Dementia Diagnosis in Postapartheid South Africa: Providers’ Perspectives in Ethnographic Context

29/05/2026

AI Summary

Racial disparities limit formal dementia diagnosis and access to care in peri-urban Mpumalanga, reinforcing unequal structural barriers.
Providers report aggression, forgetfulness, and wandering as primary observed symptoms used to label dementia, shaping referral and management practices.
The concept of diagnostic apartheid is expanded: dementia sense-making is partial, racialising, and tied to historical violence and non-integration of neuropsychiatric models.

AI Summary

This article situates perspectives of South African social service and health care providers on older adults who live with dementia and Alzheimer's disease in ethnographic context.

A review of findings from multi-year field research on long-term care and service provision for older adults in peri-urban Mpumalanga shows: racial disparities in accessing formal dementia diagnoses; aggression, forgetfulness, and wandering as the most reported symptoms of presumed dementia; and provider-reported ethno-racial differences in families' diagnostic- and care-seeking practices.

Hansen's concept of diagnostic apartheid is expanded to explain how making sense of dementia is a sometimes partial, unequal, and racializing process; how older adulthood is reproduced as a structurally vulnerable position; and how historical consciousness of violence informs understandings and non-integration of neuropsychiatric and other models of dementia.

Basic summary

Cult Med Psychiatry. 2026 May 29;50(2):36. doi: 10.1007/s11013-026-09994-z.

ABSTRACT

This article situates perspectives of South African social service and health care providers on older adults who live with dementia and Alzheimer’s disease in ethnographic context. A review of findings from multi-year field research on long-term care and service provision for older adults in peri-urban Mpumalanga shows: racial disparities in accessing formal dementia diagnoses; aggression, forgetfulness, and wandering as the most reported symptoms of presumed dementia; and provider-reported ethno-racial differences in families’ diagnostic- and care-seeking practices. Findings corroborate evaluative research showing structural barriers to diagnosis and care. Hansen’s concept of diagnostic apartheid is expanded to explain how making sense of dementia is a sometimes partial, unequal, and racializing process; how older adulthood is reproduced as a structurally vulnerable position; and how historical consciousness of violence informs understandings and non-integration of neuropsychiatric and other models of dementia.

PMID:42213235 | DOI:10.1007/s11013-026-09994-z

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