Use of multiple post-diagnostic dementia services across healthcare tiers in Beijing, China: A caregiver-reported cross-sectional study.

Abstract

BackgroundPost-diagnostic dementia care, including for Alzheimer's disease, is multi-component and requires coordinated access to cognitive assessment, medication management, consultation for behavioral and psychological symptoms of dementia (BPSD), and non-pharmacological interventions. Evidence on service use and tiered distribution in China remains limited.ObjectiveTo characterize the use, tiered distribution, and reasons for non-use of four post-diagnostic dementia services in Beijing, China, and to explore caregiver-related correlates of service use.MethodsFrom July to October 2025, 202 family caregivers were recruited by convenience sampling from three tertiary hospitals and six community health service centers across four Beijing districts. A structured questionnaire was administered through interviews. Four exploratory Firth penalized likelihood logistic regression models were fitted, with Benjamini-Hochberg correction as a supplementary assessment of multiplicity.ResultsService use varied substantially: cognitive assessment 95.5%, medication management 83.7%, BPSD consultation 61.8% (n = 131), and non-pharmacological interventions 25.7%. Only 16.8% of caregivers reporting BPSD accessed all four services. Tiered distribution was heterogeneous: non-pharmacological interventions concentrated in hospitals; medication management more often involved primary care. Higher income was associated with non-pharmacological intervention use, and regular clinic attendance with BPSD consultation. "Unaware" was the leading reason for non-use of BPSD consultation, cognitive stimulation, and cognitive training, whereas "no perceived need" predominated for ADL rehabilitation.ConclusionsPost-diagnostic dementia service use in Beijing was uneven across service types and healthcare tiers. The exploratory associations suggest that informational and economic factors may be relevant to access to underused services within China's tiered healthcare system.