A systematic review on inequalities in accessing and using community-based social care in dementia

Objectives:To evaluate and synthesize the evidence base on barriers and facilitators to accessing and using community-based social care in dementia. Design:Mixed-methods systematic review. Setting:Community-based social care (such as day care, respite care, paid home care, and peer support groups). Participants:People living with dementia and unpaid carers. Measurements:Seven databases were searched in March 2022, including English and German evidence published from 2000 focusing on inequalities in community-based social care for dementia across the globe. Titles and abstracts were screened by two reviewers, with all full texts screened by two reviewers also. Study quality was assessed using QualSyst. Results:From 3,904 screened records, 39 papers were included. The majority of studies were qualitative, with 23 countries represented. Barriers and facilitators could be categorized into the following five categories/themes: situational, psychological, interpersonal, structural, and cultural. Barriers were notably more prominent than facilitators and were multifaceted, with many factors hindering or facilitating access to social care linked together. Conclusions:People with dementia and carers experience significant barriers in accessing care in the community, and a varied approach on multiple levels is required to address systemic and individual-level barriers to enable more equitable access to care for all.