SAS Mental Health and Dementia Team

• Age
• Disability
• Gender reassignment
• Gender/Sex
• Marriage/Civil Partnership
• Pregnancy/maternity
• Race
• Religion/belief

Cross Cutting - e.g. health inequalities - people with poor mental health, low incomes, involved in the criminal justice system, those with poor literacy, are homeless or those who live in rural areas.

Scotland’s 10 year dementia strategy Scottish Government (2023) Dementia in Scotland - Everyone's Story

This ten-year strategy, along with its accompanying two-year Delivery Plan for 2024–2026, outlines expectations at both national and local levels.  The thematic priorities include developing a skilled workforce, challenging stigma, brain health, diagnosis, post-diagnostic support, resilient communities, the hospital experience, self-directed support access and short breaks/respite availability for care partners/unpaid carers, digital developments and inclusion. National campaigns to promote brain health and challenge stigma are in progress.

It highlights:

• In Scotland, approximately 90,000 people are living with dementia, including around 3,000 people under the age of 65. This is expected to increase.
• One in four people in hospital will be living with dementia and often experience longer hospital stays and delays in leaving hospital.
• 60%-70% of those caring for someone with dementia are women.

Dementia also affects people under the age of 65 years where there are often added complexities to the illness; differences in social, family, employment, and financial circumstances; increased stigma as dementia often viewed by public as condition affecting older people.

Scottish Intercollegiate Guidelines Network SIGN 168 - Assessment, diagnosis, care and support for people with dementia and their carers. National Clinical Guideline (Nov 23) https://www.sign.ac.uk/our-guidelines/dementia/ National evidence based clinical guidelines from pre-diagnosis to end of life care. This guideline provides recommendations based on current evidence for best practice in the assessment, care and support of adults with dementia. The guideline applies to all settings, including home, long-term care, care homes, hospital, hospice, day-care centres and primary care. Person-centred care is the focus of the implementation of this guideline.

The SIGN Guidelines are also supported by a completed Equality Impact Assessment 2023-11-14-eqia-SIGN dementia-v1.pdf with useful equalities evidence base.

In the dementia and health inequalities section it states “Few large-scale studies have investigated social inequalities in dementia. It is recognised that health inequalities persist into old age and that many of the risk factors for dementia are associated with socioeconomic disparities in mortality and morbidity”.

It cites Public Health Scotland and related evidence:

Gender – 67% of people with dementia are women.

Age – the risk of dementia increases with age. Estimated prevalence rates increase from 0.1% of people under the age of 64 years to 15.9% of people aged over 80 years.

Learning disability – the rate of dementia is higher amongst people with a learning disability and onset is often earlier. Up to 75% of people with Down’s Syndrome who are older than 50 years develop dementia. For those with other causes of learning disability the prevalence of dementia is estimated to be greater than 18% in those aged 65 years or over, approximately three times higher than in the general population.

Ethnicity – the estimated prevalence rates for dementia in the black and ethnic minority community are similar to the rest of the population, with the exception of young-onset and vascular dementia, which have been found to be more prevalent.

Carers – it is recognised that informal carers of people living with dementia are disproportionately female and often from areas of socioeconomic deprivation.

It also cites further evidence:

• Report and recommendations by The National Advisory Group, Dementia and Equality – Meeting the Challenge in Scotland, highlighted key themes to take forward, including raising awareness, ensuring robust services and support pathways, ensuring appropriate knowledge and skills, and research.
• Lived and living experience evidence base themes identified:
  • LGBTQ+ people - double stigma an added challenge; anticipated and experienced homophobia/discrimination; safety and concealment; recognition of same-sex partnerships. Includes suggested tools Proud to Care: LGBT and Dementia (a healthcare guide)

ethnic minority groups - deficits in knowledge of professionals and community members; lack of awareness of services; greater stigma (among minority ethnic populations), denial and concealment; lack of trust; cultural appropriateness of services.

MECOPP (June 2017) Supporting South Asian People with Dementia provides further detail on impact and supporting South Asian people and carers.

 Memory problems LGBTQ+ people with dementia may experience | Alzheimer's Society provides further detail on impact and supporting LGBTQ+ people and carers.

Best practice is also supported by The Association of Ambulance Chief Executives’ Dementia Best Practice Guidance for Ambulance Services which advocates for compassionate, person-centred care, a skilled workforce, improved communication, dementia-friendly environments, and collaborative working with local agencies.

Scotland’s Population Health Framework 2025-2035

Reference to dementia p28 in developing supportive environments that promote health and wellbeing and reduce health harming activities section:

“The forecast rise in disease over the next 20 years is largely caused by preventable diseases, including diabetes, cardiovascular disease, cancer and dementia. Many of these conditions are partly or wholly caused by modifiable risk factors such as alcohol, tobacco and drug use; physical inactivity; poor diet and the cumulative impact of poor mental health.”  Refers to Scotland’s National Dementia Strategy in building upon existing action section, and also on p32 within foster a health and social care system that delivers equity, prevention and early intervention section.

The Plan aligns to the dementia actions detailed in SAS 2030 Strategy specifically on developing staff dementia education and training packages, supporting local delivery of dementia care through building staff networks and promoting more collaborative multi-agency working.

Sensory loss. Hearing, visual, olfactory, taste, sensations impairment can be a feature of dementia and also be a co-existing condition. Amongst the general population living with dementia and their care partners - communication and accessibility for people with sensory impairment needs to be considered.

Approximately two-thirds of people live in own homes and one-third live in care homes.

Charter of Rights for People with Dementia and Their Carers 2010 – advocates human rights-based principles for people living with dementia and their rights as citizens.

The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Guidelines are national clinical guidelines for UK Paramedics and used daily by SAS staff as reference to make informed, evidence-based, clinical decisions through access to national and local guidance and referral/treatment pathways.  Reference to dementia cuts across many areas of the guidelines, including the mental health presentations guidance section which covers legislation in relation to detention, consent, Adult Support and Protection and (Adults with Incapacity (Scotland) Act 2000 in Scotland). It has specific sections on dementia, and equality in mental health with specific reference to the Equalities Act 2010.  These guidelines are regularly updated by multidisciplinary expert groups from across the UK.

People in prisons can also be living with dementia as highlighted in this small qualitative study MacRae, R et al (April 2025) The care experience of people with diagnosed or suspected dementia living in prison: A case study approach. Sage Publications .

See above

See above