Parker Michelle, Barlow Sally, Hoe Juanita, Aitken Leanne
Division of Nursing, City, University of London, London, UK.
School of Health Sciences, City, University of London, London, UK.
Int Psychogeriatr. 2020 May;32(5):611-634. doi: 10.1017/S1041610219002229. Epub 2020 Feb 6.
To identify barriers and facilitators to help seeking for a dementia diagnosis from the perspective of carers and people with dementia.
A systematic review of the literature was conducted according to the PRISMA guidelines (PROSPERO protocol registration CRD42018092524). Nine electronic databases were searched for qualitative, quantitative, and mixed methods primary research studies. Two independent reviewers screened titles and abstracts, full texts of eligible studies, and conducted quality appraisal of included articles. A convergent qualitative synthesis approach was used.
From 7496 articles, 35 papers representing 32 studies from 1986 to 2017 were included. Studies originated from 13 countries across 4 continents. Barriers and facilitators were reported predominantly by carers. A small number of studies included people with dementia. Barriers included denial, stigma and fear, lack of knowledge, normalization of symptoms, preserving autonomy, lack of perceived need, unaware of changes, lack of informal network support, carer difficulties, and problems accessing help. Facilitators included recognition of symptoms as a problem, prior knowledge and contacts, and support from informal network.
Studies from a 30-year period demonstrated that barriers to help seeking persist globally, despite increasing numbers of national dementia policies. Barriers and facilitators rarely existed independently demonstrating the complexity of help seeking for a diagnosis of dementia. Multiple barriers compounded the decision-making process and more than one facilitator was often required to overcome them. Multi-faceted interventions to reduce barriers are needed, one approach would be a focus on the development of dementia friendly communities to reduce stigma and empower people with dementia and carers.
从痴呆症患者照料者和患者自身的角度，确定寻求痴呆症诊断的障碍和促进因素。
根据PRISMA指南（PROSPERO方案注册号CRD42018092524）对文献进行系统综述。检索了九个电子数据库，以查找定性、定量和混合方法的原发性研究。两名独立评审员筛选标题和摘要、符合条件研究的全文，并对纳入文章进行质量评估。采用了收敛性定性综合方法。
从7496篇文章中，纳入了35篇论文，代表了1986年至2017年的32项研究。研究来自四大洲的13个国家。障碍和促进因素主要由照料者报告。少数研究纳入了痴呆症患者。障碍包括否认、耻辱感和恐惧、知识缺乏、症状常态化、维护自主性、缺乏感知需求、未意识到变化、缺乏非正式网络支持、照料者困难以及获取帮助的问题。促进因素包括将症状识别为问题、先前的知识和人脉，以及来自非正式网络的支持。
30年期间的研究表明，尽管国家痴呆症政策数量不断增加，但寻求帮助的障碍在全球范围内仍然存在。障碍和促进因素很少独立存在，这表明寻求痴呆症诊断帮助的复杂性。多种障碍使决策过程更加复杂，通常需要不止一个促进因素来克服这些障碍。需要采取多方面的干预措施来减少障碍，一种方法是专注于发展对痴呆症友好的社区，以减少耻辱感并增强痴呆症患者及其照料者的权能。
