Research on dementia and inequalities in care and support – a map of the terrain and discussion of key issues

Inequalities and inequities in health and social care are a significant focus of attention. We need to understand these issues in dementia care as well, particularly given the projections for increases in the number of people being affected by the condition and the related rise in costs to individuals, families, communities and nations. We provide a map of the terrain of research concerning inequalities in dementia diagnosis, care and support in the United Kingdom (UK), and discussion of key issues. We map key literature related to our objective, particularly regarding the characteristics of people protected in law in the UK, plus socioeconomic status and geography (urban/rural) to map contours of the evidence and key issues. We focus on evidence from the UK, but have also drawn on international evidence as insightful for the map. The terrain of inequalities in dementia care is complex. Inequality has not tended to be an explicit lens through which researchers have sought to understand dementia care. Literature aligned to the issue chiefly focused on a single characteristic of people, such as ethnicity. Consideration of interactions of people’s characteristics and experiences—an intersectional approach – has not been a significant focus. Consideration has mainly focused on the barriers people face, e.g. obtaining a timely diagnosis and access to appropriate support, with less robust evidence about means of removing these. More should be done to understand the systemic barriers creating inequalities in accessing dementia diagnoses, care and support, particularly understanding the related intersections of people’s characteristics and experiences, and how to remove such impediments to accessing high-quality support. Recommendations for research to build a robust evidence-base to help improve dementia policy and planning to address systemic inequalities are provided, including that a stronger ‘inequalities’ lens is used and one that draws on an intersectional understanding of people.