Dementia care in the United Arab Emirates: An environmental scan of services, policy, workforce, and caregiving contexts

doi:10.21203/rs.3.rs-8468740/v1

Dementia care in the United Arab Emirates: An environmental scan of services, policy, workforce, and caregiving contexts

2026 · doi:10.21203/rs.3.rs-8468740/v1

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Abstract Background: Dementia care in the United Arab Emirates remains poorly documented despite the country's advanced healthcare infrastructure and rapidly ageing population. The absence of a national dementia strategy, combined with limited local research, leaves policymakers and practitioners without baseline evidence to guide service development. Cultural expectations position families as primary caregivers, yet how families navigate this responsibility has not been systematically documented. This study produced the first comprehensive environmental scan of dementia care in the UAE, mapping services, policies, workforce preparation, and caregiving contexts. Methods: A two-component environmental scan was conducted. Grey literature sources were systematically identified and analysed, including government policies, health authority documents, service descriptions, and materials from non-governmental organisations; sixty-one sources published between 2017 and 2025 were included. Semi-structured interviews were conducted with twelve healthcare professionals working in dementia care settings. Both components of the data were analysed using a qualitative descriptive approach, with patterns identified inductively and integrated across sources. Results: Several patterns converged across both components: the absence of dementia-specific policy frameworks, fragmented and uncoordinated services, gaps in workforce training, and the centrality of families in caregiving amid limited formal support. National policies addressed older adult wellbeing without naming dementia, and services operated without clear care pathways. Interviews revealed delayed diagnoses attributed to the perception of cognitive decline as a normal part of ageing, reliance on pharmacological management, and the absence of community-based respite services. Families increasingly relied on domestic helpers and private homecare providers, taking supervisory roles rather than delivering care directly. Professionals were unfamiliar with person-centred care as a concept and lacked formal training in dementia-specific care approaches. Conclusions: Dementia care in the UAE is characterised by strong health infrastructure but fragmented dementia-specific services, limited workforce preparation, and heavy reliance on families and private care service providers. The absence of a national dementia strategy represents a critical gap. These findings provide baseline evidence to inform policy development, workforce training, and culturally informed service design that acknowledges the realities of family caregiving.

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Dementia care in the United Arab Emirates: An environmental scan of services, policy, workforce, and caregiving contexts | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dementia care in the United Arab Emirates: An environmental scan of services, policy, workforce, and caregiving contexts Seada A. Kassie, Arlene J. Astell This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8468740/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: Dementia care in the United Arab Emirates remains poorly documented despite the country's advanced healthcare infrastructure and rapidly ageing population. The absence of a national dementia strategy, combined with limited local research, leaves policymakers and practitioners without baseline evidence to guide service development. Cultural expectations position families as primary caregivers, yet how families navigate this responsibility has not been systematically documented. This study produced the first comprehensive environmental scan of dementia care in the UAE, mapping services, policies, workforce preparation, and caregiving contexts. Methods: A two-component environmental scan was conducted. Grey literature sources were systematically identified and analysed, including government policies, health authority documents, service descriptions, and materials from non-governmental organisations; sixty-one sources published between 2017 and 2025 were included. Semi-structured interviews were conducted with twelve healthcare professionals working in dementia care settings. Both components of the data were analysed using a qualitative descriptive approach, with patterns identified inductively and integrated across sources. Results: Several patterns converged across both components: the absence of dementia-specific policy frameworks, fragmented and uncoordinated services, gaps in workforce training, and the centrality of families in caregiving amid limited formal support. National policies addressed older adult wellbeing without naming dementia, and services operated without clear care pathways. Interviews revealed delayed diagnoses attributed to the perception of cognitive decline as a normal part of ageing, reliance on pharmacological management, and the absence of community-based respite services. Families increasingly relied on domestic helpers and private homecare providers, taking supervisory roles rather than delivering care directly. Professionals were unfamiliar with person-centred care as a concept and lacked formal training in dementia-specific care approaches. Conclusions: Dementia care in the UAE is characterised by strong health infrastructure but fragmented dementia-specific services, limited workforce preparation, and heavy reliance on families and private care service providers. The absence of a national dementia strategy represents a critical gap. These findings provide baseline evidence to inform policy development, workforce training, and culturally informed service design that acknowledges the realities of family caregiving. Dementia care environmental scan United Arab Emirates health policy and services qualitative description analysis workforce preparation family caregiving national dementia strategy 1. Introduction The United Arab Emirates (UAE) presents a distinctive context for dementia care research and policy development. As a high-income state in the Gulf Cooperation Council (GCC) where expatriates constitute approximately 88% of residents (Sibai et al., 2017; Thirlwall et al., 2021), the country combines rapid demographic transition with policy ambitions around healthy ageing, wellbeing, and quality of life for older citizens (UAE Government Portal, 2025). Yet dementia remains largely absent from national strategies and planning frameworks, addressed only implicitly within broader agendas for care for older people (Mowafi et al., 2025; Qassem et al., 2023). Family-led care remains the normative model, grounded in cultural and religious values that position filial responsibility as a moral duty (Kane et al., 2021; Hammad et al., 2024). At the same time, increasing reliance on domestic workers and private home-care agencies reflects the practical pressures facing families navigating dementia care without adequate institutional support (Hussein & Ismail, 2017). The healthcare system itself is stratified by citizenship, with nationals entitled to comprehensive government-funded services while expatriates depend primarily on employer-sponsored insurance or private provision (Koornneef et al., 2017; Lowe et al., 2024). This dual structure shapes access to diagnosis, treatment, and long-term care in ways that remain underexplored in the dementia care literature. Existing reviews have highlighted the scarcity of research on dementia in the region, with available studies predominantly focused on prevalence, caregiver burden, and risk factors, while comparatively little attention has been given to service delivery, workforce preparation, or system-level planning (El-Metwally et al., 2019; Kane et al., 2021; Mowafi et al., 2025; Qassem et al., 2023). This gap is particularly pronounced in the Gulf region, where health systems are evolving rapidly but dementia-specific infrastructure and training pathways remain nascent. Environmental scanning offers a systematic approach to mapping a domain across multiple evidence sources to identify current resources, emerging trends, and critical gaps (Rowel et al., 2005; Wilburn et al., 2016). This approach aligns with calls for context-specific evidence to inform dementia care policy and practice in the Gulf region (Dhillon & Fazal, 2025; Javaid et al., 2021). The present study applies this methodology to examine the dementia care landscape in the UAE through analysis of UAE-specific grey literature sources and interviews with healthcare professionals directly involved in dementia care delivery. The aim of this study was to conduct an environmental scan of dementia care in the UAE, mapping services, practices, and barriers and challenges to providing optimal dementia care. The study addressed the following questions: What dementia care services and initiatives exist in the UAE, and how are these framed in policy and public discourse? What are the experiences and perspectives of healthcare professionals providing dementia care? And what gaps and challenges characterise the current landscape? By integrating documentary and experiential sources, the study generates country-specific baseline evidence to inform policy development, workforce training, and future research, while offering insights of relevance to other Gulf states facing similar demographic and cultural dynamics. 2. Methods Study Design This study was designed as a comprehensive environmental scan to examine the dementia care landscape in the UAE. Environmental scanning is a systematic approach to mapping a domain by synthesising diverse sources of evidence to identify existing resources, emerging trends, and critical gaps (Rowel et al., 2005; Wilburn et al., 2016). This approach is particularly suited to applied health services research in contexts where formal evidence is sparse or fragmented, and where policy-relevant insights must be drawn from both published and unpublished sources (Shahid & Turin, 2018). The environmental scan comprised two components: Grey literature analysis of non-indexed but locally relevant sources on dementia care services and practices in the UAE Interviews with healthcare professionals directly involved in dementia care in the UAE These two components serve complementary purposes. The grey literature analysis captures the formal landscape of services, policies, and initiatives as documented by government and non-government entities, while the interviews provide experiential perspectives from practitioners navigating that landscape in everyday practice. Together, they offer a comprehensive account of dementia care in the UAE that neither source could provide alone. The study was granted ethics approval by the Dubai Scientific Research Ethics Committee (DSREC) of the Dubai Health Authority (Initial approval letter reference: DSREC-SR-03/2023_06; Annual renewal approval letter reference: DSREC-SR-05/24_08; Reference of approval letter for adding a new study site: DSREC-SR-07/24_01) and the University of Reading Research Ethics Committee (UREC) at the University of Reading, United Kingdom (Ethics approval letter reference: UREC 23/07). Preparatory work for the environmental scan included structuring the extraction templates, refining the search strategy, and arranging the interviews. The interviews with healthcare professionals were conducted between June 2023 and February 2024. The grey literature search was conducted between July and August 2025, with final synthesis and reporting completed between August and September 2025. Grey Literature Analysis A structured grey literature search was conducted to capture non-indexed but locally critical information on dementia care services and practices in the UAE. Grey literature, including government reports, policy documents, organisational websites, and service descriptions offers essential insights in contexts where peer-reviewed research is limited and where local knowledge is held by institutions rather than documented in academic publications (Adams et al., 2017; Paez, 2017; Pedersen et al., 2023). Sources included government portals, local health authority websites, private care service and training providers, and Non-Governmental Organizations (NGOs) active in dementia care policies, community initiatives, and service delivery. Search Scope and Strategy The search targeted UAE entities including the UAE Government Portal (n.d.), Ministry of Health and Prevention (MOHAP; 2024), Dubai Health Authority (DHA; 2016), Department of Health Abu Dhabi (DoH; n.d.), Emirates Health Services (EHS; 2023; 2024), Sharjah Social Services Department (n.d.), the Al Qasimi Foundation (n.d.), and local non-governmental organisations (e.g., 4get-me-not, n.d.). Manual browsing, Google searches, and snowballing were employed to ensure comprehensive coverage of relevant sources. Data Extraction and Synthesis Information from each included grey literature source was extracted into a structured spreadsheet (see supplementary table), recording source category, source name, focus area, publication date, type of service/initiative, specific dementia services, target population, key features/description, cultural/religious/family considerations, and dementia care service gaps. The extraction process captured both descriptive details and interpretive elements, such as information on how dementia is framed in policy and public discourse. The extracted data were synthesised using a qualitative descriptive approach (Sandelowski, 2000; 2010; Kim et al., 2017), with patterns, contrasts, and omissions identified inductively across sources. Recurring threads included policy visibility, service fragmentation, family centrality, and limited dementia-specific training for formal and informal caregivers. Given the heterogeneous nature of grey literature, the synthesis was exploratory and aimed at mapping breadth rather than judging quality, while acknowledging challenges in consistency of reporting and continuity of services and initiatives (Adams et al., 2017; Paez, 2017). Interviews with Healthcare Professionals Semi-structured individual and focus group interviews (See Supplementary File for interview transcripts) were conducted with healthcare professionals involved in dementia care delivery in the UAE, providing experiential insights into the realities of care practice, including systemic barriers. Sampling and Recruitment Using purposive sampling, four specialist and consultant geriatricians were recruited for the individual interviews, as well as two gender-specific focus groups consisting of nurses and assistant nurses, in line with cultural norms. Their demographic and professional characteristics are displayed in Table 1. Data Collection Conducted between September 2023 and April 2024, the individual interviews were held in person or online (Microsoft Teams) depending on the availability of the participants, whereas both focus group interviews were conducted in person. All interviews were led by the first author, audio-recorded with consent, and transcribed verbatim. Data Analysis The interview data were analysed using a qualitative descriptive approach (Sandelowski, 2000; 2010), which prioritises comprehensive summary and low-inference interpretation over deep thematic abstraction. This approach is well-suited to applied health services research where the aim is to describe phenomena as experienced by participants and to identify patterns relevant to practice and policy (Kim et al., 2017; Neergaard et al., 2009). The analysis proceeded iteratively, where the transcripts were read multiple times, and initial codes were generated inductively from the data using Quirkos (version 2.5.3). Codes were grouped into descriptive categories reflecting recurring topics across participants, including service fragmentation, workforce constraints, family expectations, and training gaps. Attention was paid to both consistencies and tensions within the data, and findings are presented as narrative summaries that synthesise perspectives across participants rather than foregrounding individual voices. Illustrative quotations are used selectively to anchor key points. Integration Across Datasets Across the grey literature analysis and the interview data, synthesis followed the same principles: systematic extraction, inductive categorisation, and descriptive pattern identification. This allowed findings from policy documents, service descriptions, and practitioner perspectives to be examined together while preserving the distinctiveness of each source type. The integration was iterative, moving between datasets to identify convergences, divergences, and gaps. The process was exploratory and descriptive (Sandelowski, 2000; 2010; Kim et al., 2017), aimed at mapping the current dementia care landscape in the UAE. 3. Results The results from the environmental scan are presented across the two components of the study. First, analysis of grey literature focusing on UAE-specific policies, services, initiatives, and emerging practices is presented. All sources were reviewed and coded as part of the iterative analysis; only representative examples are cited to illustrate each pattern, but the synthesis draws on the full dataset. Some sources that duplicated information or provided only tangential detail are not cited individually in order to avoid redundancy, though their content contributed to the patterns reported. Second, the interviews with healthcare professionals offer experiential insights into diagnosis and delivering every day care, training and education, and barriers and challenges. Each component was analysed using a qualitative descriptive approach (Sandelowski, 2000; 2010; Kim et al., 2017), with descriptive categories generated inductively from the data and refined through repeated engagement. The purpose was not to produce rigidly separate categories, but to identify recurring patterns that illustrate how dementia care is positioned across policy and practice discourse and lived professional experience. Together, these components capture both the formal landscape of dementia care in the UAE - as documented by government and non-government entities - and the realities of practice as experienced by those delivering care. Grey Literature Analysis A total of 61 sources were extracted and reviewed, spanning government policies and strategies, public and private healthcare service providers, news releases, academic contributions, training services, and community initiatives. Table 1 provides a condensed summary of findings from the 61 grey literature sources organised by key area. Detailed descriptions of individual sources are provided in the supplementary table. Sources were read iteratively, with initial codes generated inductively. Codes were then grouped into descriptive categories reflecting recurring patterns across sources. The narrative that follows presents findings organised around seven cross-cutting patterns identified through this process. Table 1. Summary of grey literature findings on dementia