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Dementia (London). 2016 Nov;15(6):1436-1456. Epub 2014 Dec 22.

Negotiating access to a diagnosis of dementia: Implications for policies in health and social care.

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Department of Gerontology, Simon Fraser University, Vancouver, Canada; Providence Health Care, Vancouver, Canada
Department of Gerontology, Simon Fraser University, Vancouver, Canada.
Sunnybrook Health Sciences Centre, Toronto, Canada.
Department of Nursing, Brock University, St. Catherines, Canada.
Department of Family Medicine, University of Alberta, Edmonton, Canada.


The 'Pathways to Diagnosis' study captured the experience of the prediagnosis period of Alzheimer's disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in Toronto. In this cross-site analysis, we use the 'Candidacy' framework to comprehensively explore the challenges to securing a diagnosis of dementia in Canada and to develop relevant health and social policy. Candidacy views eligibility for appropriate medical care as a process of joint negotiation between individuals and health services, which can be understood relative to seven dimensions: identification of need, navigation, appearances at services, adjudication by providers, acceptance of/resistance to offers, permeability of services and local conditions. Interviewees experienced challenges relative to each of the seven dimensions and these varied in form and emphasis across the four ethno-linguistic groups.


Canada; Candidacy framework; dementia diagnosis; ethnocultural minority older adults; health policy; health services accessibility

[Indexed for MEDLINE]

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