PDF(Pubmed)
Abstract：
Many people living with dementia and unpaid carers experience inequalities in care related to challenges in receiving a correct diagnosis, care and support. Whilst complexities of the evidence are well recognised including barriers in receiving a diagnosis or post-diagnostic care, no coherent model has captured the far-reaching types and levels of inequalities to date. Building on the established Dahlgren & Whitehead Rainbow model of health determinants, this paper introduces the new Dementia Inequalities model. The Dementia Inequalities model, similar to the original general rainbow model, categorises determinants of health and well-being in dementia into three layers: (1) Individual; (2) Social and community networks; and (3) Society and infrastructure. Each layer comprises of general determinants, which have been identified in the original model but also may be different in dementia, such as age (specifically referring to young- versus late-onset dementia) and ethnicity, as well as new dementia-specific determinants, such as rare dementia subtype, having an unpaid carer, and knowledge about dementia in the health and social care workforce. Each layer and its individual determinants are discussed referring to existing research and evidence syntheses in the field, arguing for the need of this new model. A total of 48 people with lived, caring, and professional experiences of dementia have been consulted in the process of the development of this model. The Dementia Inequalities model provides a coherent, evidence-based overview of inequalities in dementia diagnosis and care and can be used in health and social care, as well as in commissioning of care services, to support people living with dementia and their unpaid carers better and try and create more equity in diagnosis and care.
摘要：
许多患有痴呆症和无偿照顾者的人在接受正确诊断方面遇到了与挑战相关的护理不平等。关心和支持。虽然证据的复杂性已得到公认，包括接受诊断或诊断后护理的障碍，迄今为止，还没有一个连贯的模型捕捉到影响深远的不平等类型和水平。建立在已建立的健康决定因素的Dahlgren&WhiteheadRainbow模型的基础上，本文介绍了新的痴呆不等式模型。痴呆症不等式模型，类似于原始的一般彩虹模型，将痴呆症健康和福祉的决定因素分为三层：（1）个人；（2）社会和社区网络；（3）社会和基础设施。每一层都包括一般的决定因素，在原始模型中已经确定，但在痴呆症中也可能不同，例如年龄（特别是指青年与晚发性痴呆）和种族，以及新的痴呆症特异性决定因素，如罕见的痴呆亚型，有一个无薪照顾者，以及健康和社会护理劳动力中关于痴呆症的知识。参考该领域现有的研究和证据综合，讨论了每一层及其各个决定因素，争论这种新模式的必要性。共有48人居住，关怀,在此模型的开发过程中，已经参考了痴呆症的专业经验。痴呆症不等式模型提供了一个连贯的，痴呆症诊断和护理不平等的循证概述，可用于健康和社会护理，以及在护理服务的调试中，更好地支持痴呆症患者及其无偿护理人员，并尝试在诊断和护理方面创造更多公平。
