Abstract
ObjectivesIn the current study, the Anderson model is used to determine equitable access to dementia care in Europe. Predisposing, enabling, and need variables were investigated to find out whether there is equitable access to dementia‐specific formal care services. Results can identify which specific factors should be a target to improve access.MethodsA total of 451 People with middle‐stage dementia and their informal carers from eight European countries were included. At baseline, there was no use of formal care yet, but people were expected to start using formal care within the next year. Logistic regressions were carried out with one of four clusters of service use as dependent variables (home social care, home personal care, day care, admission). The independent variables (predisposing, enabling, and need variables) were added to the regression in blocks.ResultsThe most significant predictors for the different care clusters are disease severity, a higher sum of (un)met needs, hours spent on informal care, living alone, age, region of residence, and gender.ConclusionThe Andersen model provided for this cohort the insight that (besides need factors) the predisposing variables region of residence, gender, and age do play a role in finding access to care. In addition, it showed us that the numbers of hours spent on informal care, living alone, needs, and disease severity are also important predictors within the model's framework. Health care professionals should pay attention to these predisposing factors to ensure that they do not become barriers for those in need for care.
Highlights
Dementia has a major influence on a person's life, affecting cognitive abilities, and activities of daily living
Often it is not of the right type.[4]. It is widely accepted across many health care systems that there should be equity of access to services5.6 Equity can be explained as the absence of systematic discrepancies in access to care services, with equal access for those with equal needs
A higher Clinical Dementia Rating (CDR) score, a higher sum of met needs, more hours spent on informal care at baseline, and living alone at baseline significantly predicted the use of home social care at T1 or T2
Summary
Dementia has a major influence on a person's life, affecting cognitive abilities, and activities of daily living. Possible reasons for inequality arise from differences in availability, quality, costs, and information for different population groups.[7] A recent research project encompassing the Netherlands, Germany, Italy, Belgium, Finland, and Iceland (Assessing Needs of Care In European Nations) reported that there is low equity in access to home health care services for older people in Italy and Finland.[8] When looking at overall health care for older people in Europe, approximately 50% to 75% of all formal long‐term care is delivered at home.[8] There are major differences in how care is subsidized, organized, and delivered. Reports from WHO10 and Alzheimer's Disease International (ADI) have shown a great and unequal distribution of dementia care resources worldwide.[11]
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