This paper uses the term inequalities. In this Evidence Hub, inequities is used where differences in access or outcomes reflect avoidable and unfair structural barriers in health and social care. 

Key messages 

• people living with dementia and their carers face barriers to diagnosis and care that lead to avoidable inequities in health and social care outcomes 

• solutions identified in the literature operate at three levels: individual factors, community support, and health and social care system infrastructure 

• system-level interventions, such as dementia link workers, integrated care networks and memory clinic networks, show the strongest evidence for improving access to care 

• culturally and linguistically tailored interventions can improve dementia awareness, service navigation and carer confidence in underserved communities 

• community-based initiatives, including dementia-friendly communities and peer networks, can help reduce stigma and improve understanding of dementia 

• digital tools and telehealth services may improve access to support but can also create barriers for people with limited digital literacy or access to technology 

• evidence on cost-effectiveness and long-term impact of interventions remains limited 

Policy implications 

• develop dementia link worker or care navigator roles to help individuals and carers access services following diagnosis 

• strengthen integration between health and social care services to improve coordination of dementia care 

• invest in culturally appropriate information and support programmes for underserved communities 

• support community-based initiatives that raise awareness and reduce stigma around dementia 

• improve workforce training to increase knowledge and confidence in dementia care across health and social care settings 

• ensure digital dementia support services are accessible and accompanied by non-digital alternatives 
  • increase research and policy attention on dementia care in lower- and middle-income countries 

Gaps 

• the majority of studies were conducted in high-income countries, with very limited evidence from lower- and middle-income settings 

• many interventions were evaluated only once, limiting the strength of evidence for their effectiveness 

• there is limited evidence on the cost-effectiveness of interventions designed to reduce inequities in dementia care 

• few studies examine long-term outcomes or large-scale implementation of interventions 

• more research is needed on how different interventions affect health and social care utilisation and outcomes 

Commentary 
This systematic review examines interventions designed to reduce inequalities in dementia diagnosis and care. The review highlights that people living with dementia and their carers often face barriers when trying to access services, which can lead to avoidable differences in health outcomes. 

Many of these barriers occur at several levels. Some relate to individual circumstances such as language, cultural background or socioeconomic status. Others occur at community level, for example where stigma around dementia discourages people from seeking help. Structural barriers within health and social care systems also play an important role, particularly where services are fragmented or poorly coordinated. 

The review finds that system-level solutions appear to have the strongest evidence. These include models such as dementia link workers, integrated care networks and memory clinic collaborations. These approaches can improve coordination between services and help individuals and carers access appropriate support more easily. In some studies, link worker roles also improved quality of life for people living with dementia and reduced pressure on carers. 

Community-level initiatives can also play an important role. Programmes that raise awareness about dementia, reduce stigma and build dementia-friendly communities may encourage earlier help-seeking and improve understanding of the condition. Culturally tailored information and support programmes can also help address barriers faced by minority ethnic communities. 

The review also identifies increasing use of digital tools to support dementia care. Online information platforms, telehealth services and digital care planning tools can help some people access support more easily. However, the authors note that digital solutions can also create new barriers where people lack digital skills, access to technology or reliable internet connections. 

From a health and social care equity perspective, the findings show that inequities in dementia care often arise from structural barriers within systems rather than individual choices. Access to diagnosis, information and support can vary depending on geography, service availability and socioeconomic circumstances.

Key statistics

• people experiencing homelessness are three times more likely to use emergency health services than the general population
• 45% of respondents reported self-medicating with drugs or alcohol to cope with mental health difficulties
• average age at death for people experiencing homelessness is between 43 and 46 years.

Key messages

• people experiencing homelessness often rely on informal networks, such as friends, family or peers, to learn about available services
• mistrust of formal institutions, lack of information and fragmented systems limit engagement with health and social care
• effective outreach depends on culturally sensitive approaches delivered through trusted community resources
• collaboration with community-based organisations is central to improving access
• many participants reported confidence in using the internet to access information and support.

Policy implications

• service information may need to be shared through informal and community-based channels as well as formal routes
• outreach models should be designed around trust, cultural sensitivity and existing community relationships
• digital access should be considered as part of service engagement strategies
• stronger integration between health, social care and community organisations may improve access.

Gaps

• limited evidence on how informal information pathways affect longer-term outcomes
• lack of evaluation of different outreach models and their effectiveness
• limited insight into how digital access varies across subgroups within the homeless population.

Commentary
This study highlights how homelessness intersects with inequities in access to health and social care. People experiencing homelessness face multiple barriers, including mistrust of institutions, fragmented services and limited access to information that is relevant to their circumstances.

Reliance on informal networks plays a dual role. These networks provide vital routes to information and support, but they can also limit access to preventative or coordinated care when connections to formal systems are weak.

The findings underline the importance of outreach approaches that are culturally sensitive and rooted in trusted local organisations. Delivering support through community-based providers can help overcome barriers linked to trust and engagement.

From a care equity perspective, the study points to the need for more integrated systems that recognise how people experiencing homelessness access information and support. Aligning health and social care services with trusted community organisations may reduce exclusion and improve access for people living in vulnerable situations.