Barriers and facilitators to diagnosing dementia in migrant populations: A systematic review of European health professionals' perspectives

BackgroundRates of dementia are increasing in migrant populations, however, there is evidence that they remain underrepresented in older adult healthcare services. Barriers and facilitators to accessing dementia care have been explored from the viewpoint of migrants and caregivers, however, no review has synthesised the literature pertaining to clinicians' viewpoints. This review aimed to explore clinician perspectives as to the barriers and facilitators in assessing and diagnosing dementia in migrant populations.MethodsA systematic review of the literature was conducted. Databases included EMBASE, CINAHL, PsycINFO, MEDLINE and ProQuest. Qualitative studies from the perspective of European clinicians were included. The methodological quality of each study was assessed using the Critical Appraisals Programme Tool (CASP). The analysis adopted a thematic synthesis approach.ResultsThe review included 11 qualitative studies relating to the diagnosis of dementia in migrants. The quality of the studies was generally high, although few studies reported on the relationship between the researcher and the participants. The data related more to the barriers in diagnosing dementia, and few facilitators were found. Four themes were constructed: (1) service access (2) perceptions of migrant beliefs (3) relationships and (4) quality of the diagnostic process.ConclusionsThe review is limited by the small number of studies available. The findings highlight significant clinical concerns in the diagnosis of migrants, in particular the underrepresentation of migrants within services and the barriers to access they may face. The quality of the diagnostic process was often thought to be undermined by a lack of culturally sensitive assessment tools. Further research on the use of an interpreter in diagnosing dementia is needed. Increasing Rates of Dementia in Migrant Populations: The background highlights a rising trend of dementia in migrant populations, emphasising the need to comprehend current barriers and facilitators in diagnosing this group from the perspective of clinicians. Systematic Review Methodology: A systematic review was conducted, involving databases such as EMBASE, CINAHL, PsycINFO, MEDLINE, and ProQuest. Qualitative studies from the viewpoint of European clinicians were included, with the methodological quality assessed using the CASP tool. Thematic synthesis, was employed for analysis. Focus on Barriers in Diagnosing Dementia: The results of the review, based on 11 qualitative studies, predominantly addressed barriers in diagnosing dementia among migrants, with few facilitators identified. Four themes emerged: service access, perceptions of migrant beliefs, relationships, and the quality of the diagnostic process. Clinical Concerns and Need for Further Research: Significant clinical concerns were highlighted, particularly the underrepresentation of migrants in services and the barriers they may encounter. The quality of the diagnostic process was perceived to be compromised by a deficiency in culturally sensitive assessment tools. The review emphasised the necessity for additional research, especially regarding the role of interpreters in diagnosing dementia in migrant populations.