care in the UAE, organised by key area Key Area Main Findings Gaps/Challenges National Healthcare Policies, Strategies, and Plans Policies emphasize dignity, wellbeing, and inclusion of older citizens but rarely mention dementia explicitly Lack of dementia-specific provisions and limited operational detail Services and Initiatives Wide range of benefits and support for older citizens described; dementia services often not explicitly addressed Fragmented services; lack of coordination and documented dementia care pathways Cultural, Religious, and Family Considerations Strong emphasis on family responsibility and cultural values supporting home-based care Cultural expectations may limit uptake of formal or institutional services Non-Governmental and Sector-Specific Initiatives Community programs, academic engagement, and awareness campaigns contribute in fragmented ways Small scale, limited evaluation, and lack of sustainability and continuity Private Home-Based Healthcare Providers Use of private home-based care services is growing; providers are licensed but remain variable in quality and not dementia-specific Lack of dementia-focused training, non-standardized practices, and limited insurance coverage for services Dementia Absent from Explicit Policy Recognition Across multiple federal portals and government sources, the UAE has established a comprehensive policy framework addressing older citizens, but dementia is not named as a distinct priority. The National Policy for Senior Emiratis emphasises dignity, protection, inclusion, and improved quality of life through physical, psychological, and social supports (The National, 2017; UAE Government Portal, 2025; n.d.; UAE Legislation Portal, 2025). The National Strategy for Wellbeing 2031 aims to improve quality of life through healthcare, environment, and social cohesion, but contains no specific mention of dementia or dementia-related indicators (UAE Government Portal, n.d.). Strategic health plans, including UAE Vision 2021 and subsequent national agendas position care of older citizens within broader frameworks of universal healthcare access, but dementia care is not addressed as a specific service area (UAE Federal Government Portal, 2025). Health authority announcements describe alignment with WHO's healthy ageing framework, emphasising early detection, health promotion, and intersectoral coordination, but dementia remains embedded implicitly within these broader agendas (Ministry of Health and Prevention, 2024; The National, 2024). Although these policies set positive aspirations for older adult wellbeing, they do not establish dementia as a health priority requiring dedicated resources, services, or planning. Across the policy sources reviewed, dementia-specific provisions, implementation mechanisms, and operational guidance were consistently absent. Family Positioned as the Default Caregiving Unit A consistent pattern across government policies, academic sources, and media reporting is the positioning of the family as the primary unit of dementia care. National documents affirm family responsibility in caregiving and uphold values of dignity, protection, and intergenerational cohesion (UAE Government Portal, 2025; UAE Legislation Portal, 2025; Department of Community Development Abu Dhabi, n.d.). Academic commentaries identify the family as the default caregiving unit, noting the limited availability of institutional alternatives (Oxford Institute of Population Ageing, 2023; Tse et al., 2019). Media narratives reinforce this expectation, portraying family caregiving as a cultural duty rooted in Islamic values and Emirati traditions, while also acknowledging the strain and stigma it imposes (Arabian Business, 2022; ARN News, 2023; Gulf News, 2023; Khaleej Times, 2023a; 2023b; Middle East Health, 2024; UAE Stories, 2024). Hospital and clinic sources similarly describe family involvement as central to the care process (Cleveland Clinic Abu Dhabi, n.d.; Northwest Clinic, n.d.). Religious and cultural norms are woven into wellbeing strategies, with initiatives promoting community engagement and family-centred approaches. While this cultural framing is presented as a strength, reflecting values of respect, cohesion, and filial duty, it simultaneously exposes systemic vulnerabilities. When families are positioned as the default caregivers without access to training, respite, or coordinated support, the caregiving burden falls disproportionately on informal networks. Several sources noted caregiver stress, emotional toll, and the unsustainability of family-based systems without formal support structures (Cleveland Clinic Abu Dhabi, n.d.; Gulf News, 2023; Arabian Business, 2022). Services Fragmented Across Public and Private Sectors Healthcare services for dementia exist across government hospitals, private clinics, and home-care agencies, but they operate without systematic coordination or documented care pathways. Government announcements describe a range of services and entitlements for older citizens, including health insurance coverage, housing support, and transport concessions (UAE Government Portal, 2025; Department of Community Development Abu Dhabi, n.d.). Health authorities have announced new memory clinics and frameworks for healthy ageing (Abu Dhabi Media Office, 2019; Ministry of Health and Prevention, 2025; Rashid Hospital, n.d.), and media reporting has highlighted specialised facilities for older citizens (Emirates Health Services, 2024). Private hospitals offer diagnostic services, neuropsychological assessments, and treatment plans for dementia and Alzheimer's disease (American Center for Psychiatry and Neurology, n.d.; Brain Hub UAE, n.d.; Brainnovation, n.d.; Burjeel Hospital, n.d.; Canadian Medical Center, n.d.; Cleveland Clinic Abu Dhabi, n.d.; Dubai Royal Hospital Clinic, n.d.; Emirates Hospitals, n.d.; Fakeeh University Hospital. n.d.; German Neuroscience Center, n.d.; King's College Hospital Dubai, n.d.; Mediclinic City Hospital, n.d.; Novomed, n.d.;). While these providers describe multidisciplinary teams, early detection, and personalised care, descriptions of their services rarely mentioned coordination with community or home-based care, caregiver training, or integration with national planning. Sources consistently noted the absence of care pathways connecting diagnosis to long-term support. The Salama bint Hamdan Al Nahyan Foundation's 2014 review explicitly highlighted fragmented care, lack of coordination across services, limited public awareness, and workforce gaps. Academic sources similarly noted fragmentation and the absence of an integrated dementia care system (Oxford Institute of Population Ageing, 2023; Salama bint Hamdan Al Nahyan Foundation, 2014; n.d.; Tse et al., 2019). The pattern across these sources is one of pockets of provision without continuity, where services are available but appear to be disconnected. Private Sector Expanding Without National Integration A notable trend is the growth of privately owned and licensed home-based healthcare providers. Locally known as care agencies, these are licensed companies that families contract on a long-term basis to deliver in-home care, particularly when institutional options are limited or culturally less acceptable. As of 2020, more than 80 such agencies were licensed nationally, with approximately 50 actively operating (HealthHQ, 2020). Enayati Home Healthcare (2024) described efforts to fill gaps in dementia care for expatriate families, noting that expatriates often lack extended family networks and are dependent on private services. Private training providers have also emerged, offering caregiver certification courses that cover care for older people and dementia care basics, including daily living support, safety, mobility, hygiene, and nutrition (NLP Tech Training Centre, n.d.; Samson Training Center, n.d.; UAE Montessori, n.d.). These training opportunities respond to demand for structured caregiver education, but review of their publicly available materials revealed no evidence of standardisation across providers, cultural tailoring, or formal integration into national training pathways. The expansion of private provision demonstrates market responsiveness to an unmet need, but it also reflects the absence of public infrastructure. Private care service providers are not formally integrated into national planning, and their services remain variable in quality and scope. Home-based dementia care services may not be covered under standard UAE insurance plans, which typically exclude dementia alongside certain psychiatric conditions (Burjeel Hospital, 2023; HealthHQ, 2020). Community and Academic Initiatives Episodic and Small-Scale Beyond national policies and formal public and private healthcare services, several sources documented contributions from community organisations, academic institutions, and awareness campaigns. These initiatives demonstrate emerging recognition of dementia as a public health concern, but they are characterised by limited scale, sustainability, and follow-up. Awareness campaigns and community programs have highlighted the projected rise in dementia prevalence and the importance of early detection (Arabian Business, 2022; Khalifa University, 2023; LiveHealthy.ae, 2023; PureHealth, 2024). These are often event-driven or tied to specific campaigns, with reach and sustainability inconsistently reported. The 4get-me-not Alzheimer's Organization (n.d.) offers workshops, training, and public campaigns, often during globally observed awareness days or months, but has no documented official recognition or integration into government strategy. A dementia awareness event organised by UAE University in 2017 was held during Ramadan, suggesting cultural sensitivity, but was noted as episodic rather than sustained. Academic contributions included research on culturally adapted diagnostic tools (Khalifa University, 2023), population ageing (Oxford Institute of Population Ageing, 2023), and dementia care practices (Tse et al., 2019). These publications signal growing scholarly engagement but remain fragmented and are not systematically integrated into national dementia care planning and strategies. The Salama bint Hamdan Al Nahyan Foundation (2014; n.d.) was noted as one of the few initiatives integrating awareness, research, clinical training, and home-based care, but detailed documentation of its scope and continuity was limited. Overall, the pattern is one of visibility without sustained impact, and where contributions are valuable but piecemeal. Access Stratified by Citizenship Status Several sources revealed a distinction between services available to Emirati citizens and those accessible to expatriates. Government descriptions of benefits and entitlements consistently specified "Senior Emiratis" as the target population (UAE Government Portal, 2025; Department of Community Development Abu Dhabi, n.d.). Specialised care centres for older citizens, including Al Mamzar Community Centre for Elderly and the Dubai Health Seniors' Happiness Centre, were described as serving older citizens, with unclear or no access for expatriates (Al Mamzar Community Centre for Elderly, n.d.; Dubai Health Authority Media Office, 2020). Given that expatriates constitute the majority of the UAE population, this represents a significant gap in the documented service landscape. Enayati Home Healthcare (2024) explicitly noted limited government support for expatriates, especially for long-term dementia care, and described unclear pathways for expatriates to access affordable and specialised services. Expatriate families were described as dependent on private care agencies to fill gaps that government services do not address. This pattern of citizenship-based stratification means that the dementia care landscape differs substantially depending on residency status. For Emirati citizens, a range of entitlements and dedicated facilities exist, though dementia-specific services remain limited. For expatriates, access depends primarily on private provision, with cost and availability as significant barriers. Workforce Preparation Limited and Unstandardised Training opportunities for providing care for older people exist but are variable, lack standardisation, and are not dementia specific. Private training centres offer caregiver courses covering general care for older people, but review of their publicly available materials revealed no evidence of standardisation across providers, cultural tailoring, or formal integration into national training pathways Across hospital and clinic sources, caregiver training and education were rarely mentioned. Several private providers described services for patients but did not document support for family caregivers or workforce development. The Salama bint Hamdan Al Nahyan Foundation supported dementia-related research and public awareness initiatives, though the Foundation's health programme webpage has not been updated since 2017, and it remains unclear whether these activities are ongoing (Salama bint Hamdan Al Nahyan Foundation, n.d.) Academic and media sources identified workforce gaps as a significant barrier to dementia care development. The absence of dementia-focused training, non-standardised practices across providers, and limited cultural tailoring of training materials were consistently documented. Khalifa University (2023) noted inadequate culturally and linguistically appropriate diagnostic tools, with potential for misdiagnosis or underdiagnosis among Arabic-speaking older adults. This points to a broader gap in preparing the workforce, both formal healthcare professionals and informal caregivers to deliver dementia specific, culturally appropriate care. Summary Collectively, the grey literature depicts a dementia care environment that is evolving but underdeveloped. National strategies embed dementia within broader ageing agendas without establishing it as a distinct health priority. Services exist in pockets through government hospitals, memory clinics, and private providers, but remain fragmented and lack coordination. Cultural and religious values position families as the primary caregivers - a framing that reflects genuine cultural strengths but simultaneously exposes systemic vulnerabilities when families lack support. The private sector is expanding to meet demand but operates independently of national planning. Community and academic initiatives contribute through awareness and research, but their efforts are episodic and unintegrated. Access to services differs by citizenship status, with expatriates largely dependent on private provision. Workforce preparation remains limited and unstandardised. Across all source types, these gaps were consistently noted: the absence of a national dementia strategy, insufficient dementia-specific services, limited workforce preparation, and inadequate support for family caregivers. To explore how these systemic patterns are experienced in practice, the next section presents findings from interviews with healthcare professionals working directly within the dementia care environment in the UAE. Interviews with Healthcare Professionals While the grey literature analysis captures the formal landscape of policies, services, and initiatives, the interviews explored how dementia care is experienced by healthcare professionals working within the public healthcare sector. Table 2 provides an overview of participants' personal and professional characteristics and the original interview transcripts are displayed in the Supplementary File. Transcripts were read iteratively, with initial codes generated inductively from the data. Codes were grouped into descriptive categories reflecting recurring patterns across participants' accounts. The analysis involved comparing across participants' accounts to identify similarities and differences in their experiences and perspectives. Findings are presented as narrative summaries that synthesise perspectives across participants, with illustrative quotations used selectively to anchor key points. Four descriptive categories were identified: (1) local research and prevalence data, (2) diagnostic pathways and management practices, (3) workforce preparation and training, and (4) day-to-day care practices and challenges. Table 2. Demographic characteristics of interview participants Participant ID Gender Professional Role Years of Experience G1 Male Specialist Geriatrics >15 years G2 Male Consultant Geriatrics >27 years G3 Female Consultant Geriatrics >25 years G4 Male Senior Specialist Geriatrics >13 years RN1 Female Registered Nurse >17 years RN2 Female Registered Nurse >20 years RN3 Female Registered Nurse >12 years RN4 Male Registered Nurse >15 years AN1 Female Assistant Nurse >10 years AN2 Male Assistant Nurse >10 years AN3 Male Assistant Nurse >20 years AN4 Male Assistant Nurse >18 years Local Research and Prevalence Data Participants described dementia as substantially more prevalent than official figures suggest. Physicians estimated that between 40 and 75 percent of patients they encountered presented with some form of cognitive impairment, though these figures were based on clinical experience rather than documented data. Cognitive issues were often identified incidentally during assessments for falls or fractures rather than through targeted screening. As one physician observed, "the numbers are quite high… it's just that we don't have enough data and research" to quantify them (G1). The absence of a health registry was consistently noted as a barrier to establishing prevalence: "we cannot find out the exact percentage of Dementia" (G3). The lack of local epidemiological data was attributed to time constraints and absent research infrastructure. Clinical demands left little opportunity for data collection, and research associates or protected scholarly time were not available. Physicians described conducting any research "out of clinical time," which was "exhaustive" and "cumbersome" (G1). There was recognition that local evidence was needed rather than reliance on global figures, but competing demands precluded this: "no time… our academic life was a long time ago" (G2). Gendered patterns in long-term care admissions were also noted. Female patients were described as more likely to remain at home with extended family, even in the absence of immediate children. One physician observed that "women are protected in the community" and that families were reluctant to admit women to institutional care (G3). Diagnostic Pathways and Management Practices Diagnosis was described as typically occurring late in the disease trajectory, often after behavioural or cognitive problems had become unmanageable. Families frequently attributed memory decline to normal ageing and sought medical attention only when symptoms were severe, such as when patients "start to get lost" or exhibited "behavioural struggle" (G2). The availability of domestic support, including drivers and helpers who managed appointments and daily tasks, was identified as a factor that delayed recognition of impairment. One physician explained that when patients are "surrounded by all these kinds of support," problems are discovered "later on" (G4). Public awareness of dementia services was described as limited. Families often did not know which specialists