To evaluate and synthesize the evidence base on barriers and facilitators to accessing and using community-based social care in dementia.

Mixed-methods systematic review.

Community-based social care (such as day care, respite care, paid home care, and peer support groups).

People living with dementia and unpaid carers.

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.

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.

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.

To explore the care and support received and wanted by United Kingdom (UK) South Asian and White British people affected by dementia and whether access to it is equitable.

Semi-structured interviews using a topic guide.

Eight memory clinics across four UK National Health Service Trusts; three in London and one in Leicester.

We purposefully recruited a maximum variation sample of people living with dementia from South Asian or White British backgrounds, their family carers, and memory clinic clinicians. We interviewed 62 participants including 13 people living with dementia, 24 family carers, and 25 clinicians.

We audio-recorded interviews, transcribed them, and analyzed them using reflexive thematic analysis.

People from either background were willing to accept needed care and wanted competence and communication from carers. South Asian people frequently discussed needing care from someone with a shared language, but language differences could also be an issue for White British people. Some clinicians thought South Asian people had a stronger preference to provide care within the family. We found that preferences for who provides care varied across families regardless of ethnicity. Those with more financial resources and English language have more options for care that meets their needs.

People of the same background make differing choices about care. Equitable access to care is impacted by people’s personal resources, and people from South Asian backgrounds may experience the double disadvantage of having fewer options for care that meets their needs and fewer resources to seek care elsewhere.

This study investigated whether the association between modifiable dementia risk and rate of cognitive decline differs across socioeconomic status (SES) strata.

Data were used from Maastricht Aging Study, a prospective cohort study with a 12-year follow-up. The baseline sample consisted of 1023 adults over 40 years old.

The “LIfestyle for BRAin health” (LIBRA) index was used to assess modifiable dementia risk. Cognitive performance was assessed at baseline, 6 and 12 years, and measured in the domains of information processing speed, executive functioning and verbal memory function. An SES score was calculated from equivalent income and educational level (tertiles). Linear mixed models were used to study the association between LIBRA, SES and their interaction on the rate of cognitive decline.

Participants in the lowest SES tertile displayed more decline in information processing speed (vs. middle SES: X2 = 7.08, P = 0.029; vs. high SES: X2 = 9.49, P = 0.009) and verbal memory (vs. middle SES: X2 = 9.28, P < 0.001; vs. high SES: X2 = 16.68, P < 0.001) over 6 years compared to their middle- and high-SES counterparts. Higher (unhealthier) LIBRA scores were associated with more decline in information processing speed (X2 = 12.66, P = 0.002) over 12 years and verbal memory (X2 = 4.63, P = 0.032) over 6 years. No consistent effect modification by SES on the association between LIBRA and cognition was found.

Results suggest that lifestyle is an important determinant of cognitive decline across SES groups. Yet, people with low SES had a more unfavorable modifiable risk score suggesting more potential for lifestyle-based interventions.

The aim of this study was to investigate the factors influencing urban–rural differences in depressive symptoms among old people in China and to measure the contribution of relevant influencing factors.

A cross-sectional research. The 2018 data from The Chinese Longitudinal Health Longevity Survey (CLHLS).

Twenty-three provinces in China.

From the 8th CLHLS, 11,245 elderly participants were selected who met the requirements of the study.

We established binary logistic regression models to explore the main influencing factors of their depressive symptoms and used Fairlie models to analyze the influencing factors of the differences in depressive symptoms between the urban and rural elderly and their contribution.

The percentage of depressive symptoms among Chinese older adults was 11.72%, and the results showed that rural older adults (12.41%) had higher rates of depressive symptoms than urban (10.13%). The Fairlie decomposition analysis revealed that 73.96% of the difference in depressive symptoms could be explained, which was primarily associated with differences in annual income (31.51%), education level (28.05%), sleep time ( − 25.67%), self-reported health (24.18%), instrumental activities of daily living dysfunction (20.73%), exercise (17.72%), living status ( − 8.31%), age ( − 3.84%), activities of daily living dysfunction ( − 3.29%), and social activity (2.44%).

The prevalence of depressive symptoms was higher in rural than in urban older adults, which was primarily associated with differences in socioeconomic status, personal lifestyle, and health status factors between the urban and rural residents. If these factors were addressed, we could make targeted and precise intervention strategies to improve the mental health of high-risk elderly.

To examine the role of subjective cognitive difficulties (SCD), posttraumatic stress disorder (PTSD), and their interaction in predicting suicidal ideation and current suicidal intent in middle-aged and older United States (US) military veterans.

Population-based cross-sectional study.

Data were analyzed from the 2019 to 2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 3602 US veterans aged 50 years and older (mean age = 69.0).

Questionnaires including the Medical Outcomes Study Cognitive Functioning Scale (SCD), PTSD Checklist for DSM-5 (PTSD), Patient Health Questionnaire-9 (suicidal ideation in the previous two weeks), and the Suicide Behaviors Questionnaire-Revised (current suicidal intent).

A total of 154 (4.4%) veterans screened positive for current PTSD, 239 (6.7%) reported past two-week suicidal ideation, and 37 (1.0%) reported current suicidal intent. The probability of suicidal ideation among veterans with both SCD and PTSD was more than six times higher than that observed in the full sample (44.5% vs. 6.7%) and more than 2.5 times higher than that observed in veterans with SCD and no PTSD (44.5% vs. 17.5%). Veterans with both subjective memory and concentration difficulties were more likely to report suicidal intent, though the interaction between SCD and PTSD was not significantly associated with suicidal intent.

Middle-aged and older U.S. veterans with subjective cognitive impairment and PTSD report higher rates of suicidal ideation than those with SCD alone. Interventions targeting SCD and PTSD may mitigate suicide risk among middle-aged and older veterans.