Timely diagnosis of dementia in rural areas in Austria: the Dementia Service Centre model

The Dementia Service Centre Model was developed in order to serve rural communities in Upper Austria. The goals of the Dementia Service Centre were defined as a multicomponent, low threshold, ‘one-stop shop’ psychosocial support model, specifically addressing the needs of persons with dementia and their family carers and support providers in rural communities. The main goals of the DSC care model are: a) timely detection of dementia, b) delaying the institutionalisation of persons with dementia and c) reducing the burden of support providers. In 2001, a data base was established with the goal to providing evidence for the support model. Research projects, including a randomized controlled trial, were conducted. The results of the research influenced the decision of policy makers to promote the model for roll-out. During the pilot phase, 7 Centres were opened. The model has been selected for rollout and in 2020 eleven Centres will be available.

Remote and rural dementia care: why is this important for policy, research, practice and the lived experience of dementia?

This chapter sets out the need for a focus on remote and rural dementia care. It highlights the need to consider the interconnections between policy, practice and research evidence and the lived experience of people living with dementia in remote and rural areas. The chapter provides an overview of the structure and aims of the book.

Conclusion: navigating 21st-century remote and rural dementia care and a future research agenda

This chapter summarises key themes across rural and remote dementia care internationally. It highlights consistent issues as well as innovations and points to note, across the three areas of policy, practice and research. The chapter concludes there is still significant work to be done in finding and translating new models for providing high quality rural dementia care and thus good experiences for people with dementia, carers and communities. The chapter throws down the gauntlet inviting more research and study in this area.

Living with dementia in rural Scotland

This chapter discusses what it is like for one individual with dementia living in a remote and rural area of Scotland. The benefits of living in a rural community are highlighted, as are the range of groups available that help the author to live well with dementia in her community. Self-help approaches are also discussed. Overall the chapter provides an inspiring account of a life well lived with dementia.

Living with dementia in rural Ireland

This chapter sets out a series of recommendations for anyone who does not have dementia to consider based on the experience of living with dementia in rural Ireland. The author highlights how she has adapted to living with dementia and how her community has supported her as she strives to continue to live as well as she can with dementia and continue to remain socially connected. She provides an uplifting account of her success in living with dementia but sets out clearly the challenges that accompany being able to do so.

Key issues for people with dementia living in rural Ireland: social exclusion, models of care and policy change

The way we think about older people’s lives at the intersection of dementia and rurality, and our recognition of the importance of their world, is crucial to ensuring the delivery of more effective public supports that can enable them to realise full personhood and citizenship, connected to the people that they love and the places where they live. This chapter uses a social exclusion conceptual framework to unpack complex and multiple challenges facing rural older people with dementia and highlights the importance of adopting a multifaceted holistic approach to support full societal participation. The analysis provides an argument for the recalibration of current dementia policy towards a genuine social production model for rural dwelling people with dementia; one that focuses on supporting them to continue to enjoy active and connected lives in rural communities through practical social policies, such as additional home supports, innovative psychosocial provision and integrated transport arrangements.

Norwegian remote and rural dementia care

A fifth of Norwegians (one million people) live rurally and approximately 80,000 rural people currently live with dementia. Diagnosis and follow-up support for people with dementia takes place in municipalities (local government areas). Most municipalities have a memory team that assists general medical practitioners in assessing dementia. In-home care is from district nurses and home helpers employed directly, or through contracts, by the municipalities. An early adopter of national dementia planning, Norway has instituted and adapted several innovative approaches that help to contextualise care to rural places, including service collaborations, joint upskilling and developing local workers that focus on people with dementia. While rural Norwegians with dementia experience many challenges shared internationally, such as long distances to access specialists, rural people tend to benefit from ‘everybody knows everybody’ communities and a relatively stable rural workforce.

The future of dementia care in rural areas of the world

This chapter specifically features the challenges for people living with dementia and their carers in rural areas of low- and middle-income countries (LMICs). It highlights the vital role of the community and primary health care workers and the need to raise awareness and skill development. The chapter considers how supra-national organisations and responses might specifically affect dementia care and development of policy in LMICs, including the role of the World Health Organisation which has produced planning and strategy guidance plus a range of useful tools for under-resourced settings. Other sectors significant to dementia care improvement, are civil society and the research community – of which key organisations are discussed. In LMIC settings dementia can be a poorly understood and culturally contested issue, and the care of people in resource-depleted rural areas of developing countries still requires significant work and advocacy. While WHO strategies can influence the worldwide burden of dementia substantially in the next 10 years, the chapter highlights that particular attention should be given to development and studies of rural areas of LMICs.

Considerations in dementia care for Indigenous populations in Canada

Over the last decade age-related dementias emerged as a significant health concern for Indigenous populations in Canada. Current research suggest that Indigenous communities hold culturally grounded understandings of dementia that are important in determining health services use and needs. This chapter combines a cultural safety framework with a health equity lens to discuss Indigenous dementia care needs in rural and remote Indigenous communities. Based on qualitative ethnographic data from Canada supported by published accounts of Indigenous experiences with dementia and dementia care internationally, we discuss promising approaches grounded in cultural safety aimed at improving prevention, diagnosis and care practices. Developing Indigenous specific care tools and adapting best practice mainstream approaches to care to adequately address cultural frameworks for dementia and the impacts of colonial trauma are necessary steps in providing decolonized, culturally safe care for Indigenous patients and fundamental to health equity.

Developing collaborative relationships with rural-dwelling older men with dementia in the UK: lessons learned from a community technological initiative

This chapter discusses the process of developing collaborative working relationships with a particularly hard-to-reach population; rural-dwelling older men with dementia. It draws on theoretical knowledge around masculinities as well as reflexive practice undertaken in rural areas within the UK to detail potential challenges facilitators may be faced with when engaging this population. It concludes by providing a list of recommendations for facilitators to consider when delivering community initiatives to rural-dwelling older men with dementia.