to consult, and the term "dementia" was unfamiliar to many, while "Alzheimer's" was more widely recognised (G1). Awareness of a diagnosis could trigger stigma, with families sometimes reluctant to seek formal confirmation of what they already suspected (G3). Neuropsychologists and clinical psychologists were not available in government facilities. Participants indicated that diagnosis was nonetheless achievable through clinical assessment by geriatricians or neurologists: "We don't have a neuropsychologist, but we can diagnose dementia without a neuropsychologist" (G3). However, the absence of clinical psychologists limited post-diagnostic options. As one physician explained: "We don't have a clinical psychologist on board. We don't have other support personnel, so our options here are we will directly start off with medications" (G1). Management thus often commenced pharmacologically following clinical diagnosis. Management of behavioural changes associated with dementia relied heavily on antipsychotic medication. Physicians estimated that 60 to 70 percent of patients exhibiting agitation or aggression received antipsychotics (G1). A stepwise approach was described: physical causes such as infection, pain, or constipation were ruled out first, followed by non-pharmacological strategies, with medication used when these approaches proved insufficient. However, antipsychotic use was also described as serving a dual purpose. Beyond managing patient symptoms, alleviating family burden beyond addressing behavioural changes. One physician acknowledged that at advanced stages, "the family maybe is the number one target for me" and that medication was sometimes prescribed "to relieve the family" (G4). Family involvement in care was consistently described as central, reflecting cultural values of filial responsibility. Physicians rated family dedication highly and noted that government leave provisions facilitated caregiving. At the same time, an increasing reliance on domestic helpers and private home-care agencies was evident, particularly among Emirati families. One physician estimated that 95 percent of Emirati patients had care provided through nursing agencies, with family members "supervising" rather than providing direct care (G1, G2). For non-Emirati patients, family members - typically spouses or children - remained primary caregivers. Language barriers were described as manageable in government facilities due to mixed staffing. Care teams included Arabic-speaking staff who assisted with communication, and this arrangement was described as effective: "keeping one of the [Arabic-speaking] staff is the magic technique" (G4). Occasional challenges with patients who spoke only Arabic were acknowledged, but these were addressed through team collaboration. Workforce Preparation and Training Dementia-specific training was described as limited across the care team. Nurses and assistant nurses reported receiving no specialised dementia-related education as part of their nursing training or upon employment. One nurse stated plainly: "dementia is not a topic, a special topic that we cover" (RN2). Another confirmed the absence of dementia-specific training when commencing employment (RN3). A physician summarised: "Nothing special [for] nurses. Routine stuff" (G2). Orientation programmes were described as brief and general, covering routine procedures rather than dementia-specific care. Physicians reported receiving dementia exposure as part of their residency programmes, including rotations with inpatients and home visits to patients with cognitive impairment. However, this was described as part of general geriatric education rather than specialised dementia care preparation. Communication gaps between members of the care team were evident. Nurses and assistant nurses described learning about patients' diagnoses by reading records or asking physicians rather than through formal handover. Psychosocial concerns were frequently delegated to social workers, who were described as responsible for emotional support and family communication. This reflected both role boundaries and language considerations, with Arabic-speaking social workers better positioned to communicate with patients and families. Familiarity with person-centred care concepts was limited, and terminology was often conflated with patient-centred care. When asked directly, one physician responded: "Patient-centred care? Person-centred care? Sorry, no…We are trying to do all our intervention and care just for what is good for the patient" (G4). Another initially expressed unfamiliarity - "I'm not familiar with that in practice, except maybe I'm doing it, but I don't know that is the terminology" (G2) - before describing geriatric care in broad terms as "whole person-concerned, holistic application," though without reference to formal frameworks or operational guidelines (G2). A third physician acknowledged uncertainty about whether specific policies governed person-centred approaches: "I don't know if there are any particular guidelines or any particular policies that are followed about it" (G1). Despite limited familiarity with formal frameworks, nurses and assistant nurses described small acts of personalisation in their daily practice. These included offering choices, adjusting approaches based on patients' moods, and recognising non-verbal cues. One assistant nurse described respecting a patient's refusal of medication: "if he doesn't like, we will not force him, because you know we know this is [a] human being" (AN3). Another described reading facial expressions to detect pain or distress (AN2). These accounts suggested that elements of person-centred practice were present in routine care, even if not articulated in formal terms. Day-to-Day Care Practices and Challenges Physicians described a systematic approach to managing behavioural changes: first ruling out physical triggers such as infection, pain, or constipation; then attempting non-pharmacological strategies; and resorting to medication only when other approaches failed or safety was at risk. One physician summarised the approach: "if there isn't an[y] identifiable trigger… you have to push this into being the agitation associated with dementia" (G1). Another emphasised keeping patients "surrounded by familiar faces" and using medication only when the patient posed a risk to himself or others (G4). Nurses and assistant nurses described relying on teamwork to address challenges. When their own interventions were insufficient, they called on social workers, physicians, or Arabic-speaking colleagues. Social workers were described as responsible for psychological support, and language considerations reinforced this division of labour. This reliance reflected both collaborative practice and the absence of dementia-specific training that might equip nurses to address psychosocial needs directly. The absence of community-based respite services was identified as a significant gap. Physicians described family caregiving as exhausting over the long term and suggested that daycare centres or temporary respite facilities would provide relief without requiring permanent institutional placement. One physician noted that while Emirati culture was "not pro" long-term care homes, temporary respite might be more acceptable and could offer "a more uniform way of caregiving" than current arrangements (G1). Another suggested that dedicated dementia facilities, if properly framed, need not be seen as abandonment but as a means to help families (G2). Nurses and assistant nurses described particular difficulty with patients in the early stages of dementia, whose needs were less predictable and whose communication was more variable. One nurse described early-stage dementia as "difficult to manage" (RN1). Interpreting patients' attempts to communicate was challenging, and uncertainty about how to address emotional needs was acknowledged. Physical demands were also noted: patients who walked continuously, who forgot to swallow food, or who denied having been fed moments after eating. One assistant nurse described the emotional toll: "when you explain to them [but] they are not able to talk, then you will feel bad. You want to help them… but cannot" (RN4). Summary Across the interviews, participants described a care environment characterised by high but undocumented prevalence, delayed diagnosis, reliance on antipsychotic medication, limited dementia-specific training, and family-centred care arrangements increasingly supplemented by private care agencies. Physicians emphasised systemic issues, including the absence of local data, the shortage of specialists, the lack of respite services, while nurses and assistant nurses focused on the practicalities of daily care and the challenges of responding to patients whose needs they could not always interpret or address. Person-centred care concepts were unfamiliar in formal terms, though small acts of personalisation were evident in routine care practice. Together, these accounts depict a workforce navigating dementia care with limited infrastructure, training, and support, while remaining committed to the wellbeing of patients and families within the constraints of the current system. Integration of Findings Several patterns recurred across the analyses of both grey literature sources and interviews with healthcare professionals: the absence of dementia-specific policy recognition, fragmented and uncoordinated services, the centrality of families in caregiving, reliance on private providers and domestic helpers, and gaps in workforce training. The consistency of these patterns across documented policies and lived professional experience strengthens confidence in the findings. At the same time, each component made distinctive contributions. The grey literature captured the formal dementia care landscape: national policies that address ageing without naming dementia, service announcements that lack detail on continuity or care pathways, episodic NGO and academic initiatives, and the stratification of access by citizenship status. The interviews added experiential depth: late diagnosis resulting from delayed help-seeking and navigation challenges, antipsychotic use serving the dual purpose of managing patient symptoms and alleviating family burden, communication gaps within care teams, unfamiliarity with person-centred care terminology despite evidence of personalised practice, and the absence of community-based respite services. Where the grey literature documented fragmentation, the interviews described its consequences. Where the grey literature noted family centrality as a policy framing, the interviews revealed how this plays out in practice - families supervising nurses from care agencies, cultural expectations shaping care arrangements, and the implications of long-term caregiving without respite. Together, these components provide a layered account that neither source could offer alone: a formal mapping of the landscape and an experiential account of navigating it. These findings establish a baseline understanding of the dementia care environment in the UAE and identify key issues that warrant closer consideration in the discussion that follows. 4. Discussion This study set out to produce a comprehensive account of dementia care in the United Arab Emirates through an environmental scan that combined analysis of UAE-focused grey literature with interviews with healthcare professionals directly engaged in dementia care delivery. The findings presented in the preceding section capture both the formal landscape of policies, services, and initiatives and the perspectives of those navigating that landscape in daily practice. In the discussion that follows, these findings are interpreted in relation to existing research, policy frameworks, and cultural considerations. Particular attention is given to how the two components inform and contextualise one another, the implications for service delivery and policy development in the UAE, and the ways in which this study contributes to the broader understanding of dementia care in the region. The interpretation of these findings requires situating them within the broader context of regional realities and international literature. By bringing together evidence from documented policies and the perspectives of healthcare professionals, this analysis highlights recurring patterns that converge on four main issues: policy invisibility, service fragmentation, family centrality, and workforce training deficits. The findings from the two components are not uniform; they vary in emphasis, with some patterns appearing strongly in practice but absent in formal documentation, and others framed positively in policy discourse but contested in lived accounts. This variability is itself analytically significant, underscoring how dementia care in the UAE is constructed differently across knowledge domains. The following discussion evaluates these patterns, explores their convergences and divergences, and considers their implications for policy, research, and practice. Overview of Key Findings The findings from this study provide a layered account of dementia care in the UAE. The analysis of grey literature captured the formal landscape, revealing the presence of national policies addressing older adult wellbeing, local health authority programmes, NGO activities, and scattered awareness and training efforts, but also exposing important gaps: the absence of dementia-specific policy recognition, uneven practices and documentation across public and private sectors, and limited coordination across services (Javaid et al., 2021; 2025; Mowafi et al., 2025). Analysis of the interviews added experiential depth, highlighting barriers such as insufficient dementia-specific training (Mowafi et al., 2025; Yaghmour et al., 2019), limited institutional support (Kane et al., 2021; Javaid et al., 2021), and reliance on families and domestic workers for care (Hussein & Ismail, 2017; Kane et al., 2021; Qassem et al., 2023). Taken together, these two components converge to show that while the UAE has strong health infrastructure and a policy environment supportive of innovation, dementia care services remain fragmented, under-documented, and heavily dependent on informal systems. Grey Literature Findings in Context The findings from the grey literature analysis highlight persistent gaps in dementia-specific strategies in the UAE and underscore the need for structured education and training frameworks for healthcare staff (Javaid et al., 2021; Mowafi et al., 2025). They also point to the importance of enhancing existing services to strengthen care practices and better align emerging initiatives with broader policy aspirations. While grey sources documented scattered services and programmes across government bodies and NGOs, they also revealed inconsistency in availability and coordination. National policies addressed older adult wellbeing, dignity, and inclusion but did not name dementia as a distinct priority requiring dedicated resources or planning. This absence of dementia-specific policy recognition suggests that dementia remains a relatively underdeveloped domain (Javaid et al., 2021) within the UAE's otherwise advanced healthcare system (Goonetilleke, 2025). The grey literature also documented the growth of private provision: licensed home-care agencies and private hospitals offering dementia-related services operating independently of national planning. This market-driven expansion reflects responsiveness to unmet need but raises questions about standardisation, quality assurance, and equity of access. The stratification of services by citizenship status, with government entitlements specified for Emirati citizens and expatriates largely dependent on private provision, emerged as a significant structural feature of the care landscape. Interview Findings in Context The interviews provided practice-based perspectives that illustrated how systemic limitations translate into daily care routines. Across the descriptive categories, a picture emerges of dementia care that is both resource-constrained and fragmented (Kane et al., 2021; Mowafi et al., 2025). The absence of local research capacity and limited dementia-specific training available to healthcare professionals (Javaid et al., 2021; Mowafi et al., 2025) were reflected in reliance on pharmacological solutions such as antipsychotic use when non-pharmacological alternatives were both unknown and inaccessible. Cultural expectations of family-led care coexisted with growing reliance on domestic helpers and private home-care agencies. Physicians described families supervising agency nurses rather than providing direct care, while noting that cultural expectations continued to shape help-seeking behaviour and care arrangements. The concepts of personhood and person-centred care were unfamiliar in formal terms, frequently conflated with patient-centred care or upheld superficially in ways that were difficult to operationalise in practice (Kitwood, 1997; Brooker, 2003). Despite this, nurses and assistant nurses described small acts of personalisation of care, such as offering choices, reading non-verbal cues, and adjusting approaches based on patients' moods that suggested elements of person-centred practice were present even without formal frameworks. Several accounts described how antipsychotics were prescribed not only to manage agitation and aggression in patients but also to relieve the strain experienced by family caregivers. In such cases, prescribing was framed as a pragmatic response to the dual challenge of supporting the person living with dementia and addressing the demands placed on families, indicating that treatment decisions were influenced by caregiver strain as much as by clinical presentation (Ballard & Aarsland, 2021; Levy et al., 2012). The analysis also revealed differences in emphasis across participants: physicians focused on systemic issues such as the absence of local data, the shortage of specialists, and the lack of respite services, while nurses and assistant nurses focused on the practicalities of daily care and the challenges of responding to patients whose needs they could not always interpret or address. Together, these perspectives depict a dementia care landscape shaped simultaneously by systemic constraints, professional competencies, ethical considerations, and pragmatic responses. Integration of Findings Across the two components, dementia surfaces as largely invisible in formal national planning. The grey literature documented national strategies framed around wellbeing and care for older adults without naming dementia directly (UAE Government Portal, n.d.; UAE Legislation Portal, 2025; National Strategy for Wellbeing 2031). The interviews added nuance: while some participants expressed concern about the unavailability of country-specific research and statistics, others focused on immediate challenges such as service accessibility and workforce preparedness. Despite differences in emphasis, both components consistently point to systemic barriers. The grey literature documented the availability of memory clinics, geriatric units, and outpatient neurology services but rarely linked them into clear care pathways. The interviews described the