This systematic review assesses the evidence on the pathways people with dementia take into and through the health and aged care system, and the implications of these transitions for the quality of life of people with dementia and their families and carers.

Predictors of care transition: There are three consistent predictors of entry to nursing home care: dementia severity and cognitive decline, behavioural and psychological symptoms of dementia (BPSD) and caregivers’ health and burden. However, there is a lack of research into the predictors of community care use and transitions to and from these services.

Description of care pathways: The majority of the reviewed research into care pathways has focused on the admission to long-term residential care. These studies have found that people with dementia are more likely than those without dementia to move into full-time residential care. Further research is required into the common care pathways in Australia – particularly the use of hospitals, community care and early intervention programs, and the role of diagnosis in those care pathways.

Intervention to modify care pathways: The reviewed material suggests that early intervention that targets both the person with dementia and their caregivers is successful at reducing the likelihood of nursing home placement, delaying and even preventing placement. However, once the dementia progresses to a severe stage, the benefit of intervention diminishes. Therefore, it is important that diagnosis and intervention occur early in the course of the condition.

Care pathways of special population groups: The care pathways and transitions experienced by people from special population groups such as Aboriginal and Torres Strait Islander people and people born overseas have been poorly researched and are a key gap in the current understanding.