Month: March 2025

Barriers to Dementia Care Services in Europe: Key Insights and Ways Forward

Dementia, including Alzheimer’s disease, is a significant public health challenge in Europe, with nearly 14 million people currently affected. Despite available healthcare and social care services, utilisation of these services by people living with dementia remains suboptimal due to various barriers. Our recent systematic review published in BMC Geriatrics provides critical insights into these challenges, highlighting barriers across informational, organisational, cultural, stigma-related, financial, and logistical domains.

Informational and Educational Barriers

A lack of awareness and insufficient knowledge among caregivers and healthcare professionals stands out as a key barrier. Inadequate dissemination of dementia-related information contributes to difficulties in planning and accessing appropriate care. Enhancing educational resources and improving health literacy among caregivers and healthcare workers are essential for overcoming these challenges.

Organisational Barriers

Fragmented services and poor coordination among healthcare providers frequently hinder effective dementia care. Issues such as inconsistent care strategies, unclear roles, and insufficient resources exacerbate the difficulties faced by families and professionals alike. The Covid-19 pandemic has further intensified these problems, highlighting the urgency for integrated, person-centred care systems.

Cultural and Stigma-related Challenges

Societal stigma and cultural misunderstandings significantly impact dementia care, deterring individuals from seeking necessary help. Cultural sensitivity, improved community education, and targeted interventions can mitigate stigma-related issues, promoting better acceptance and utilization of dementia services.

Financial and Logistical Challenges

The economic burden of dementia care often strains family resources, compounded by complex administrative procedures and insufficient public funding. Additionally, logistical issues, including long waiting lists, transportation problems, and limited service availability, particularly in rural areas, create further barriers.

Policy Recommendations

To address these challenges, tailored, context-specific policies and integrated care pathways are necessary. European initiatives, such as Alzheimer Europe’s Strategic Plan and the Glasgow Declaration, underline the importance of inclusive strategies and active involvement of people with dementia in policy-making processes.

By addressing these identified barriers through coordinated actions, Europe can improve access to dementia care, enhancing the quality of life for individuals living with dementia and also for their caregivers.

The Covid-19 pandemic five years on

As we reach the fifth anniversary of the onset of the Covid-19 pandemic, this moment provides an opportunity for reflection on the many challenges faced by healthcare workers like me during the early days of the pandemic. At that time, the SARS-CoV-2 virus was a largely unknown entity. Clinical guidelines were still under development and personal protective equipment (PPE) was scarce. For those on the NHS frontline, the experience was marked by a mix of anxiety, urgency, and dedication to the patients we were trained to serve.

Unfamiliar Territory 

In the initial stages, Covid-19 was a “novel” infection. There was a scarcity of data on the illness, and the disease was manifesting in ways that were not entirely well understood. As primary care physicians, we were suddenly thrust into the realm of the unknown, treating patients with undifferentiated respiratory illnesses that did not yet have well-defined and evidence-based treatment protocols.

The Personal Risk Factor 

One of the most daunting aspects of those early days was the awareness of personal risk. It became apparent that healthcare workers were at a significantly higher risk of contracting the disease through their exposure to infected individuals. One thing struck me and others very profoundly was the pattern among the first NHS staff who died due to Covid-19. Many of them were like me: male, over 50, and from ethnic minority groups. This resemblance was not just a statistical observation; it was a stark reminder of my own clinical vulnerability and that of many of my colleagues.

Ethical Duty vs. Personal Safety 

Yet, despite these risks, we had patients to treat. Faced with an ethical duty to provide care, healthcare workers had to weigh this against the risks to their own health. It was an emotionally and ethically complex position to be in. While the fear and anxiety were real, they had to be balanced against our professional obligations to our patients and the NHS. It was a test of not just our medical skills but also our commitment to the Hippocratic Oath.

The Importance of Resilience 

The job had to be done, and so we donned our PPE, took the necessary precautions, and went to work. This resilience is a testament to the dedication of healthcare workers globally who stood firm in their commitment despite the many unknowns in early 2020. The role of healthcare providers in those critical moments was instrumental in broadening our understanding of the virus, which subsequently guided future public health responses, medical treatments and vaccination.