consequences of this fragmentation: delayed diagnoses, families unsure where to seek help, reliance on medication to manage what systems cannot support, and a workforce operating without dementia-specific preparation. These accounts suggest that while the service landscape is expanding, its unevenness and limited coordination leave care recipients navigating an opaque system. A strong pattern running through both components is the centrality of family in dementia care. Policy documents and media coverage often celebrate family duty as a cultural strength (UAE Government Portal, n.d.; UAE Legislation Portal, 2025), and the interviews affirmed that caregiving is often seen as a moral and religious obligation. However, participants also highlighted the difficulty of balancing cultural expectations with practical realities. This contrast points to a disjuncture between policy and public discourse, which frames family support in idealised terms, and lived experiences, where the absence of structural support turns a cultural value into a source of vulnerability (Qassem et al., 2023; Sharif et al., 2024). The role of non-governmental actors appears inconsistent and often peripheral. The grey literature documented awareness campaigns, university-led events, and private training initiatives, but these efforts were episodic and lacked integration into national planning. The interviews highlighted the need for respite and community-based services that do not currently exist. This unevenness underscores the potential of non-governmental contributions but also their limitations when left outside national coordination. The findings also reveal glimpses of optimism: references to new memory clinics, awareness campaigns, and training initiatives suggest that momentum is building, albeit unevenly. The challenge, therefore, appears to lie less in the absence of activity and more in the absence of coherence, integration, and cultural tailoring. Taken together, these patterns depict dementia care in the UAE as a field that is evolving - increasingly visible in discourse and services yet constrained by fragmentation and lack of national coordination. Where policy and public discourse frame family caregiving positively, interviews reveal its challenges, and where new services are promoted, care professionals describe the public's difficulty in accessing them. This complexity suggests that dementia care is at a transitional stage - no longer invisible, but not yet fully integrated into health and social care systems. Policy and Cultural Dimensions The findings underscore the extent to which dementia care in the UAE is shaped by cultural norms and governance structures that distinguish between citizens and expatriates. Family-led care remains the dominant model, rooted in cultural and religious expectations of filial duty and reinforced by the limited availability of institutional alternatives (Kane et al., 2021). While this aligns with long-standing traditions of family caregiving in the Gulf, it also places considerable strain on households, particularly as the ageing population increases (Qassem et al., 2023). The growing reliance on domestic helpers and private healthcare agencies introduces additional complexities, including variability in training, language and cultural barriers, and limited familiarity with dementia-specific needs (Mowafi et al., 2025). At the policy level, the UAE reflects the broader Gulf model of citizen-centric welfare provision, where nationals are entitled to comprehensive, government-funded health and social services, while expatriates access care primarily through employer-sponsored health insurance (AlRuthia et al., 2025; Koornneef et al., 2017; Lowe et al., 2024). This structural arrangement means that expatriate families, who constitute the majority of the UAE population, often face limited access to dementia-specific services unless they can afford private care. From a Western welfare-state perspective, such arrangements may appear inequitable, but in the Gulf context, they reflect a governance model that prioritises citizens as the primary beneficiaries of state-funded welfare (Hertog, 2025). Within this model, expatriates rely on employment-based or private-sector provision, resulting in marked variation in service accessibility and continuity. The absence of a national dementia strategy further compounds these challenges (Mowafi et al., 2025; Qassem et al., 2023). Although policy aspirations for improved care of older citizens have been articulated in various government visions and health strategies (UAE Government Portal, 2025), dementia-specific planning remains fragmented. This policy gap contributes to reliance on ad-hoc initiatives by individual emirates, private institutions, or NGOs, leading to uneven service availability (Javaid et al., 2021; 2025). Together, these findings suggest that any meaningful expansion of dementia care in the UAE must navigate the intersection of cultural expectations, demographic pressures, and citizen-expatriate distinctions while advancing toward more integrated and dementia-specific policy frameworks. Contribution of the Study This study makes several contributions to the understanding of dementia care in the UAE. First, it represents the first comprehensive environmental scan of dementia care services in the UAE, integrating evidence from grey literature sources and perspectives with healthcare professionals. By examining findings from both documented policies and professional experiences, the study provides a more complete picture of the UAE dementia care landscape than either source could offer alone, capturing both formal structures and the realities of navigating them. Second, the study addresses a critical evidence gap. Research on dementia care in the Gulf remains fragmented and often limited to narrow foci such as caregiver burden, genetic factors, and pharmacological management, with little attention to systemic service delivery or national-level strategies (Mowafi et al., 2025). By generating UAE-specific evidence from grey literature and experiential accounts from healthcare professionals, the present study consolidates baseline evidence that has not previously been assembled. Third, the study advances understanding of how cultural and policy contexts shape dementia care. It demonstrates that the governance model distinguishing citizens from expatriates has direct implications for access and entitlement, while cultural expectations of family care continue to structure day-to-day practices (Kane et al., 2021). Bringing these dimensions together underscores the importance of designing dementia care strategies that are not only evidence-based but also culturally and contextually grounded (Mowafi et al., 2025). Finally, by producing baseline data on the scope, distribution, and challenges of dementia care services in the UAE, this study offers a foundation for future policy development, workforce training initiatives, and the design of culturally appropriate dementia care services (Javaid et al., 2021). It provides both a descriptive map of the current landscape and a foundation for future action. Strengths and Limitations This study has several notable strengths. It is the first to undertake a comprehensive environmental scan of dementia care services in the UAE, combining systematic analysis of grey literature with interviews. The use of two complementary data sources allowed findings from policy documents, service descriptions, and practitioner perspectives to be examined together while preserving the distinctiveness of each. Methodological transparency was maintained through the use of structured extraction frameworks and detailed documentation of sources. Both components were analysed using a qualitative descriptive approach (Sandelowski, 2000; 2010), which prioritises comprehensive summary and low-inference interpretation. This approach is well-suited to applied health services research where the aim is to describe phenomena and identify patterns relevant to practice and policy (Kim et al., 2017). Findings were generated inductively through iterative engagement with the data, and attention was paid to both consistencies and tensions across accounts. The convergence of key patterns across both components, including the absence of dementia-specific policy recognition, service fragmentation, family centrality, and workforce training gaps, strengthens confidence in the findings. At the same time, certain limitations should be acknowledged. Grey literature searches are inherently incomplete and time-bound, and it is possible that some relevant local initiatives were not captured (Adams et al., 2017; Paez, 2017; Pedersen et al., 2023). The sample for the interest-holder interviews was relatively small and focused on healthcare professionals in the public sector, which means that perspectives from private sector providers, family caregivers, people living with dementia, and policymakers were not directly represented. The study's focus on the UAE limits the generalisability of findings to other countries, although the patterns identified are likely to resonate in contexts with similar demographic and governance structures, such as the other Gulf states. Implications for Practice, Policy, and Research The findings of this study carry several implications for practice, policy, and future research. At the practice level, the limited dementia-specific training identified across both components underscores the need for structured dementia care education programmes (Mowafi et al., 2025). Enhancing the competencies of healthcare professionals is essential to reduce reliance on pharmacological interventions and promote non-pharmacological, person-centred approaches to dementia care. Support for family caregivers also requires strengthening, whether through dementia care training, counselling, or respite services (Kane et al., 2021). At the policy level, the absence of a coordinated national dementia strategy in the UAE represents a critical gap (Mowafi et al., 2025). While sector-specific initiatives and NGO activities demonstrate promising efforts, they remain fragmented and uneven in scope. Developing a comprehensive, integrated dementia strategy at the federal level would provide the structure needed to harmonise existing initiatives, align them with international standards, and ensure equitable access across the country. Such a strategy should also explicitly address the distinct needs of expatriate populations, who constitute the majority of the UAE's residents but often fall outside citizen-centric entitlement frameworks (Lowe et al., 2024). At the research level, this study highlights the need for systematic investigation of dementia care services and practices in the region. Future research should move beyond descriptive mapping to develop and evaluate tailored dementia care interventions, assess the impact of culturally adapted training and awareness programmes, and explore innovative care models suited to the region's contexts (Mowafi et al., 2025). Longitudinal studies are needed to capture the evolving needs of persons living with dementia and their families, while cross-country comparisons within the Gulf region could help identify transferable practices and policy lessons. 5. Conclusion This study provides the first comprehensive environmental scan of dementia care in the United Arab Emirates, drawing together evidence from UAE-specific grey literature and the perspectives of healthcare professionals. The findings reveal a landscape that is simultaneously marked by strong health infrastructure and policy ambitions yet constrained by fragmented services, the absence of dementia-specific policy recognition, reliance on family and informal caregivers, and limited dementia-specific training and education. The structural distinction between citizens and expatriates further shapes access and provision, highlighting the need for coordinated, culturally informed approaches to dementia care. By consolidating diverse sources of evidence, this study establishes a baseline that can guide future research, policy development, and dementia care education, while also offering insights of relevance to other Gulf states facing similar demographic and cultural dynamics. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. Ethics approval was granted by the Dubai Scientific Research Ethics Committee (DSREC) of the Dubai Health Authority (initial approval: DSREC-SR-03/2023_06; annual renewal: DSREC-SR-05/24_08; additional study site: DSREC-SR-07/24_01) and the University of Reading Research Ethics Committee (UREC 23/07). All participants received information sheets and provided written informed consent prior to participation. Consent for publication Participants provided written consent for publication of anonymised quotations. Author Contributions: Seada Kassie conceptualised and designed the study, conducted the grey literature search and analysis, conducted and transcribed the interviews, performed qualitative descriptive analysis, and wrote the manuscript. Arlene Astell supervised the research and critically reviewed the initial draft. All authors read and approved the final manuscript. Competing Interests The authors declare no competing interests. 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Conducting comprehensive environmental scans in health research: A process for assessing the subject matter landscape. Journal of the Association of Nurses in AIDS Care, 29 (2), 249–258. Sharif, L., Basri, S., Alsahafi, F., Al Hariri, S., Alsolami, A., Alfaifi, M., & Filfilan, R. (2024). Dementia caregiving in Saudi Arabia: Challenges and support needs. Saudi Medical Journal , 45(3), 267–275. Sharjah Social Services Department. (n.d.). Home . Retrieved 2025, from https://sssd.shj.ae/ Sibai, A. M., Semaan, A., Tabbara, J., & Rizk, A. (2017). Ageing and health in the Arab region: Challenges, opportunities and the way forward. Population Horizons, 14 (2), 73–84. https://10.1515/pophzn-2017-0007 The National. (2017, October 1). Lifestyle changes early in life may prevent dementia as the UAE's population ages. https://www.thenationalnews.com/uae/lifestyle-changes-early-in-life-may-prevent-dementia-as-the-uae-s-population-ages-1.612931 The National. (2024, March 30). WHO states dementia mental health. https://www.thenationalnews.com/health/2024/05/30/who-states-dementia-mental-health/ Thirlwall, A., Kuzemski, D., Baghestani, M., Brunton, M., & Brownie, S. (2021). ‘Every day is a challenge’: Expatriate acculturation in the United Arab Emirates. International Journal of Cross Cultural Management , 21 (3), 430-451. https://doi.org/10.1177/14705958211039071 Tse, M. M. Y., Hartanto, E. C. P., & Enguidanos, S. (2019). Dementia care in the United Arab Emirates. In M. Downs & B. Bowers (Eds.), Dementia care: International perspectives . Oxford University Press. https://academic.oup.com/book/25044/chapter-abstract/189131943 UAE Government Portal. (2025). Elderly care services. https://u.ae/en/information-and-services/social-affairs/elderly-care [Accessed December 2025] UAE Government Portal. (n.d.). Health policy and laws . Retrieved 2025, from https://u.ae/en/information-and-services/health-and-fitness/healthy-policy-and-laws UAE Government Portal. (n.d.). National Strategy for Wellbeing 2031 . Retrieved 2025, from https://u.ae/en/about-the-uae/strategies-initiatives-and-awards/strategies-plans-and-visions/social-affairs/national-strategy-for-wellbeing-2031 UAE Government Portal. (n.d.). Senior Emiratis . Retrieved 2025, from https://u.ae/en/information-and-services/social-affairs/senior-emiratis UAE Legislation Portal. (n.d.). National policy for senior citizens . Retrieved 2025, from https://www.uaelegislation.gov.ae/en/policy/details/lsy-s-lotny-lkb-r-lmo-tnyn UAE Ministry of Foreign Affairs. (n.d.). Health care . Retrieved 2025, from https://www.mofa.gov.ae/en/Missions/Paris/The-UAE/Health-Care UAE Montessori. (n.d.). Dementia and aged care . Retrieved 2025, from https://uaemontessori.com/dementia-and-aged-care/ UAE Stories. (2024, June 10). Cutting-edge centre for Alzheimer's. https://uaestories.com/cutting-edge-centre-for-alzheimers/ UAE Times. (2023, October 1). Living with Alzheimer's: How patients and families in the UAE are coping. https://uaetimes.ae/living-with-alzheimers-how-patients-and-families-in-the-uae-are-coping/ United Arab Emirates University. (2017, May 1). Dementia . https://www.uaeu.ac.ae/en/news/2017/may/dementia.shtml Wilburn, A., Vanderpool, R. C., & Knight, J. R. (2016). Environmental scanning as a public health tool: Kentucky's human papillomavirus vaccination project. Preventing Chronic Disease, 13 , E109. https://doi.org/10.5888/pcd13.160165 Yaghmour, S. M., Bartlett, R., & Brannelly, T. (2019). Dementia in Eastern Mediterranean countries: A systematic review. Dementia, 18 (7–8), 2635–2661. https://doi.org/10.1177/1471301217753776 Additional Declarations No competing interests reported. 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Introduction","content":"\u003cp\u003eThe United Arab Emirates (UAE) presents a distinctive context for dementia care research and policy development. As a high-income state in the Gulf Cooperation Council (GCC) where expatriates constitute approximately 88% of residents (Sibai et al., 2017; Thirlwall et al., 2021), the country combines rapid demographic transition with policy ambitions around healthy ageing, wellbeing, and quality of life for older citizens (UAE Government Portal, 2025). Yet dementia remains largely absent from national strategies and planning frameworks, addressed only implicitly within broader agendas for care for older people (Mowafi et al., 2025; Qassem et al., 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFamily-led care remains the normative model, grounded in cultural and religious values that position filial responsibility as a moral duty (Kane et al., 2021; Hammad et al., 2024). At the same time, increasing reliance on domestic workers and private home-care agencies reflects the practical pressures facing families navigating dementia care without adequate institutional support (Hussein \u0026amp; Ismail, 2017). The healthcare system itself is stratified by citizenship, with nationals entitled to comprehensive government-funded services while expatriates depend primarily on employer-sponsored insurance or private provision (Koornneef et al., 2017; Lowe et al., 2024). This dual structure shapes access to diagnosis, treatment, and long-term care in ways that remain underexplored in the dementia care literature.\u003c/p\u003e\n\u003cp\u003eExisting reviews have highlighted the scarcity of research on dementia in the region, with available studies predominantly focused on prevalence, caregiver burden, and risk factors, while comparatively little attention has been given to service delivery, workforce preparation, or system-level planning (El-Metwally et al., 2019; Kane et al., 2021; Mowafi et al., 2025; Qassem et al., 2023). This gap is particularly pronounced in the Gulf region, where health systems are evolving rapidly but dementia-specific infrastructure and training pathways remain nascent. Environmental scanning offers a systematic approach to mapping a domain across multiple evidence sources to identify current resources, emerging trends, and critical gaps (Rowel et al., 2005; Wilburn et al., 2016). This approach aligns with calls for context-specific evidence to inform dementia care policy and practice in the Gulf region (Dhillon \u0026amp; Fazal, 2025; Javaid et al., 2021).