Geographical inequalities in dementia diagnosis and care: A systematic review
Open accessAbstract
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.
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Individuals with rarer forms of dementia may face even greater challenges in accessing appropriate transitional support, due to lower clinical awareness and limited availability of tailored services.
“Individuals with rarer forms of dementia may face even greater challenges in accessing appropriate transitional support, due to lower clinical awareness and limited availability of tailored services (Giebel et al., 2025).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Giebel et al., 2025
The Discussion (page unavailable) says people with rarer dementia subtypes can struggle to get support in low-populated areas and that improving rural care providers’ knowledge is important. The Results (page unavailable) describe difficulty accessing specialist services for people with primary progressive aphasia in Italy. The review does not specifically address transitional support, and its evidence is geographically qualified rather than a general finding about all people with rarer forms of dementia. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBenefits of these models appear unevenly distributed, with continued inequities linked to geography, socioeconomic status, and service availability.
“Unfortunately, these benefits appear unevenly distributed, with continued inequities linked to geography, socioeconomic status, and service availability (Giebel et al., 2025; Watson et al., 2021).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Giebel et al., 2025
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- Authors
- Giebel, C., Readman, M. R., Godfrey, A., Gray, A., Carton, J., & Polden, M.
- Affiliations
- University of Liverpool (GB)
- NIHR Applied Research Collaboration North West Coast (GB)
- Corresponding author
- Giebel, Clarissa
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2025-06
- Volume
- 37
- Issue
- 3
- Pages
- 100051
- ISSN
- 1041-6102 (ISSN-L)
- PMC
- PMC12149024
- OpenAlex
- W4407824874
- Cited by
- 44
- References
- 51
- Citations by year
- 2026: 33 · 2025: 11
- FWCI
- 7.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- Funders
- Alzheimer Society
- School for Social Care Research
- National Institute for Health and Care Research
- National Institute on Handicapped Research
- 1001 New Worshiping Communities
- National Institute for Health Research Applied Research Collaboration West
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- dementia, regional disparities, dementia diagnosis, dementia care, urban-rural differences, health care access, social care services, residential care, service availability
- MeSH terms
- Australia, Canada, Dementia, Health Services Accessibility, Humans, Rural Population, Socioeconomic Factors, Healthcare Disparities
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