A new knowledge agenda prepared by researchers Jonathan Berg, Jeroen van Wijngaarden and Lieke Oldenhof reveals the far-reaching impact of socio-economic insecurity on the onset, course and perception of dementia in the Netherlands. For instance, dementia is up to twice as common among people on the lowest incomes. Also, dementia is often diagnosed (too) late in people living in socio-economic insecurity, who have less access to existing care and dementia services. At the same time, dementia also appears to reinforce or cause socio-economic insecurity. This happens, for example, because people in the early stages of dementia are no longer able to oversee financial choices, people with young-onset dementia lose their jobs, informal carers can do less paid work and people with dementia can be financially abused.
These insights are the result of research conducted by Erasmus School of Health Policy & Management (ESHPM) and commissioned by ZonMw. The research, which was part of the academic workshop CARE lab Rotterdam, aimed to gain insight into what is known about the mutual influence between socio-economic insecurity and dementia through interviews with knowledge experts, care and welfare professionals and a number of expert patients. The results have been compiled as a guide for future research in the Knowledge Agenda on Socio-Economic Insecurity and Dementia. This report details the different stages people with dementia go through and how socio-economic insecurity plays a role.
Social inequalities
An ageing population means an increasing number of people in the Netherlands have dementia. On top of that, more people will have to care for others with dementia in the coming years. The hopes of many policymakers are pinned on socialisation of care. The researchers of this project warn that there may continue to be an unequal distribution of the burdens of disease and care, as dementia reflects persistent social inequalities. For example, this is because people living in socio-economic insecurity have less access to professional help, health information and care services due to lack of money and skills. They are also more likely to live in unhealthy living conditions, which increases the risk of disease. The risk of socialisation of care is therefore that more pressure will be put on informal carers in networks with limited capacity and that health inequalities will grow.
“Social inequalities in the occurrence and perception of disease should therefore be a priority of future research”, Berg said. “This can be done by examining how people living in socio-economic insecurity cope with disease together with their environment. It would be interesting to look at both metropolitan communities and rural municipalities in this regard. What are the specific challenges they face? And what are starting points to improve access to resources, including care and support, for living a decent life with dementia? The problems experienced by the many different people with dementia are simply not the same. As a consequence, tackling dementia should involve context-sensitive policies and personalised support.”
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