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe present study applies this methodology to examine the dementia care landscape in the UAE through analysis of UAE-specific grey literature sources and interviews with healthcare professionals directly involved in dementia care delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to conduct an environmental scan of dementia care in the UAE, mapping services, practices, and barriers and challenges to providing optimal dementia care. The study addressed the following questions: What dementia care services and initiatives exist in the UAE, and how are these framed in policy and public discourse? What are the experiences and perspectives of healthcare professionals providing dementia care? And what gaps and challenges characterise the current landscape? By integrating documentary and experiential sources, the study generates country-specific baseline evidence to inform policy development, workforce training, and future research, while offering insights of relevance to other Gulf states facing similar demographic and cultural dynamics.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was designed as a comprehensive environmental scan to examine the dementia care landscape in the UAE. Environmental scanning is a systematic approach to mapping a domain by synthesising diverse sources of evidence to identify existing resources, emerging trends, and critical gaps (Rowel et al., 2005; Wilburn et al., 2016). This approach is particularly suited to applied health services research in contexts where formal evidence is sparse or fragmented, and where policy-relevant insights must be drawn from both published and unpublished sources (Shahid \u0026amp; Turin, 2018).\u003c/p\u003e\n\u003cp\u003eThe environmental scan comprised two components:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eGrey literature analysis of non-indexed but locally relevant sources on dementia care services and practices in the UAE\u003c/li\u003e\n \u003cli\u003eInterviews with healthcare professionals directly involved in dementia care in the UAE\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThese two components serve complementary purposes. The grey literature analysis captures the formal landscape of services, policies, and initiatives as documented by government and non-government entities, while the interviews provide experiential perspectives from practitioners navigating that landscape in everyday practice. Together, they offer a comprehensive account of dementia care in the UAE that neither source could provide alone. The study was granted ethics approval by the Dubai Scientific Research Ethics Committee (DSREC) of the Dubai Health Authority (Initial approval letter reference: DSREC-SR-03/2023_06; Annual renewal approval letter reference: DSREC-SR-05/24_08; Reference of approval letter for adding a new study site: DSREC-SR-07/24_01) and the University of Reading Research Ethics Committee (UREC) at the University of Reading, United Kingdom (Ethics approval letter reference: UREC 23/07).\u003c/p\u003e\n\u003cp\u003ePreparatory work for the environmental scan included structuring the extraction templates, refining the search strategy, and arranging the interviews. The interviews with healthcare professionals were conducted between June 2023 and February 2024. The grey literature search was conducted between July and August 2025, with final synthesis and reporting completed between August and September 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrey Literature Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured grey literature search was conducted to capture non-indexed but locally critical information on dementia care services and practices in the UAE. Grey literature, including government reports, policy documents, organisational websites, and service descriptions offers essential insights in contexts where peer-reviewed research is limited and where local knowledge is held by institutions rather than documented in academic publications (Adams et al., 2017; Paez, 2017; Pedersen et al., 2023). Sources included government portals, local health authority websites, private care service and training providers, and Non-Governmental Organizations (NGOs) active in dementia care policies, community initiatives, and service delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch Scope and Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe search targeted UAE entities including the UAE Government Portal (n.d.), Ministry of Health and Prevention (MOHAP; 2024), Dubai Health Authority (DHA; 2016), Department of Health Abu Dhabi (DoH; n.d.), Emirates Health Services (EHS; 2023; 2024), Sharjah Social Services Department (n.d.), the Al Qasimi Foundation (n.d.), and local non-governmental organisations (e.g., 4get-me-not, n.d.). Manual browsing, Google searches, and snowballing were employed to ensure comprehensive coverage of relevant sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Extraction and Synthesis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformation from each included grey literature source was extracted into a structured spreadsheet (see supplementary table), recording source category, source name, focus area, publication date, type of service/initiative, specific dementia services, target population, key features/description, cultural/religious/family considerations, and dementia care service gaps. The extraction process captured both descriptive details and interpretive elements, such as information on how dementia is framed in policy and public discourse.\u003c/p\u003e\n\u003cp\u003eThe extracted data were synthesised using a qualitative descriptive approach (Sandelowski, 2000; 2010; Kim et al., 2017), with patterns, contrasts, and omissions identified inductively across sources. Recurring threads included policy visibility, service fragmentation, family centrality, and limited dementia-specific training for formal and informal caregivers. Given the heterogeneous nature of grey literature, the synthesis was exploratory and aimed at mapping breadth rather than judging quality, while acknowledging challenges in consistency of reporting and continuity of services and initiatives (Adams et al., 2017; Paez, 2017).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterviews with Healthcare Professionals\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSemi-structured individual and focus group interviews (See Supplementary File for interview transcripts) were conducted with healthcare professionals involved in dementia care delivery in the UAE, providing experiential insights into the realities of care practice, including systemic barriers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling and Recruitment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing purposive sampling, four specialist and consultant geriatricians were recruited for the individual interviews, as well as two gender-specific focus groups consisting of nurses and assistant nurses, in line with cultural norms. Their demographic and professional characteristics are displayed in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConducted between September 2023 and April 2024, the individual interviews were held in person or online (Microsoft Teams) depending on the availability of the participants, whereas both focus group interviews were conducted in person. All interviews were led by the first author, audio-recorded with consent, and transcribed verbatim.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interview data were analysed using a qualitative descriptive approach (Sandelowski, 2000; 2010), which prioritises comprehensive summary and low-inference interpretation over deep thematic abstraction. This approach is well-suited to applied health services research where the aim is to describe phenomena as experienced by participants and to identify patterns relevant to practice and policy (Kim et al., 2017; Neergaard et al., 2009). The analysis proceeded iteratively, where the transcripts were read multiple times, and initial codes were generated inductively from the data using Quirkos (version 2.5.3). Codes were grouped into descriptive categories reflecting recurring topics across participants, including service fragmentation, workforce constraints, family expectations, and training gaps. Attention was paid to both consistencies and tensions within the data, and findings are presented as narrative summaries that synthesise perspectives across participants rather than foregrounding individual voices. Illustrative quotations are used selectively to anchor key points.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntegration Across Datasets\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross the grey literature analysis and the interview data, synthesis followed the same principles: systematic extraction, inductive categorisation, and descriptive pattern identification. This allowed findings from policy documents, service descriptions, and practitioner perspectives to be examined together while preserving the distinctiveness of each source type. The integration was iterative, moving between datasets to identify convergences, divergences, and gaps. The process was exploratory and descriptive (Sandelowski, 2000; 2010; Kim et al., 2017), aimed at mapping the current dementia care landscape in the UAE.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe results from the environmental scan are presented across the two components of the study. First, analysis of grey literature focusing on UAE-specific policies, services, initiatives, and emerging practices is presented. All sources were reviewed and coded as part of the iterative analysis; only representative examples are cited to illustrate each pattern, but the synthesis draws on the full dataset. Some sources that duplicated information or provided only tangential detail are not cited individually in order to avoid redundancy, though their content contributed to the patterns reported. Second, the interviews with healthcare professionals offer experiential insights into diagnosis and delivering every day care, training and education, and barriers and challenges.\u003c/p\u003e\n\u003cp\u003eEach component was analysed using a qualitative descriptive approach (Sandelowski, 2000; 2010; Kim et al., 2017), with descriptive categories generated inductively from the data and refined through repeated engagement. The purpose was not to produce rigidly separate categories, but to identify recurring patterns that illustrate how dementia care is positioned across policy and practice discourse and lived professional experience. Together, these components capture both the formal landscape of dementia care in the UAE - as documented by government and non-government entities - and the realities of practice as experienced by those delivering care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrey Literature Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 61 sources were extracted and reviewed, spanning government policies and strategies, public and private healthcare service providers, news releases, academic contributions, training services, and community initiatives. Table 1 provides a condensed summary of findings from the 61 grey literature sources organised by key area. Detailed descriptions of individual sources are provided in the supplementary table. Sources were read iteratively, with initial codes generated inductively. Codes were then grouped into descriptive categories reflecting recurring patterns across sources. The narrative that follows presents findings organised around seven cross-cutting patterns identified through this process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Summary of grey literature findings on dementia care in the UAE, organised by key area\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKey Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain Findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGaps/Challenges\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNational Healthcare Policies, Strategies, and Plans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePolicies emphasize dignity, wellbeing, and inclusion of older citizens but rarely mention dementia explicitly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLack of dementia-specific provisions and limited operational detail\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eServices and Initiatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWide range of benefits and support for older citizens described; dementia services often not explicitly addressed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFragmented services; lack of coordination and documented dementia care pathways\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCultural, Religious, and Family Considerations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStrong emphasis on family responsibility and cultural values supporting home-based care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCultural expectations may limit uptake of formal or institutional services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon-Governmental and Sector-Specific Initiatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCommunity programs, academic engagement, and awareness campaigns contribute in fragmented ways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSmall scale, limited evaluation, and lack of sustainability and continuity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrivate Home-Based Healthcare Providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUse of private home-based care services is growing; providers are licensed but remain variable in quality and not dementia-specific\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLack of dementia-focused training, non-standardized practices, and limited insurance coverage for services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDementia Absent from Explicit Policy Recognition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross multiple federal portals and government sources, the UAE has established a comprehensive policy framework addressing older citizens, but dementia is not named as a distinct priority. The National Policy for Senior Emiratis emphasises dignity, protection, inclusion, and improved quality of life through physical, psychological, and social supports (The National, 2017; UAE Government Portal, 2025; n.d.; UAE Legislation Portal, 2025). The National Strategy for Wellbeing 2031 aims to improve quality of life through healthcare, environment, and social cohesion, but contains no specific mention of dementia or dementia-related indicators (UAE Government Portal, n.d.). Strategic health plans, including UAE Vision 2021 and subsequent national agendas position care of older citizens within broader frameworks of universal healthcare access, but dementia care is not addressed as a specific service area (UAE Federal Government Portal, 2025). Health authority announcements describe alignment with WHO\u0026apos;s healthy ageing framework, emphasising early detection, health promotion, and intersectoral coordination, but dementia remains embedded implicitly within these broader agendas (Ministry of Health and Prevention, 2024; The National, 2024). Although these policies set positive aspirations for older adult wellbeing, they do not establish dementia as a health priority requiring dedicated resources, services, or planning. Across the policy sources reviewed, dementia-specific provisions, implementation mechanisms, and operational guidance were consistently absent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFamily Positioned as the Default Caregiving Unit\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA consistent pattern across government policies, academic sources, and media reporting is the positioning of the family as the primary unit of dementia care. National documents affirm family responsibility in caregiving and uphold values of dignity, protection, and intergenerational cohesion (UAE Government Portal, 2025; UAE Legislation Portal, 2025; Department of Community Development Abu Dhabi, n.d.). Academic commentaries identify the family as the default caregiving unit, noting the limited availability of institutional alternatives (Oxford Institute of Population Ageing, 2023; Tse et al., 2019).\u003c/p\u003e\n\u003cp\u003eMedia narratives reinforce this expectation, portraying family caregiving as a cultural duty rooted in Islamic values and Emirati traditions, while also acknowledging the strain and stigma it imposes (Arabian Business, 2022; ARN News, 2023; Gulf News, 2023; Khaleej Times, 2023a; 2023b; Middle East Health, 2024; UAE Stories, 2024). Hospital and clinic sources similarly describe family involvement as central to the care process (Cleveland Clinic Abu Dhabi, n.d.; Northwest Clinic, n.d.). Religious and cultural norms are woven into wellbeing strategies, with initiatives promoting community engagement and family-centred approaches.\u003c/p\u003e\n\u003cp\u003eWhile this cultural framing is presented as a strength, reflecting values of respect, cohesion, and filial duty, it simultaneously exposes systemic vulnerabilities. When families are positioned as the default caregivers without access to training, respite, or coordinated support, the caregiving burden falls disproportionately on informal networks. Several sources noted caregiver stress, emotional toll, and the unsustainability of family-based systems without formal support structures (Cleveland Clinic Abu Dhabi, n.d.; Gulf News, 2023; Arabian Business, 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eServices Fragmented Across Public and Private Sectors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealthcare services for dementia exist across government hospitals, private clinics, and home-care agencies, but they operate without systematic coordination or documented care pathways. Government announcements describe a range of services and entitlements for older citizens, including health insurance coverage, housing support, and transport concessions (UAE Government Portal, 2025; Department of Community Development Abu Dhabi, n.d.). Health authorities have announced new memory clinics and frameworks for healthy ageing (Abu Dhabi Media Office, 2019; Ministry of Health and Prevention, 2025; Rashid Hospital, n.d.), and media reporting has highlighted specialised facilities for older citizens (Emirates Health Services, 2024).