Dementia care research is embracing intersectionality—but power dynamics remain largely unexamined

When Kimberlé Crenshaw coined intersectionality in 1989, she was describing how racism and sexism do not simply add together in the lives of Black women—they multiply, producing forms of disadvantage that neither concept alone can explain. Nearly four decades later, that idea has finally begun to reshape how scientists study dementia care. A new scoping review published in Frontiers in Dementia maps a decade of intersectional research in the field, and its findings reveal both a genuine conceptual shift and a stubborn analytical gap: researchers are naming intersecting identities, but they are rarely dissecting the power structures that turn those identities into inequity.

The review, led by Martina Roes of the German Center for Neurodegenerative Diseases and colleagues across Europe, set out to answer a deceptively simple question: which intersectionality frameworks have actually been applied in dementia care research published between 2015 and 2025? The team followed Arksey and O’Malley’s six-stage scoping review methodology, extended with PRISMA reporting guidelines, and searched six databases—PubMed, PsycINFO, Scopus, CINAHL, Embase and Web of Science. Their search string combined terms for dementia and Alzheimer’s disease with terms for intersectionality, structural inequality, migrants, minority groups and social determinants, and then with care-related and framework-related vocabulary. From 870 retrieved articles, 320 duplicates were removed, 550 went through title and abstract screening, and 110 survived to full-text review. Thirteen articles ultimately met the inclusion criteria, which required a clear link to dementia care, an intersectional framework or intersectional focus, and publication in English or German.

The framework counts tell their own story. Crenshaw’s original concept was cited in eight of the included publications, McCall’s framework in seven, and Hankivsky’s and Collins’s frameworks in three each. McCall’s contribution is particularly important for the technical architecture of the field: she distinguished anti-categorical, inter-categorical and intra-categorical approaches to studying inequality. Anti-categorical analysis questions the very categories society uses; inter-categorical analysis compares patterns across groups defined by existing categories; and intra-categorical analysis zooms in on a single marginalized intersection to examine it in depth. Hankivsky’s Intersectionality-Based Policy Analysis extends the lens to power relations and operational structures across micro, meso and macro levels, while Collins defines intersectionality as a critical social theory built on constructs such as relationality and complexity. Bowleg’s public health perspective, which emphasizes how interlocking systems of power and oppression shape lived experience, rounds out the theoretical toolkit.

Why does this matter for dementia specifically? The review’s authors argue that dementia is not only a neurodegenerative disease but also a social construct—a label that shapes how people living with dementia are treated by society. Experiences such as stigma, the removal of autonomy and citizen rights, and the dismissal of personhood and decision-making capacity suggest that the diagnosis itself interacts with social positioning. The experiences of people living with dementia are heterogeneous and differ at the intersection of axes of identity such as age and ethnicity, social geography such as where one lives, and societal context such as income. Analyzing these complex individual experiences through an intersectional lens can uncover inequalities that would otherwise remain invisible within the health care system.

The target groups of the included studies clustered around migrants, ethnicity and race, and sex and gender. One qualitative study of migrant family carers used life-story interviews and shadowing to show how gender, migration trajectories, class and legal status interact to distribute and constrain care roles—revealing that migrant women more often work as unpaid carers while navigating precarious employment and restrictive welfare services. Another study applying Collins’s framework to ethnographic observations in UK acute hospitals found that privilege and marginalization are products of power dynamics between identity axes and institutional regulations, with institutional power systems driving inequalities in whether care needs are even recognized. A Canadian interview study of immigrants living with dementia and their caregivers identified how racism, cultural norms, immigration histories and cognitive impairment interact to produce layered stigma, social exclusion and barriers to support.

Quantitative work appeared too, though in limited form. A logistic regression analysis of informal caregivers found that ethnicity and gender intersections yield distinct caregiving burdens, calling for tailored interventions. A US study of geographic patterns of dementia used a life-course and social health-disparity lens to show that disadvantage is embedded within place of residence, place of birth and subpopulation groupings. And a selective literature review on Black female Americans with Alzheimer’s disease examined how social and biological factors—poverty, education, discrimination, allostatic load, vascular risk factors, access to care and under-representation in trials—intersect with female biological sex and Black American race to increase disease risk. Studies of sexual and gender minority older adults with dementia found compounded discrimination at individual, interpersonal and institutional levels, with risk magnified for those who are also transgender, racially minoritized or HIV-positive, and with facility and staff knowledge often remaining inadequate.

