Protection against discrimination in national dementia guideline recommendations: A systematic review

Abstract

Background National dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. Methods and findings We searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country’s official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded. Conclusions National guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world’s countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services.

Considering inequities in national dementia strategies: Breadth, depth, and scope

“…Our ndings echo those of a 2022 systematic review investigating protection against discrimination in national guidelines for assessment, diagnosis and management of dementia (54). The authors highlighted that although most guidelines mentioned SDH and inequities, only a fraction included speci c recommendations to mitigate them (54).…”

Do clinical guidelines support person-centred care for women affected by dementia: A content analysis

“…In so doing, it supplements the aforementioned qualitative research ( Bamford et al, 2021 ; Wheatley et al, 2021 ) by revealing strategies that clinicians can apply to achieve holistic, person-centred dementia care. Our work also expands upon a prior analysis of dementia guidelines that specifically focused on intersectional factors, and like our study, found that most guidelines recognized the need to tailor dementia care to the needs of diverse persons ( James et al, 2022 ).…”

Optimizing the Aging Brain: The BEAD Study on the Ethics of Dementia Prevention

“…To foster the successful translation of the "new dementia" into effective public health initiatives, due attention must be paid to the uneven prevalence (and burden) of dementia risk factors across different populations, geographies and demographics. Evidence is starting to accumulate demonstrating that dementia risk factors play out differently for different people both nationally and at a global level (30,31).…”