Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review

Abstract

Background There are challenges in healthcare service delivery in rural areas, and this may be especially true for persons with dementia, who have higher needs to access to the healthcare system, and may have difficulties to commute easily and safely to these services. There is a growing body of literature regarding geographical disparities, but there is no comprehensive systematic review of geographical differences in persons with dementia across all domains of care quality. Therefore, the objective of this study is to conduct a systematic review of the literature on rural and urban differences in quality of dementia care outcomes of persons with dementia across all quality-of-care domains. Methods We performed a digital search in Ovid MEDLINE on July 16, 2019, updated on May 3, 2021, for French or English records. We selected studies that reported outcome from at least one domain of quality of dementia care (Access, Integration, Effective Care, Efficient Care, Population Health, Safety, and Patient-Centered) in both rural and urban persons with dementia or caregivers. We used rigorous, systematic methods for screening, selection, data extraction and we analyzed outcomes reported by at least two studies using vote counting and appraised the certainty of evidence. Finally, we explored sources of heterogeneity. Results From the 38 included studies, we found differences in many dementia care domains. Rural persons with dementia had higher mortality rates (Population Health), lower visits to any physicians (Access), more hospitalizations but shorter stays (Integration), higher antipsychotic medications (Safety), lower use of home care services and higher use of nursing home (Patient-Centered Care) compared to urban persons with dementia. Conclusions This comprehensive portrait of rural–urban differences in dementia care highlights possible geographically based inequities and can be used by researchers and decision makers to guide development of more equitable dementia care policies.

Impact of COVID‐19 pandemic on mortality rate in memory clinic patients

“…Previous studies show that people living with dementia (at home) have increased risk of mortality when good quality healthcare is limited. 34,35 Especially in the first year of the pandemic, with Due to this postponed and worse quality healthcare, people living with dementia should have increased risk of mortality. Finally, it is possible that the follow-up time in the current study was too short for observing a higher mortality rate in pre-dementia patients.…”

“…For example, people who badly fell in their own home may have been found too late by a healthcare provider due to the COVID‐19 restrictions. Previous studies show that people living with dementia (at home) have increased risk of mortality when good quality healthcare is limited 34,35 . Especially in the first year of the pandemic, with the introduction of the strictest COVID‐19 measures, good quality healthcare was definitely worse and lots of healthcare was postponed.…”

An investigation of psychoactive polypharmacy and related gender-differences in older adults with dementia: A retrospective cohort study

“…Previous reports from Quebec suggest that there are differences for those with dementia when comparing those residing in an urban or rural location -rural residents living with dementia had higher mortality, lower physicians access, more hospitalizations, shorter hospital stays, higher antipsychotic medication use, lower use of home care services, and higher use of nursing home compared to urban persons with dementia. 40 Older age was consistently associated with a reduced risk of psychoactive polypharmacy. This is also reinforced by the nding that later (more recent) years of diagnosis were associated with less psychoactive polypharmacy.…”

Enhancing post-diagnostic care in Australian memory clinics: Health professionals’ insights into current practices, barriers and facilitators, and desirable support

“…Memory clinics in regional areas were constrained by the limited post-diagnostic services available in the community, which is a well-recognised disparity in Australia (Van Gaans & Dent, 2018). People with dementia and their care partners living in regional areas experience substantial challenges in accessing services (Arsenault-Lapierre et al, 2023; Dawson et al, 2017; Gardiner et al, 2019; Gibson et al, 2019). Similar challenges accessing post-diagnostic services in regional areas have been reported in England, the Netherlands and Canada (Giebel et al, 2021; Gridley et al, 2019; Lee et al, 2019; Lee et al, 2019a).…”