\u003c/p\u003e\n\u003cp\u003ePrivate hospitals offer diagnostic services, neuropsychological assessments, and treatment plans for dementia and Alzheimer\u0026apos;s disease (American Center for Psychiatry and Neurology, n.d.; Brain Hub UAE, n.d.; Brainnovation, n.d.; Burjeel Hospital, n.d.; Canadian Medical Center, n.d.; Cleveland Clinic Abu Dhabi, n.d.; Dubai Royal Hospital Clinic, n.d.; Emirates Hospitals, n.d.; Fakeeh University Hospital. n.d.; German Neuroscience Center, n.d.; King\u0026apos;s College Hospital Dubai, n.d.; Mediclinic City Hospital, n.d.; Novomed, n.d.;). While these providers describe multidisciplinary teams, early detection, and personalised care, descriptions of their services rarely mentioned coordination with community or home-based care, caregiver training, or integration with national planning. Sources consistently noted the absence of care pathways connecting diagnosis to long-term support. The Salama bint Hamdan Al Nahyan Foundation\u0026apos;s 2014 review explicitly highlighted fragmented care, lack of coordination across services, limited public awareness, and workforce gaps. Academic sources similarly noted fragmentation and the absence of an integrated dementia care system (Oxford Institute of Population Ageing, 2023; Salama bint Hamdan Al Nahyan Foundation, 2014; n.d.; Tse et al., 2019). The pattern across these sources is one of pockets of provision without continuity, where services are available but appear to be disconnected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrivate Sector Expanding Without National Integration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA notable trend is the growth of privately owned and licensed home-based healthcare providers. Locally known as care agencies, these are licensed companies that families contract on a long-term basis to deliver in-home care, particularly when institutional options are limited or culturally less acceptable. As of 2020, more than 80 such agencies were licensed nationally, with approximately 50 actively operating (HealthHQ, 2020). Enayati Home Healthcare (2024) described efforts to fill gaps in dementia care for expatriate families, noting that expatriates often lack extended family networks and are dependent on private services.\u003c/p\u003e\n\u003cp\u003ePrivate training providers have also emerged, offering caregiver certification courses that cover care for older people and dementia care basics, including daily living support, safety, mobility, hygiene, and nutrition (NLP Tech Training Centre, n.d.; Samson Training Center, n.d.; UAE Montessori, n.d.). These training opportunities respond to demand for structured caregiver education, but review of their publicly available materials revealed no evidence of standardisation across providers, cultural tailoring, or formal integration into national training pathways.\u003c/p\u003e\n\u003cp\u003eThe expansion of private provision demonstrates market responsiveness to an unmet need, but it also reflects the absence of public infrastructure. Private care service providers are not formally integrated into national planning, and their services remain variable in quality and scope. Home-based dementia care services may not be covered under standard UAE insurance plans, which typically exclude dementia alongside certain psychiatric conditions (Burjeel Hospital, 2023; HealthHQ, 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunity and Academic Initiatives Episodic and Small-Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeyond national policies and formal public and private healthcare services, several sources documented contributions from community organisations, academic institutions, and awareness campaigns. These initiatives demonstrate emerging recognition of dementia as a public health concern, but they are characterised by limited scale, sustainability, and follow-up. Awareness campaigns and community programs have highlighted the projected rise in dementia prevalence and the importance of early detection (Arabian Business, 2022; Khalifa University, 2023; LiveHealthy.ae, 2023; PureHealth, 2024). These are often event-driven or tied to specific campaigns, with reach and sustainability inconsistently reported. The 4get-me-not Alzheimer\u0026apos;s Organization (n.d.) offers workshops, training, and public campaigns, often during globally observed awareness days or months, but has no documented official recognition or integration into government strategy. A dementia awareness event organised by UAE University in 2017 was held during Ramadan, suggesting cultural sensitivity, but was noted as episodic rather than sustained.\u003c/p\u003e\n\u003cp\u003eAcademic contributions included research on culturally adapted diagnostic tools (Khalifa University, 2023), population ageing (Oxford Institute of Population Ageing, 2023), and dementia care practices (Tse et al., 2019). These publications signal growing scholarly engagement but remain fragmented and are not systematically integrated into national dementia care planning and strategies. The Salama bint Hamdan Al Nahyan Foundation (2014; n.d.) was noted as one of the few initiatives integrating awareness, research, clinical training, and home-based care, but detailed documentation of its scope and continuity was limited. Overall, the pattern is one of visibility without sustained impact, and where contributions are valuable but piecemeal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccess Stratified by Citizenship Status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral sources revealed a distinction between services available to Emirati citizens and those accessible to expatriates. Government descriptions of benefits and entitlements consistently specified \u0026quot;Senior Emiratis\u0026quot; as the target population (UAE Government Portal, 2025; Department of Community Development Abu Dhabi, n.d.). Specialised care centres for older citizens, including Al Mamzar Community Centre for Elderly and the Dubai Health Seniors\u0026apos; Happiness Centre, were described as serving older citizens, with unclear or no access for expatriates (Al Mamzar Community Centre for Elderly, n.d.; Dubai Health Authority Media Office, 2020).\u003c/p\u003e\n\u003cp\u003eGiven that expatriates constitute the majority of the UAE population, this represents a significant gap in the documented service landscape. Enayati Home Healthcare (2024) explicitly noted limited government support for expatriates, especially for long-term dementia care, and described unclear pathways for expatriates to access affordable and specialised services. Expatriate families were described as dependent on private care agencies to fill gaps that government services do not address.\u003c/p\u003e\n\u003cp\u003eThis pattern of citizenship-based stratification means that the dementia care landscape differs substantially depending on residency status. For Emirati citizens, a range of entitlements and dedicated facilities exist, though dementia-specific services remain limited. For expatriates, access depends primarily on private provision, with cost and availability as significant barriers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWorkforce Preparation Limited and Unstandardised\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTraining opportunities for providing care for older people exist but are variable, lack standardisation, and are not dementia specific. Private training centres offer caregiver courses covering general care for older people, but review of their publicly available materials revealed no evidence of standardisation across providers, cultural tailoring, or formal integration into national training pathways\u003c/p\u003e\n\u003cp\u003eAcross hospital and clinic sources, caregiver training and education were rarely mentioned. Several private providers described services for patients but did not document support for family caregivers or workforce development. The Salama bint Hamdan Al Nahyan Foundation supported dementia-related research and public awareness initiatives, though the Foundation\u0026apos;s health programme webpage has not been updated since 2017, and it remains unclear whether these activities are ongoing (Salama bint Hamdan Al Nahyan Foundation, n.d.)\u003c/p\u003e\n\u003cp\u003eAcademic and media sources identified workforce gaps as a significant barrier to dementia care development. The absence of dementia-focused training, non-standardised practices across providers, and limited cultural tailoring of training materials were consistently documented. Khalifa University (2023) noted inadequate culturally and linguistically appropriate diagnostic tools, with potential for misdiagnosis or underdiagnosis among Arabic-speaking older adults. This points to a broader gap in preparing the workforce, both formal healthcare professionals and informal caregivers to deliver dementia specific, culturally appropriate care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCollectively, the grey literature depicts a dementia care environment that is evolving but underdeveloped. National strategies embed dementia within broader ageing agendas without establishing it as a distinct health priority. Services exist in pockets through government hospitals, memory clinics, and private providers, but remain fragmented and lack coordination. Cultural and religious values position families as the primary caregivers - a framing that reflects genuine cultural strengths but simultaneously exposes systemic vulnerabilities when families lack support. The private sector is expanding to meet demand but operates independently of national planning. Community and academic initiatives contribute through awareness and research, but their efforts are episodic and unintegrated. Access to services differs by citizenship status, with expatriates largely dependent on private provision. Workforce preparation remains limited and unstandardised. Across all source types, these gaps were consistently noted: the absence of a national dementia strategy, insufficient dementia-specific services, limited workforce preparation, and inadequate support for family caregivers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo explore how these systemic patterns are experienced in practice, the next section presents findings from interviews with healthcare professionals working directly within the dementia care environment in the UAE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterviews with Healthcare Professionals\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile the grey literature analysis captures the formal landscape of policies, services, and initiatives, the interviews explored how dementia care is experienced by healthcare professionals working within the public healthcare sector. Table 2 provides an overview of participants\u0026apos; personal and professional characteristics and the original interview transcripts are displayed in the Supplementary File.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTranscripts were read iteratively, with initial codes generated inductively from the data. Codes were grouped into descriptive categories reflecting recurring patterns across participants\u0026apos; accounts. The analysis involved comparing across participants\u0026apos; accounts to identify similarities and differences in their experiences and perspectives. Findings are presented as narrative summaries that synthesise perspectives across participants, with illustrative quotations used selectively to anchor key points. Four descriptive categories were identified: (1) local research and prevalence data, (2) diagnostic pathways and management practices, (3) workforce preparation and training, and (4) day-to-day care practices and challenges.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Demographic characteristics of interview participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipant ID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional Role\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of Experience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eG1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSpecialist Geriatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eG2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConsultant Geriatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;27 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eG3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eConsultant Geriatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;25 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eG4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSenior Specialist Geriatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;13 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eRN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRegistered Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eRN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRegistered Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eRN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRegistered Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eRN4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eRegistered Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAssistant Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAssistant Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAssistant Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAN4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAssistant Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026gt;18 years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eLocal Research and Prevalence Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described dementia as substantially more prevalent than official figures suggest. Physicians estimated that between 40 and 75 percent of patients they encountered presented with some form of cognitive impairment, though these figures were based on clinical experience rather than documented data. Cognitive issues were often identified incidentally during assessments for falls or fractures rather than through targeted screening. As one physician observed, \u0026quot;the numbers are quite high\u0026hellip; it\u0026apos;s just that we don\u0026apos;t have enough data and research\u0026quot; to quantify them (G1). The absence of a health registry was consistently noted as a barrier to establishing prevalence: \u0026quot;we cannot find out the exact percentage of Dementia\u0026quot; (G3).\u003c/p\u003e\n\u003cp\u003eThe lack of local epidemiological data was attributed to time constraints and absent research infrastructure. Clinical demands left little opportunity for data collection, and research associates or protected scholarly time were not available. Physicians described conducting any research \u0026quot;out of clinical time,\u0026quot; which was \u0026quot;exhaustive\u0026quot; and \u0026quot;cumbersome\u0026quot; (G1). There was recognition that local evidence was needed rather than reliance on global figures, but competing demands precluded this: \u0026quot;no time\u0026hellip; our academic life was a long time ago\u0026quot; (G2).\u003c/p\u003e\n\u003cp\u003eGendered patterns in long-term care admissions were also noted. Female patients were described as more likely to remain at home with extended family, even in the absence of immediate children. One physician observed that \u0026quot;women are protected in the community\u0026quot; and that families were reluctant to admit women to institutional care (G3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Pathways and Management Practices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDiagnosis was described as typically occurring late in the disease trajectory, often after behavioural or cognitive problems had become unmanageable. Families frequently attributed memory decline to normal ageing and sought medical attention only when symptoms were severe, such as when patients \u0026quot;start to get lost\u0026quot; or exhibited \u0026quot;behavioural struggle\u0026quot; (G2). The availability of domestic support, including drivers and helpers who managed appointments and daily tasks, was identified as a factor that delayed recognition of impairment. One physician explained that when patients are \u0026quot;surrounded by all these kinds of support,\u0026quot; problems are discovered \u0026quot;later on\u0026quot; (G4).\u003c/p\u003e\n\u003cp\u003ePublic awareness of dementia services was described as limited. Families often did not know which specialists to consult, and the term \u0026quot;dementia\u0026quot; was unfamiliar to many, while \u0026quot;Alzheimer\u0026apos;s\u0026quot; was more widely recognised (G1). Awareness of a diagnosis could trigger stigma, with families sometimes reluctant to seek formal confirmation of what they already suspected (G3).\u003c/p\u003e\n\u003cp\u003eNeuropsychologists and clinical psychologists were not available in government facilities. Participants indicated that diagnosis was nonetheless achievable through clinical assessment by geriatricians or neurologists: \u0026quot;We don\u0026apos;t have a neuropsychologist, but we can diagnose dementia without a neuropsychologist\u0026quot; (G3). However, the absence of clinical psychologists limited post-diagnostic options. As one physician explained: \u0026quot;We don\u0026apos;t have a clinical psychologist on board. We don\u0026apos;t have other support personnel, so our options here are we will directly start off with medications\u0026quot; (G1). Management thus often commenced pharmacologically following clinical diagnosis.\u003c/p\u003e\n\u003cp\u003eManagement of behavioural changes associated with dementia relied heavily on antipsychotic medication. Physicians estimated that 60 to 70 percent of patients exhibiting agitation or aggression received antipsychotics (G1). A stepwise approach was described: physical causes such as infection, pain, or constipation were ruled out first, followed by non-pharmacological strategies, with medication used when these approaches proved insufficient. However, antipsychotic use was also described as serving a dual purpose. Beyond managing patient symptoms, alleviating family burden beyond addressing behavioural changes. One physician acknowledged that at advanced stages, \u0026quot;the family maybe is the number one target for me\u0026quot; and that medication was sometimes prescribed \u0026quot;to relieve the family\u0026quot; (G4).\u003c/p\u003e\n\u003cp\u003eFamily involvement in care was consistently described as central, reflecting cultural values of filial responsibility. Physicians rated family dedication highly and noted that government leave provisions facilitated caregiving. At the same time, an increasing reliance on domestic helpers and private home-care agencies was evident, particularly among Emirati families. One physician estimated that 95 percent of Emirati patients had care provided through nursing agencies, with family members \u0026quot;supervising\u0026quot; rather than providing direct care (G1, G2). For non-Emirati patients, family members - typically spouses or children - remained primary caregivers.