Ongoing Challenges 

The situation has evolved and we now know much more about Covid-19. We now also have vaccines that reduce the risk of serious illness, hospitalisation and death. Yet the lessons of those early days continue to resonate. Healthcare providers still face risks, both physical and emotional, particularly as new variants of the SARS-CoV-2 virus emerge. The Covid-19 story is not over, particularly for those people who suffer recurrent infections or with Long Covid but the experiences of the past provide a foundation upon which we build our ongoing responses.

The broader implications of healthcare workers’ experiences during the Covid-19 pandemic extend far beyond individual resilience and sacrifice. These experiences have exposed critical vulnerabilities in global health systems, highlighting the urgent need for better preparedness, clearer communication strategies and equitable access to protective resources. Furthermore, the pandemic underscored profound health inequalities, notably the increased risks faced by poorer people, ethnic minority groups and the elderly. Recognising these inequalities provides an impetus for policy makers and healthcare leaders to implement structural changes, fostering a more robust, responsive, and inclusive approach to future public health emergencies.

Conclusions 

As we navigate the ongoing challenges posed by Covid-19, reflecting on where we began and the progress we have made since early 2020 is essential. The evidence presented in the Covid-19 Inquiry serves as a timely reminder of healthcare workers’ immense bravery, resilience, and sacrifice globally. While anxiety was palpable, commitment to patient care remained unwavering. Looking ahead, it’s vital we learn from these experiences, investing in preparedness, communication, and systems that protect both patients and those who care for them, ensuring we’re better equipped for future health crises.

Medical Journals Should Use the Term “Public Health and Social Measures”

The COVID-19 pandemic brought many terms into the spotlight, one of which was “non-pharmaceutical interventions” (NPIs). Used widely in academic papers, public health guidelines, and media reports, NPIs became a catch-all phrase for measures like contact tracing, quarantine, and hand hygiene; essentially anything that wasn’t a drug or vaccine. However, BMJ Editor Kamran Abbasi and I argue in our editorial it is time to end the use of this term in favour of “public health and social measures.” Here’s why this shift matters.

The Problem with Defining by Negation

The term “non-pharmaceutical interventions” defines these strategies by what they aren’t rather than what they are. This framing is inherently limiting. Imagine calling surgery a “non-drug intervention”—it sounds absurd because surgery stands on its own as a complex, evidence-based practice. Similarly, public health measures like sanitation or hand hygiene aren’t just stopgaps until a drug or vaccine becomes available. They are powerful tools with scientific grounding, often critical in the early stages of a health crisis and remain valuable even after pharmaceutical options emerge. By labelling them as “non-pharmaceutical,” we risk undervaluing their role and complexity.

A Misleading Hierarchy

The NPI label also subtly suggests that these interventions are second-rate compared to drugs or vaccines. This perception can lead to serious consequences: underfunding, limited evaluation and a reluctance to fully integrate them into health strategies. Yet, history shows that measures like clean water systems or contact tracing can have major impacts of public health; sometimes more effective than any medication. The implied inferiority of NPIs feeds into a biomedical bias, prioritising technological fixes over holistic approaches that address behaviour, culture, and social determinants like poverty or housing.

Missing the Social Dimension

Another flaw in the term “non-pharmaceutical” is its failure to reflect the social and behavioural core of these measures. Hand-washing campaigns do not succeed through science alone. They depend on people’s willingness to adapt, shaped by trust, norms, and socioeconomic context. Calling them “non-pharmaceutical” strips away this human element, reducing them to technical fixes rather than collective efforts. This oversight can widen health inequities, as solutions that ignore social factors often fall short for vulnerable populations.

Clarity for the Public

Communication is critical in a health crisis, and “non-pharmaceutical interventions” may not mean much to the average person. It is jargon that obscures rather than enlightens. In contrast, “public health and social measures” is straightforward. It signals that these actions protect communities and require shared effort. When people understand what is at stake and why it matters, they are more likely to follow the advice they have been given.

