Obstacles in accessing dementia care for people with a migration background in Basel. A qualitative interview study with professionals

Introduction: As our population is aging, age-related medical issues including mild
and major cognitive impairments are becoming more and more common. Literature
shows concerns related to access to health care for people with a migration
background in western countries. The connection between dementia and migration
and the access to dementia care for people with a migration background has not yet
been widely explored. Especially, in Switzerland, there are only a few studies on the
subject. The canton (federal state) of Basel-Stadt has a high percentage of people with
a migration background compared to the rest of Switzerland. This study aimed to
explore the care situation for people with a migration background and dementia living
in Basel-Stadt and to elaborate on the obstacles they might face to access dementia
care services compared to their local counterparts, causing inequalities in access to
dementia care, by interviewing professionals working in the thematic field.
Methods: Participants were acquired via online research and supplemented with
personal contacts and recommendations of other participants. Therefore, the sampling
strategy was both purposive and snowball. Interviews were performed via Zoom
following a semi-structured interview guide. The interviews concentrated on
differences in access to dementia care during different stages of the disease from a
professional view. Data analysis was performed using MAXQDA 2020.
Results: Sixteen professionals were interviewed belonging to different professions
such as general practitioner, hospital doctor, politicians, and those working in dementia
support services, ambulant care, home care, and nursing homes. We found that the
migrant population was underrepresented in the participating services, which lead to
in-depth exchange about obstacles that could potentially burden their access to the
available services. These challenges were grouped into four themes: (1) Delayed
diagnosis and lack of diagnostic tools and scores; (2) Obstacles to seeking help; (3)
Lack of migration sensitivity in dementia care services; and (4) Administrative and
financial obstacles.
Discussion and Conclusion: Our findings are in line with literature from other
countries. The interviewed services reported an underrepresentation of people with a
migration background compared to the demographic numbers, especially in postdiagnostic services. During our interviews and in context with the actual literature from
other countries it became clear that despite our broad and specialized health care
system we have not yet reached a point of equal access for people with a migration
background. To even out inequalities we suggest different measures including
adapting the diagnostic process and existing dementia care services with a focus on
migrant sensitivity in regard to language, culture, religion, and socio-economic aspects.
We also touch upon legal and political changes necessary to advance migration
sensitivity in dementia care. And finally, we want to encourage further research on a
national basis and explore the needs of the migrant community directly with the
affected population itself.