\u003c/p\u003e\n\u003cp\u003eLanguage barriers were described as manageable in government facilities due to mixed staffing. Care teams included Arabic-speaking staff who assisted with communication, and this arrangement was described as effective: \u0026quot;keeping one of the [Arabic-speaking] staff is the magic technique\u0026quot; (G4). Occasional challenges with patients who spoke only Arabic were acknowledged, but these were addressed through team collaboration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWorkforce Preparation and Training\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDementia-specific training was described as limited across the care team. Nurses and assistant nurses reported receiving no specialised dementia-related education as part of their nursing training or upon employment. One nurse stated plainly: \u0026quot;dementia is not a topic, a special topic that we cover\u0026quot; (RN2). Another confirmed the absence of dementia-specific training when commencing employment (RN3). A physician summarised: \u0026quot;Nothing special [for] nurses. Routine stuff\u0026quot; (G2). Orientation programmes were described as brief and general, covering routine procedures rather than dementia-specific care. Physicians reported receiving dementia exposure as part of their residency programmes, including rotations with inpatients and home visits to patients with cognitive impairment. However, this was described as part of general geriatric education rather than specialised dementia care preparation.\u003c/p\u003e\n\u003cp\u003eCommunication gaps between members of the care team were evident. Nurses and assistant nurses described learning about patients\u0026apos; diagnoses by reading records or asking physicians rather than through formal handover. Psychosocial concerns were frequently delegated to social workers, who were described as responsible for emotional support and family communication. This reflected both role boundaries and language considerations, with Arabic-speaking social workers better positioned to communicate with patients and families.\u003c/p\u003e\n\u003cp\u003eFamiliarity with person-centred care concepts was limited, and terminology was often conflated with patient-centred care. When asked directly, one physician responded: \u0026quot;Patient-centred care? Person-centred care? Sorry, no\u0026hellip;We are trying to do all our intervention and care just for what is good for the patient\u0026quot; (G4). Another initially expressed unfamiliarity - \u0026quot;I\u0026apos;m not familiar with that in practice, except maybe I\u0026apos;m doing it, but I don\u0026apos;t know that is the terminology\u0026quot; (G2) - before describing geriatric care in broad terms as \u0026quot;whole person-concerned, holistic application,\u0026quot; though without reference to formal frameworks or operational guidelines (G2). A third physician acknowledged uncertainty about whether specific policies governed person-centred approaches: \u0026quot;I don\u0026apos;t know if there are any particular guidelines or any particular policies that are followed about it\u0026quot; (G1).\u003c/p\u003e\n\u003cp\u003eDespite limited familiarity with formal frameworks, nurses and assistant nurses described small acts of personalisation in their daily practice. These included offering choices, adjusting approaches based on patients\u0026apos; moods, and recognising non-verbal cues. One assistant nurse described respecting a patient\u0026apos;s refusal of medication: \u0026quot;if he doesn\u0026apos;t like, we will not force him, because you know we know this is [a] human being\u0026quot; (AN3). Another described reading facial expressions to detect pain or distress (AN2). These accounts suggested that elements of person-centred practice were present in routine care, even if not articulated in formal terms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDay-to-Day Care Practices and Challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysicians described a systematic approach to managing behavioural changes: first ruling out physical triggers such as infection, pain, or constipation; then attempting non-pharmacological strategies; and resorting to medication only when other approaches failed or safety was at risk. One physician summarised the approach: \u0026quot;if there isn\u0026apos;t an[y] identifiable trigger\u0026hellip; you have to push this into being the agitation associated with dementia\u0026quot; (G1). Another emphasised keeping patients \u0026quot;surrounded by familiar faces\u0026quot; and using medication only when the patient posed a risk to himself or others (G4).\u003c/p\u003e\n\u003cp\u003eNurses and assistant nurses described relying on teamwork to address challenges. When their own interventions were insufficient, they called on social workers, physicians, or Arabic-speaking colleagues. Social workers were described as responsible for psychological support, and language considerations reinforced this division of labour. This reliance reflected both collaborative practice and the absence of dementia-specific training that might equip nurses to address psychosocial needs directly.\u003c/p\u003e\n\u003cp\u003eThe absence of community-based respite services was identified as a significant gap. Physicians described family caregiving as exhausting over the long term and suggested that daycare centres or temporary respite facilities would provide relief without requiring permanent institutional placement. One physician noted that while Emirati culture was \u0026quot;not pro\u0026quot; long-term care homes, temporary respite might be more acceptable and could offer \u0026quot;a more uniform way of caregiving\u0026quot; than current arrangements (G1). Another suggested that dedicated dementia facilities, if properly framed, need not be seen as abandonment but as a means to help families (G2).\u003c/p\u003e\n\u003cp\u003eNurses and assistant nurses described particular difficulty with patients in the early stages of dementia, whose needs were less predictable and whose communication was more variable. One nurse described early-stage dementia as \u0026quot;difficult to manage\u0026quot; (RN1). Interpreting patients\u0026apos; attempts to communicate was challenging, and uncertainty about how to address emotional needs was acknowledged. Physical demands were also noted: patients who walked continuously, who forgot to swallow food, or who denied having been fed moments after eating. One assistant nurse described the emotional toll: \u0026quot;when you explain to them [but] they are not able to talk, then you will feel bad. You want to help them\u0026hellip; but cannot\u0026quot; (RN4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross the interviews, participants described a care environment characterised by high but undocumented prevalence, delayed diagnosis, reliance on antipsychotic medication, limited dementia-specific training, and family-centred care arrangements increasingly supplemented by private care agencies. Physicians emphasised systemic issues, including the absence of local data, the shortage of specialists, the lack of respite services, while nurses and assistant nurses focused on the practicalities of daily care and the challenges of responding to patients whose needs they could not always interpret or address. Person-centred care concepts were unfamiliar in formal terms, though small acts of personalisation were evident in routine care practice. Together, these accounts depict a workforce navigating dementia care with limited infrastructure, training, and support, while remaining committed to the wellbeing of patients and families within the constraints of the current system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntegration of Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral patterns recurred across the analyses of both grey literature sources and interviews with healthcare professionals: the absence of dementia-specific policy recognition, fragmented and uncoordinated services, the centrality of families in caregiving, reliance on private providers and domestic helpers, and gaps in workforce training. The consistency of these patterns across documented policies and lived professional experience strengthens confidence in the findings.\u003c/p\u003e\n\u003cp\u003eAt the same time, each component made distinctive contributions. The grey literature captured the formal dementia care landscape: national policies that address ageing without naming dementia, service announcements that lack detail on continuity or care pathways, episodic NGO and academic initiatives, and the stratification of access by citizenship status. The interviews added experiential depth: late diagnosis resulting from delayed help-seeking and navigation challenges, antipsychotic use serving the dual purpose of managing patient symptoms and alleviating family burden, communication gaps within care teams, unfamiliarity with person-centred care terminology despite evidence of personalised practice, and the absence of community-based respite services.\u003c/p\u003e\n\u003cp\u003eWhere the grey literature documented fragmentation, the interviews described its consequences. Where the grey literature noted family centrality as a policy framing, the interviews revealed how this plays out in practice - families supervising nurses from care agencies, cultural expectations shaping care arrangements, and the implications of long-term caregiving without respite. Together, these components provide a layered account that neither source could offer alone: a formal mapping of the landscape and an experiential account of navigating it. These findings establish a baseline understanding of the dementia care environment in the UAE and identify key issues that warrant closer consideration in the discussion that follows.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study set out to produce a comprehensive account of dementia care in the United Arab Emirates through an environmental scan that combined analysis of UAE-focused grey literature with interviews with healthcare professionals directly engaged in dementia care delivery. The findings presented in the preceding section capture both the formal landscape of policies, services, and initiatives and the perspectives of those navigating that landscape in daily practice. In the discussion that follows, these findings are interpreted in relation to existing research, policy frameworks, and cultural considerations. Particular attention is given to how the two components inform and contextualise one another, the implications for service delivery and policy development in the UAE, and the ways in which this study contributes to the broader understanding of dementia care in the region.\u003c/p\u003e\n\u003cp\u003eThe interpretation of these findings requires situating them within the broader context of regional realities and international literature. By bringing together evidence from documented policies and the perspectives of healthcare professionals, this analysis highlights recurring patterns that converge on four main issues: policy invisibility, service fragmentation, family centrality, and workforce training deficits. The findings from the two components are not uniform; they vary in emphasis, with some patterns appearing strongly in practice but absent in formal documentation, and others framed positively in policy discourse but contested in lived accounts. This variability is itself analytically significant, underscoring how dementia care in the UAE is constructed differently across knowledge domains. The following discussion evaluates these patterns, explores their convergences and divergences, and considers their implications for policy, research, and practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOverview of Key Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings from this study provide a layered account of dementia care in the UAE. The analysis of grey literature captured the formal landscape, revealing the presence of national policies addressing older adult wellbeing, local health authority programmes, NGO activities, and scattered awareness and training efforts, but also exposing important gaps: the absence of dementia-specific policy recognition, uneven practices and documentation across public and private sectors, and limited coordination across services (Javaid et al., 2021; 2025; Mowafi et al., 2025). Analysis of the interviews added experiential depth, highlighting barriers such as insufficient dementia-specific training (Mowafi et al., 2025; Yaghmour et al., 2019), limited institutional support (Kane et al., 2021; Javaid et al., 2021), and reliance on families and domestic workers for care (Hussein \u0026amp; Ismail, 2017; Kane et al., 2021; Qassem et al., 2023). Taken together, these two components converge to show that while the UAE has strong health infrastructure and a policy environment supportive of innovation, dementia care services remain fragmented, under-documented, and heavily dependent on informal systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrey Literature Findings in Context\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings from the grey literature analysis highlight persistent gaps in dementia-specific strategies in the UAE and underscore the need for structured education and training frameworks for healthcare staff (Javaid et al., 2021; Mowafi et al., 2025). They also point to the importance of enhancing existing services to strengthen care practices and better align emerging initiatives with broader policy aspirations. While grey sources documented scattered services and programmes across government bodies and NGOs, they also revealed inconsistency in availability and coordination. National policies addressed older adult wellbeing, dignity, and inclusion but did not name dementia as a distinct priority requiring dedicated resources or planning. This absence of dementia-specific policy recognition suggests that dementia remains a relatively underdeveloped domain (Javaid et al., 2021) within the UAE\u0026apos;s otherwise advanced healthcare system (Goonetilleke, 2025).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe grey literature also documented the growth of private provision: licensed home-care agencies and private hospitals offering dementia-related services operating independently of national planning. This market-driven expansion reflects responsiveness to unmet need but raises questions about standardisation, quality assurance, and equity of access. The stratification of services by citizenship status, with government entitlements specified for Emirati citizens and expatriates largely dependent on private provision, emerged as a significant structural feature of the care landscape.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterview Findings in Context\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interviews provided practice-based perspectives that illustrated how systemic limitations translate into daily care routines. Across the descriptive categories, a picture emerges of dementia care that is both resource-constrained and fragmented (Kane et al., 2021; Mowafi et al., 2025). The absence of local research capacity and limited dementia-specific training available to healthcare professionals (Javaid et al., 2021; Mowafi et al., 2025) were reflected in reliance on pharmacological solutions such as antipsychotic use when non-pharmacological alternatives were both unknown and inaccessible.\u003c/p\u003e\n\u003cp\u003eCultural expectations of family-led care coexisted with growing reliance on domestic helpers and private home-care agencies. Physicians described families supervising agency nurses rather than providing direct care, while noting that cultural expectations continued to shape help-seeking behaviour and care arrangements. The concepts of personhood and person-centred care were unfamiliar in formal terms, frequently conflated with patient-centred care or upheld superficially in ways that were difficult to operationalise in practice (Kitwood, 1997; Brooker, 2003). Despite this, nurses and assistant nurses described small acts of personalisation of care, such as offering choices, reading non-verbal cues, and adjusting approaches based on patients\u0026apos; moods that suggested elements of person-centred practice were present even without formal frameworks.\u003c/p\u003e\n\u003cp\u003eSeveral accounts described how antipsychotics were prescribed not only to manage agitation and aggression in patients but also to relieve the strain experienced by family caregivers. In such cases, prescribing was framed as a pragmatic response to the dual challenge of supporting the person living with dementia and addressing the demands placed on families, indicating that treatment decisions were influenced by caregiver strain as much as by clinical presentation (Ballard \u0026amp; Aarsland, 2021; Levy et al., 2012).\u003c/p\u003e\n\u003cp\u003eThe analysis also revealed differences in emphasis across participants: physicians focused on systemic issues such as the absence of local data, the shortage of specialists, and the lack of respite services, while nurses and assistant nurses focused on the practicalities of daily care and the challenges of responding to patients whose needs they could not always interpret or address. Together, these perspectives depict a dementia care landscape shaped simultaneously by systemic constraints, professional competencies, ethical considerations, and pragmatic responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntegration of Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross the two components, dementia surfaces as largely invisible in formal national planning. The grey literature documented national strategies framed around wellbeing and care for older adults without naming dementia directly (UAE Government Portal, n.d.; UAE Legislation Portal, 2025; National Strategy for Wellbeing 2031). The interviews added nuance: while some participants expressed concern about the unavailability of country-specific research and statistics, others focused on immediate challenges such as service accessibility and workforce preparedness.\u003c/p\u003e\n\u003cp\u003eDespite differences in emphasis, both components consistently point to systemic barriers. The grey literature documented the availability of memory clinics, geriatric units, and outpatient neurology services but rarely linked them into clear care pathways. The interviews described the consequences of this fragmentation: delayed diagnoses, families unsure where to seek help, reliance on medication to manage what systems cannot support, and a workforce operating without dementia-specific preparation. These accounts suggest that while the service landscape is expanding, its unevenness and limited coordination leave care recipients navigating an opaque system.\u003c/p\u003e\n\u003cp\u003eA strong pattern running through both components is the centrality of family in dementia care. Policy documents and media coverage often celebrate family duty as a cultural strength (UAE Government Portal, n.d.; UAE Legislation Portal, 2025), and the interviews affirmed that caregiving is often seen as a moral and religious obligation. However, participants also highlighted the difficulty of balancing cultural expectations with practical realities. This contrast points to a disjuncture between policy and public discourse, which frames family support in idealised terms, and lived experiences, where the absence of structural support turns a cultural value into a source of vulnerability (Qassem et al., 2023; Sharif et al., 2024).\u003c/p\u003e\n\u003cp\u003eThe role of non-governmental actors appears inconsistent and often peripheral. The grey literature documented awareness campaigns, university-led events, and private training initiatives, but these efforts were episodic and lacked integration into national planning. The interviews highlighted the need for respite and community-based services that do not currently exist. This unevenness underscores the potential of non-governmental contributions but also their limitations when left outside national coordination.