Solutions to inequalities in dementia diagnosis and care: A systematic review.

Abstract

Background: People with dementia and their carers often face barriers during diagnosis and accessing post-diagnostic care, causing avoidable inequalities in health outcomes. Without any previous synthesis to date to help improve people with dementia’s health outcomes, the aim of this systematic review was to identify and synthesise existing solutions to increase equity in dementia diagnosis and care. Methods: A search was conducted across five databases in March 2025. All abstracts and full texts were independently screened by two researchers, with a third researcher sorting through any conflicts. Data were extracted by two public advisor researchers and reviewed by a senior research team member, who synthesised the data into solutions on individual, community, and system and infrastructure levels. Findings: Forty-three studies (42 from High Income Countries) comprising solutions from 13 countries, were included in this systematic review. The majority of studies focused on access to care, with most solutions centering on system-level change. Only one study was conducted in two middle-income countries. Evidence is diverse and minimal for most types of solutions, with a lack of cost-effectiveness data. There are clear indications for key solutions including dementia link workers, communities of practice and wider networks, as well as one-stop memory clinics providing same day diagnostic assessments in rural countries or regions. Conclusions: Whilst this review highlights a diversity in solutions, more research needs to be conducted that uses clear measurements of health and social care usage and health economics. Importantly, research needs to be undertaken across different countries, particularly lower- and middle-income countries.