Here is the review’s most striking technical finding: none of the thirteen included articles directly addressed power dynamics with a specific intersectional focus. The authors searched each study for mentions and descriptions of power relations between axes of identity and the social or health care system, and found that detailed analysis of how power operates within the healthcare system or society was mostly not conducted—or only mentioned as a need. Most studies treated race, ethnicity, migration status, sex, gender, age or socioeconomic status more as separate covariates or descriptive subgroups than as interlocking categories embedded in systems of power. The review distinguishes inequality, an unequal distribution of resources, from inequity, which refers to unfairness and injustice produced by human behavior, social structures and policies—and is therefore avoidable. The included studies documented inequities in access to diagnosis and services, in care burden, in double discrimination, and in institutional ignorance, but rarely traced them back to the power structures that produce them.

The authors identify four research gaps: underrepresentation of minority groups in dementia care research, a primary focus on intersections rather than underlying power dynamics, unclear methodology for how frameworks are applied, and undefined theoretical backgrounds. They also call for critical reflection on the coloniality of power and its ongoing impact on knowledge production—including Eurocentric diagnostic norms, care models, research priorities and dementia strategies in Europe. Without this reflection, psychosocial interventions will not be tailored to care recipients with intersecting marginalized identities, and assessments will lack validation for diverse populations. The review notes that almost all included articles combined at least two intersectionality frameworks, but methodological details on how the frameworks were operationalized were missing—with one exception, a study theorizing intersectionality and cultures of control in acute hospital settings.

The recommendations are concrete. Methodologically, the authors urge moving beyond simple group comparisons toward analyzing the combined impact of overlapping intersections—for example, living in a rural and poor neighborhood with a biography of migration—on patient-related outcomes. They highlight MAIHDA, multilevel analysis of individual heterogeneity and discriminatory accuracy, as a quantitative intersectional approach to socio-demographic inequalities, alongside mixed-method designs that capture the how and why of intersecting experiences. Structurally, they call for analyzing how structural determinants impact disparities in dementia incidence, prevalence, diagnosis, treatment and care, including the double jeopardy faced by people holding multiple marginalized identities. And in research design, they recommend rethinking recruitment strategies for populations facing high levels of inequity—LGBTQI+ communities, ethnic minority groups, indigenous communities—through community-based participatory research, which ensures that research topics are relevant to marginalized communities, and developing longitudinal datasets to understand structural determinants such as neighborhood deprivation.

As a first attempt to critically analyze the application of intersectionality frameworks in dementia care research, the review offers a clear benchmark for what genuine intersectional power analysis would require: an explicitly defined system such as sexism or migration regulations that interlocks with observed outcomes of oppression; a connection between individual experiences such as stigma and exclusion and organizational norms, admission practices, national dementia plans and professional guidelines; and an understanding of identity axes and power dynamics as historically situated and relational. The authors believe the recent increase in intersectional adoption will enable research that analyzes not only social categories but also the dynamics and relations between them, embedded in specific context and produced by their conjunction. For a field built on the principle that real lives are too complex for single-lens analysis, that is the direction the evidence now points.

Subject of Research: Use of intersectionality frameworks in dementia care research over the past decade

Article Title: Mapping intersectionality in dementia care research: a decadal scoping review

Article References: Roes, M., Laporte Uribe, F., Felding, S. A., Charlesworth, G., Müller, N., Berdai, S., Bhatt, J., Altinok, K., & Peters-Nehrenheim, V. (2026). Mapping intersectionality in dementia care research: a decadal scoping review. Frontiers in Dementia, 5, Article 1779670. https://doi.org/10.3389/frdem.2026.1779670

Image Credits: AI Generated

DOI: 10.3389/frdem.2026.1779670

Keywords: dementia, dementia care, intersectionality, scoping review, health disparities, power dynamics, health equity, migrants, sex and gender, Crenshaw, research gaps, caregiving