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The End of Life With Dementia in Asian Countries: Barriers, Facilitators and a Research Agenda for Advancing a Palliative Approach
Chetna Malhotra, Ellie Bostwick Andres, Chandrika Ramakrishnan. Journal of the American Geriatrics Society, 2026-01-13
Topic: Risk, prevention and care in population studies
Broad barriers identified in the outer setting of the implementation framework include sociocultural values and a lack of supportive policies, guidelines, and financing. Within the inner setting of the healthcare system, challenges stem from underdeveloped long-term care infrastructure, limited professional training, and gaps in equity and person-centeredness. At the individual level, barriers include low dementia literacy and limited uptake of advance care planning. Potential facilitators were growing digital fluency and established community norms around caring for older adults at home. Based on our review, we propose a research agenda prioritizing partnering with individuals with dementia and their caregivers, especially in low- and middle-income countries, de-implementing low-value interventions and implementing community-level palliative care models, leveraging technological innovations, and developing core evaluation metrics to advance WHO's action plan and foster culturally relevant and effective interventions tailored to the region's unique needs.
Key findings
- Broad barriers identified in the outer setting of the implementation framework include sociocultural values and a lack of supportive policies, guidelines, and financing.
- Within the inner setting of the healthcare system, challenges stem from underdeveloped long-term care infrastructure, limited professional training, and gaps in equity and person-centeredness.
- At the individual level, barriers include low dementia literacy and limited uptake of advance care planning.
- Potential facilitators were growing digital fluency and established community norms around caring for older adults at home.
- Based on our review, we propose a research agenda prioritizing partnering with individuals with dementia and their caregivers, especially in low- and middle-income countries, de-implementing low-value interventions and implementing community-level palliative care models, leveraging technological innovations, and developing core evaluation metrics to advance WHO's action plan and foster culturally relevant and effective interventions tailored to the region's unique needs.
Why it matters
This review identifies barriers to end-of-life care with dementia in Asian countries, including low dementia literacy and limited uptake of advance care planning, alongside facilitators such as community norms around caring for older adults at home. It proposes a research agenda prioritizing partnership with individuals with dementia and their caregivers.
Study details
- Evidence strengthLow
How this study scored 40/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 4 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 5 / 6 | Cited 25.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 1 / 4 | Cited 4 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Chandrika Ramakrishnan: h-index 10 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | Duke-NUS Medical School: institution h-index 612 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41531188) |
| Free to read | 2 / 2 | Free to read |
| Total | 40 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1111/jgs.70283
- PubMed: 41531188
- Original source →
- Free full text: Journal of the American Geriatrics Society →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Malhotra, C., Andres, E. B., & Ramakrishnan, C. (2026). The End of Life With Dementia in Asian Countries: Barriers, Facilitators and a Research Agenda for Advancing a Palliative Approach. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.70283
Vancouver
Malhotra C, Andres EB, Ramakrishnan C. The End of Life With Dementia in Asian Countries: Barriers, Facilitators and a Research Agenda for Advancing a Palliative Approach. Journal of the American Geriatrics Society. 2026. doi:10.1111/jgs.70283. PMID: 41531188.
BibTeX
@article{malhotra2026-41531188,
author = {Malhotra, Chetna and Andres, Ellie Bostwick and Ramakrishnan, Chandrika},
title = {{The End of Life With Dementia in Asian Countries: Barriers, Facilitators and a Research Agenda for Advancing a Palliative Approach}},
journal = {Journal of the American Geriatrics Society},
year = {2026},
doi = {10.1111/jgs.70283},
pmid = {41531188},
url = {https://doi.org/10.1111/jgs.70283}
}
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