\u003c/p\u003e\n\u003cp\u003eThe findings also reveal glimpses of optimism: references to new memory clinics, awareness campaigns, and training initiatives suggest that momentum is building, albeit unevenly. The challenge, therefore, appears to lie less in the absence of activity and more in the absence of coherence, integration, and cultural tailoring. Taken together, these patterns depict dementia care in the UAE as a field that is evolving - increasingly visible in discourse and services yet constrained by fragmentation and lack of national coordination. Where policy and public discourse frame family caregiving positively, interviews reveal its challenges, and where new services are promoted, care professionals describe the public\u0026apos;s difficulty in accessing them. This complexity suggests that dementia care is at a transitional stage - no longer invisible, but not yet fully integrated into health and social care systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePolicy and Cultural Dimensions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings underscore the extent to which dementia care in the UAE is shaped by cultural norms and governance structures that distinguish between citizens and expatriates. Family-led care remains the dominant model, rooted in cultural and religious expectations of filial duty and reinforced by the limited availability of institutional alternatives (Kane et al., 2021). While this aligns with long-standing traditions of family caregiving in the Gulf, it also places considerable strain on households, particularly as the ageing population increases (Qassem et al., 2023). The growing reliance on domestic helpers and private healthcare agencies introduces additional complexities, including variability in training, language and cultural barriers, and limited familiarity with dementia-specific needs (Mowafi et al., 2025).\u003c/p\u003e\n\u003cp\u003eAt the policy level, the UAE reflects the broader Gulf model of citizen-centric welfare provision, where nationals are entitled to comprehensive, government-funded health and social services, while expatriates access care primarily through employer-sponsored health insurance (AlRuthia et al., 2025; Koornneef et al., 2017; Lowe et al., 2024). This structural arrangement means that expatriate families, who constitute the majority of the UAE population, often face limited access to dementia-specific services unless they can afford private care. From a Western welfare-state perspective, such arrangements may appear inequitable, but in the Gulf context, they reflect a governance model that prioritises citizens as the primary beneficiaries of state-funded welfare (Hertog, 2025). Within this model, expatriates rely on employment-based or private-sector provision, resulting in marked variation in service accessibility and continuity.\u003c/p\u003e\n\u003cp\u003eThe absence of a national dementia strategy further compounds these challenges (Mowafi et al., 2025; Qassem et al., 2023). Although policy aspirations for improved care of older citizens have been articulated in various government visions and health strategies (UAE Government Portal, 2025), dementia-specific planning remains fragmented. This policy gap contributes to reliance on ad-hoc initiatives by individual emirates, private institutions, or NGOs, leading to uneven service availability (Javaid et al., 2021; 2025). Together, these findings suggest that any meaningful expansion of dementia care in the UAE must navigate the intersection of cultural expectations, demographic pressures, and citizen-expatriate distinctions while advancing toward more integrated and dementia-specific policy frameworks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContribution of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study makes several contributions to the understanding of dementia care in the UAE. First, it represents the first comprehensive environmental scan of dementia care services in the UAE, integrating evidence from grey literature sources and perspectives with healthcare professionals. By examining findings from both documented policies and professional experiences, the study provides a more complete picture of the UAE dementia care landscape than either source could offer alone, capturing both formal structures and the realities of navigating them.\u003c/p\u003e\n\u003cp\u003eSecond, the study addresses a critical evidence gap. Research on dementia care in the Gulf remains fragmented and often limited to narrow foci such as caregiver burden, genetic factors, and pharmacological management, with little attention to systemic service delivery or national-level strategies (Mowafi et al., 2025). By generating UAE-specific evidence from grey literature and experiential accounts from healthcare professionals, the present study consolidates baseline evidence that has not previously been assembled.\u003c/p\u003e\n\u003cp\u003eThird, the study advances understanding of how cultural and policy contexts shape dementia care. It demonstrates that the governance model distinguishing citizens from expatriates has direct implications for access and entitlement, while cultural expectations of family care continue to structure day-to-day practices (Kane et al., 2021). Bringing these dimensions together underscores the importance of designing dementia care strategies that are not only evidence-based but also culturally and contextually grounded (Mowafi et al., 2025).\u003c/p\u003e\n\u003cp\u003eFinally, by producing baseline data on the scope, distribution, and challenges of dementia care services in the UAE, this study offers a foundation for future policy development, workforce training initiatives, and the design of culturally appropriate dementia care services (Javaid et al., 2021). It provides both a descriptive map of the current landscape and a foundation for future action.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several notable strengths. It is the first to undertake a comprehensive environmental scan of dementia care services in the UAE, combining systematic analysis of grey literature with interviews. The use of two complementary data sources allowed findings from policy documents, service descriptions, and practitioner perspectives to be examined together while preserving the distinctiveness of each. Methodological transparency was maintained through the use of structured extraction frameworks and detailed documentation of sources.\u003c/p\u003e\n\u003cp\u003eBoth components were analysed using a qualitative descriptive approach (Sandelowski, 2000; 2010), which prioritises comprehensive summary and low-inference interpretation. This approach is well-suited to applied health services research where the aim is to describe phenomena and identify patterns relevant to practice and policy (Kim et al., 2017). Findings were generated inductively through iterative engagement with the data, and attention was paid to both consistencies and tensions across accounts. The convergence of key patterns across both components, including the absence of dementia-specific policy recognition, service fragmentation, family centrality, and workforce training gaps, strengthens confidence in the findings.\u003c/p\u003e\n\u003cp\u003eAt the same time, certain limitations should be acknowledged. Grey literature searches are inherently incomplete and time-bound, and it is possible that some relevant local initiatives were not captured (Adams et al., 2017; Paez, 2017; Pedersen et al., 2023). The sample for the interest-holder interviews was relatively small and focused on healthcare professionals in the public sector, which means that perspectives from private sector providers, family caregivers, people living with dementia, and policymakers were not directly represented. The study\u0026apos;s focus on the UAE limits the generalisability of findings to other countries, although the patterns identified are likely to resonate in contexts with similar demographic and governance structures, such as the other Gulf states.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Practice, Policy, and Research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study carry several implications for practice, policy, and future research. At the practice level, the limited dementia-specific training identified across both components underscores the need for structured dementia care education programmes (Mowafi et al., 2025). Enhancing the competencies of healthcare professionals is essential to reduce reliance on pharmacological interventions and promote non-pharmacological, person-centred approaches to dementia care. Support for family caregivers also requires strengthening, whether through dementia care training, counselling, or respite services (Kane et al., 2021).\u003c/p\u003e\n\u003cp\u003eAt the policy level, the absence of a coordinated national dementia strategy in the UAE represents a critical gap (Mowafi et al., 2025). While sector-specific initiatives and NGO activities demonstrate promising efforts, they remain fragmented and uneven in scope. Developing a comprehensive, integrated dementia strategy at the federal level would provide the structure needed to harmonise existing initiatives, align them with international standards, and ensure equitable access across the country. Such a strategy should also explicitly address the distinct needs of expatriate populations, who constitute the majority of the UAE\u0026apos;s residents but often fall outside citizen-centric entitlement frameworks (Lowe et al., 2024).\u003c/p\u003e\n\u003cp\u003eAt the research level, this study highlights the need for systematic investigation of dementia care services and practices in the region. Future research should move beyond descriptive mapping to develop and evaluate tailored dementia care interventions, assess the impact of culturally adapted training and awareness programmes, and explore innovative care models suited to the region\u0026apos;s contexts (Mowafi et al., 2025). Longitudinal studies are needed to capture the evolving needs of persons living with dementia and their families, while cross-country comparisons within the Gulf region could help identify transferable practices and policy lessons.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study provides the first comprehensive environmental scan of dementia care in the United Arab Emirates, drawing together evidence from UAE-specific grey literature and the perspectives of healthcare professionals. The findings reveal a landscape that is simultaneously marked by strong health infrastructure and policy ambitions yet constrained by fragmented services, the absence of dementia-specific policy recognition, reliance on family and informal caregivers, and limited dementia-specific training and education. The structural distinction between citizens and expatriates further shapes access and provision, highlighting the need for coordinated, culturally informed approaches to dementia care. By consolidating diverse sources of evidence, this study establishes a baseline that can guide future research, policy development, and dementia care education, while also offering insights of relevance to other Gulf states facing similar demographic and cultural dynamics.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethics approval was granted by the Dubai Scientific Research Ethics Committee (DSREC) of the Dubai Health Authority (initial approval: DSREC-SR-03/2023_06; annual renewal: DSREC-SR-05/24_08; additional study site: DSREC-SR-07/24_01) and the University of Reading Research Ethics Committee (UREC 23/07). All participants received information sheets and provided written informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants provided written consent for publication of anonymised quotations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeada Kassie conceptualised and designed the study, conducted the grey literature search and analysis, conducted and transcribed the interviews, performed qualitative descriptive analysis, and wrote the manuscript. Arlene Astell supervised the research and critically reviewed the initial draft. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Ms. Menatalla Abdelghani, Ms. Drishti Meghnani, Ms. Angel Donasco, and Ms. Shifa Said for assisting with the transcription of the interviews. They also would like to thank the physicians, nurses, and assistant nurses who participated in the individual and focus group interviews.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e4get-me-not Alzheimer\u0026apos;s Organization. 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(2021). \u0026lsquo;Every day is a challenge\u0026rsquo;: Expatriate acculturation in the United Arab Emirates. \u003cem\u003eInternational Journal of Cross Cultural Management\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(3), 430-451. https://doi.org/10.1177/14705958211039071 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTse, M. M. Y., Hartanto, E. C. P., \u0026amp; Enguidanos, S. (2019). Dementia care in the United Arab Emirates. In M. Downs \u0026amp; B. Bowers (Eds.), \u003cem\u003eDementia care: International perspectives\u003c/em\u003e. Oxford University Press. https://academic.oup.com/book/25044/chapter-abstract/189131943\u003c/li\u003e\n \u003cli\u003eUAE Government Portal. (2025). \u003cem\u003eElderly care services.\u003c/em\u003e https://u.ae/en/information-and-services/social-affairs/elderly-care [Accessed December 2025]\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUAE Government Portal. (n.d.). \u003cem\u003eHealth policy and laws\u003c/em\u003e. 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Environmental scanning as a public health tool: Kentucky\u0026apos;s human papillomavirus vaccination project. \u003cem\u003ePreventing Chronic Disease, 13\u003c/em\u003e, E109. https://doi.org/10.5888/pcd13.160165\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYaghmour, S. M., Bartlett, R., \u0026amp; Brannelly, T. (2019). Dementia in Eastern Mediterranean countries: A systematic review. \u003cem\u003eDementia, 18\u003c/em\u003e(7\u0026ndash;8), 2635\u0026ndash;2661. https://doi.org/10.1177/1471301217753776\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dementia care, environmental scan, United Arab Emirates, health policy and services, qualitative description analysis, workforce preparation, family caregiving, national dementia strategy","lastPublishedDoi":"10.21203/rs.3.rs-8468740/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8468740/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Dementia care in the United Arab Emirates remains poorly documented despite the country's advanced healthcare infrastructure and rapidly ageing population. The absence of a national dementia strategy, combined with limited local research, leaves policymakers and practitioners without baseline evidence to guide service development. Cultural expectations position families as primary caregivers, yet how families navigate this responsibility has not been systematically documented. This study produced the first comprehensive environmental scan of dementia care in the UAE, mapping services, policies, workforce preparation, and caregiving contexts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: A two-component environmental scan was conducted. Grey literature sources were systematically identified and analysed, including government policies, health authority documents, service descriptions, and materials from non-governmental organisations; sixty-one sources published between 2017 and 2025 were included. Semi-structured interviews were conducted with twelve healthcare professionals working in dementia care settings. Both components of the data were analysed using a qualitative descriptive approach, with patterns identified inductively and integrated across sources.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Several patterns converged across both components: the absence of dementia-specific policy frameworks, fragmented and uncoordinated services, gaps in workforce training, and the centrality of families in caregiving amid limited formal support. National policies addressed older adult wellbeing without naming dementia, and services operated without clear care pathways. Interviews revealed delayed diagnoses attributed to the perception of cognitive decline as a normal part of ageing, reliance on pharmacological management, and the absence of community-based respite services. Families increasingly relied on domestic helpers and private homecare providers, taking supervisory roles rather than delivering care directly. Professionals were unfamiliar with person-centred care as a concept and lacked formal training in dementia-specific care approaches.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: Dementia care in the UAE is characterised by strong health infrastructure but fragmented dementia-specific services, limited workforce preparation, and heavy reliance on families and private care service providers. The absence of a national dementia strategy represents a critical gap. These findings provide baseline evidence to inform policy development, workforce training, and culturally informed service design that acknowledges the realities of family caregiving.\u003c/p\u003e","manuscriptTitle":"Dementia care in the United Arab Emirates: An environmental scan of services, policy, workforce, and caregiving contexts","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 08:35:06","doi":"10.21203/rs.3.rs-8468740/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-04T05:02:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-02T07:38:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-27T12:26:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-21T03:31:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74706233792167601719866564953517444592","date":"2026-01-16T07:26:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169079045693913655773092290290096071227","date":"2026-01-15T20:55:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161202842201185384787573106091452024275","date":"2026-01-15T17:11:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146941311927983498286248560281609917285","date":"2026-01-15T08:01:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-15T07:55:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-15T07:14:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-12T05:14:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-10T07:03:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-01-10T06:59:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a5f6754-2c91-4ff2-9b3c-bc37c33d3ee8","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T07:10:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 08:35:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8468740","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8468740","identity":"rs-8468740","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}

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