Sources of inequality in ‘living well’ with dementia: an intersectional analysis using a British cohort study

Abstract Background and Objectives A key aim of national dementia policies is to enable people to ‘live well’ with the condition, but the experience of living with dementia, including access to health and social care services, is markedly affected by numerous sources of socioeconomic disparity. We explored how combinations of these disparities among groups of people with dementia are associated with the capability to ‘live well’. Research Design and Methods We used baseline data from 1,537 people with mild-to-moderate dementia in the British IDEAL cohort (2014-2016). This included personal characteristics, living situation, socioeconomic position, and geographical area, and three indices of ‘living well’ – quality of life, satisfaction with life, and well-being. Through regression-tree analyses, we explored how the intersection of factors beyond type of dementia and co-morbidity is associated with subgroups of people with dementia experiencing higher or lower capability for ‘living well’. Results Age, education, living situation, income, and home ownership emerged as the strongest differentiators. Drawing on the concept of precarity, we show how the connections between unequal distribution of resources and personal vulnerabilities lead to an accumulation of pressures and shape outcomes. Discussion and Implications These findings from a cohort of people with dementia in a major Western economy represent the tip of the iceberg relative to the full extent of national and especially global inequalities. Addressing the impact of these social inequalities requires a sustained focus on developing and implementing policies that improve equity of access to care and support and increase the potential for ‘living well’.