Dilemmas of early dementia screening among community-dwelling older adults: a qualitative study from the perspective of social determinants of health
Abstract
Background Dementia is one of the most urgent public health challenges globally. Early screening is indispensable for timely identification and intervention. However, early dementia screening among community-dwelling older adults remains low, and the mechanisms underlying screening barriers remain insufficiently understood. Methods A qualitative study involving semi-structured interviews was conducted with 23 older adults who were purposively recruited from three communities in Wuhan, China. Interviews were transcribed verbatim and analyzed using thematic analysis that combined deductive coding guided by the social determinants of health framework with inductive coding to capture themes emerging from the data. Results Five themes and 12 subthemes were identified: (1) economic stability, comprising economic burden concerns and the lack of material incentives; (2) education access and quality, comprising limited disease-related knowledge, the double effect of educational level, and fixed beliefs about dementia risk; (3) social and community context, comprising perceived stigma, result-related anxiety and family concerns, and late-life values; (4) health care access and quality, comprising insufficient medical trust and service assurance, limited information accessibility, and symptom-oriented healthcare-seeking behavior; and (5) neighborhood and built environment, comprising limitations in convenience and accessibility. Conclusion Low uptake of early dementia screening among community-dwelling older adults in China reflects a system-level behavioral dilemma shaped by social determinants of health. Future screening programs should build integrated, community-embedded pathways that make screening affordable, understandable, trustworthy, connected, and convenient, thereby strengthening the acceptability, equity, and sustainability of dementia prevention and early detection.