A Call for Change

We propose “public health and social measures” as a term that captures the full scope of these interventions; their diversity, their evidence base and their reliance on social dynamics. It aligns with the World Health Organization’s recommendations and encourages a broader view of health, one that integrates biology with environment and society. The BMJ is aiming to lead by example, committing to this terminology across its content. We urge other journals, reviewers, and health professionals to follow this example.

Why It Matters Now

As we face ongoing and future health challenges – such as pandemics, climate-related crises or an increase in chronic diseases – this shift is not just semantic. It is about ensuring these measures get the research, funding and respect they deserve. By reframing them as “public health and social measures,” we elevate their status, improve public understanding, and foster interdisciplinary solutions that address public health challenges effectively.

Missed Appointments: An Opportunity to Address Patient Safety

Our recent article in the Journal of Patient Safety discusses the topic of missed appointments in healthcare. Missed appointments are often seen as an administrative inconvenience in healthcare; wasting appointments that could have gone to other patients. However, missed appointments are also a critical patient safety concern that can delay necessary interventions, worsen health outcomes, and erode trust between patients and clinicians. Instead of viewing them as patient noncompliance, we must shift our perspective to understand the underlying barriers that prevent people from attending their scheduled appointments.

Understanding the Root Causes of Missed Appointments

Patients miss appointments for a variety of reasons, many of which are outside their control. Socioeconomic challenges, work obligations, caregiving responsibilities, mental health issues, transportation difficulties, and previous negative experiences with the healthcare system all contribute to non-attendance. Disadvantaged populations – such as poorer individuals, ethnic minorities, the elderly and rural communities – face even greater hurdles in accessing healthcare. When these challenges are ignored, healthcare systems risk isolating the very patients who need support the most.

The Consequences of Missed Appointments

The impact of missed appointments extends beyond inconvenience. They disrupt continuity of care, leading to delayed diagnoses and potentially preventable complications. Patients with chronic diseases, such as diabetes, hypertension, or mental health conditions, face particularly severe consequences when they miss follow-ups. Additionally, when healthcare providers interpret missed appointments as a lack of commitment, punitive measures – such as discharging patients from services – can further alienate vulnerable individuals and create barriers to essential care.

Beyond direct clinical risks, there is also the issue of trust. Patients who feel unheard, rushed, or judged during healthcare interactions may disengage from the system altogether, leading to long-term avoidance of care. This breakdown in trust is a significant patient safety issue, as it discourages individuals from seeking timely medical attention.

A Patient-Centred Approach to Reducing Missed Appointments

Addressing missed appointments requires a fundamental shift in approach. Instead of punitive policies, healthcare providers should focus on identifying and removing barriers to attendance. Some key strategies include:

  • Understanding Social Determinants of Health: Recognising that financial constraints, transportation issues, and job inflexibility impact appointment attendance. Partnering with community organisations to provide support services – such as transportation assistance or mobile health clinics – can help overcome these barriers.
  • Creating a Compassionate Healthcare Environment: Patients are more likely to attend appointments when they feel valued and respected. Clinicians should take time to listen, address concerns, and ensure that healthcare settings are welcoming and inclusive.
  • Flexible Scheduling Options: Evening and weekend appointments can accommodate patients with demanding work schedules or caregiving responsibilities.
  • Leveraging Technology: Telemedicine offers an alternative for patients who struggle to attend in-person visits. AI-driven predictive analytics can also help identify individuals at high risk of missing appointments, allowing for targeted interventions such as personalized reminders or proactive outreach.

Turning Missed Appointments into Opportunities for Improvement

Rather than viewing missed appointments solely as a problem to be fixed, healthcare systems should treat them as a diagnostic tool—an indicator of broader systemic issues. By shifting the focus to patient safety and proactive intervention, healthcare providers can transform these challenges into opportunities to improve engagement, build trust, and ensure that every patient receives the care they need when they need it. A patient-centred, safety-focused approach to missed appointments benefits everyone. It leads to better health outcomes, strengthens patient-provider relationships, and ultimately creates a more equitable and accessible healthcare system for all.