethnic care workers are essential steps toward a fairer and more resilient care system.