Rural and remote experiences of living with dementia as well as service delivery and accessibility are often neglected in dementia care research and policy in Canada and internationally. This is in spite of the fact that the population in rural areas is growing older at a faster rate than the population in many urban areas because of a combination of demographic, socio-economic, and political factors. The diverse challenges and experiences of rural aging are well documented (Keating, Swindle, & Fletcher, Reference Keating, Swindle and Fletcher2011), but less is known about rural and remote dementia care. This book is the first edited collection to focus on rural and remote dementia care. Even more importantly, it does so with attention to the diversity of, and within, rural places. This book offers an international perspective on current research, policy, and practice from Canada, Australia, the United Kingdom, Ireland, and Austria. In doing so, the authors acknowledge the challenges and inequities associated with rural dementia care while also disrupting deficit discourses with innovative examples of rural practices that are attentive to the people and places they serve.
After a brief introduction and outline of the book in Chapter one, Part I sets the scene for rural dementia care with a particular focus on policy drivers across different settings. Chapter 2 focuses on issues experienced by people living with dementia, carers, and service providers in low- and middle-income countries, which are often neglected in dementia care research. The authors highlight the role of supra-national policy organizations and advocacy in advancing dementia policy globally. They also outline common characteristics of rural places that cut across policy contexts, such as distance, rural dynamics of stigma, need for training and resources, issues of poverty and low income, challenges of digital literacy and connectivity, and the need for culturally sensitive care. The subsequent two chapters focus on global north countries, Australia and Norway, and provide examples of initiatives to improve accessibility to support services for rural and remote people living with dementia. The authors emphasize the importance of local initiatives that involve rural people, with an understanding of the importance of the culture of places in program navigation and support. Both Chapters 3 and 4 briefly touch on the need to develop initiatives with Indigenous peoples in rural and remote places to improve dementia care for all. Chapter 4 also provides a longer-term perspective on policy drivers in Norway—an early leader in the development of national dementia planning—recognizing the challenges of sustaining dementia care developments in rural places.
Part II focuses on research evidence from Canada, Austria, and Ireland in relation to diagnosis, continuing care, and social exclusion. Chapters 5 and 6 offer examples of different models of care that address challenges of distance and stigma with low-burden solutions for people living with dementia and carers, including collaborative care models, remote interventions, and local-level capacity-building initiatives. Both chapters underscore the importance of having some type of “one-stop shop” (p. 107) for diagnosis and diverse dementia-specific supports over the course of the condition. Chapter 7 addresses life beyond service provision with attention to social exclusion and the goal of supporting full societal participation of people living with dementia.
Chapters 8–11 offer readers examples of novel practices that recognize the importance of identity, continued engagement, mobility, and growth in dementia care. Chapter 8 focuses on rural-dwelling older men with dementia, recognizing the neglected dimension of gender (Bartlett, Gjernes, Lotherington, & Obstefelder, Reference Bartlett, Gjernes, Lotherington and Obstefelder2018) in community-based programing with people living with dementia. The other important contribution of this critical chapter is the way that it challenges assumptions about the abilities of older men living with dementia through the introduction of diverse technologies in community programs. Chapter 9 provides an inspiring alternative to more conventional day programs through its exploration of farm-based care in Scotland. Importantly, this chapter also speaks to wide range of community actors and workforces that can be engaged to support meaningful relationships, skill development, and the contributions of people living with dementia. Chapter 10 outlines the risks of driving as well as the risks associated with losing a license for people living with dementia, emphasizing the need for accessible transportation alternatives for people living in rural places. The final chapter in this section outlines considerations in the provision of equitable and culturally safe dementia care for Indigenous peoples. Overall, this section challenges care practices that reinforce gender neutrality, ableism, and colonialism in rural places.
The most important voices in this book are the authors of Chapters 12 and 13. In these contributions, Helen and Nancy write about their experiences living with dementia in Ireland and Scotland. Helen observes, “It seems strange that we think it is acceptable to gather together all the people with dementia and put us in a village when we want to be fully integrated into our community. I do not believe that would be considered for a group of people with any other chronic illness” (p. 274). The voices, questions, and disability rights that infuse these chapters must guide future rural dementia care research, policy, and practice.
Missing from this book are the perspectives of informal carers. Their voices would add to the complex understanding of care in rural places (Herron & Rosenberg, Reference Herron and Rosenberg2019). Still, the authors should be commended for their rich view and presentation of rural and remote dementia care. Their focus on humanistic supports, cultural safety, community, technology, and policy sets the agenda for future work in this field.
