Navigating the Continuum: System-Level Requirements for High-Quality Dementia Care Transitions

The worldwide rise in dementia cases is creating significant pressures on healthcare systems, clinicians, and decision-makers. As dementia does not follow a single predictable pathway, individuals commonly move across different care settings as their needs evolve, requiring coordinated and integrated responses across the healthcare system rather than isolated efforts within single services. This perspective study explores service quality and underlying structural challenges throughout the dementia care pathway with a particular concentration on transitions between various stages. Key barriers to successful implementation include fragmented service delivery, short-term funding structures, weak coordination across care settings, staffing constraints, and challenges in staff retention. These challenges undermine care standards and result in avoidable emergency department and acute care utilization that contribute to increasing health systems expenditures. Strengthening integrated, person-centered, and transition-oriented care frameworks is critical to enhance outcomes and support sustainable health system responses to an increasing global impact of dementia.