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  • Astrid Stephan
    Martin-Luther University, Halle-Wittenberg
  • Anja Bieber
    Martin-Luther University, Halle-Wittenberg
  • Louise Hopper
  • Rachael Joyce
    Dublin City University
  • Kate Irving
    Dublin City University
  • Orazio Zanetti
    IRCCS S. Giovanni di Dio “Fatebenefratelli”
  • Elisa Portolani
    IRCCS S. Giovanni di Dio “Fatebenefratelli”
  • Liselot Kerpershoek
    Maastricht University
  • Frans Verhey
    Maastricht University
  • Marjolein de Vught
  • Claire Wolfs
    Maastricht University
  • Siren Eriksen
    Vestfold Hospital Trust, Tønsberg
  • Janne Røsvik
    Vestfold Hospital Trust, Tønsberg
  • Maria J. Marques
    Universidade Nova de Lisboa
  • Manuel Gonçalves-Pereira
    Universidade Nova de Lisboa
  • Britt-Marie Sjölund
    Stockholm University
  • Hannah Jelley
  • Bob Woods
  • Gabriele Meyer
Consortium Actifcare

People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals.
Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports.
Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives.
Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families.


  • Dementia, Person with dementia, Informal carer, Formal care, Utilisation, Focus Groups
Original languageEnglish
Article number131
JournalBMC Geriatrics
Publication statusPublished - 4 Jun 2018

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