Current state of Dementia Management Within the South African Public Healthcare system: A Scoping Review

Background: Dementia is a primary cause of disability and dependence among older adults worldwide, with cases increasing most rapidly in low- and middle-income countries. In South Africa, the ageing population faces growing dementia needs, but current management systems remain fragmented and under-resourced. Aim: To review and summarise how dementia is currently managed in South Africa, covering its prevalence, causes, diagnosis, treatment, care, and the health system and policy responses. Methods: We conducted a broad review in accordance with established methods and reporting guidelines. We searched both published and unpublished sources from 2000 to 2024 across multiple databases and websites. Two reviewers independently screened and extracted data. Findings were summarised in text and organised into topic-based tables. Results: Twelve studies and relevant grey literature were included. Among adults aged 60 and older, the prevalence of dementia ranges from approximately 8% to 12%. This highlights the need for additional resources to improve dementia management. Expanding screening programs, notably in underserved areas, could help guarantee equitable access and earlier detection. Key risk factors include age, vascular disease, female sex, low educational attainment, poverty, and rural residence. Most screening and diagnosis occur in urban specialist settings, and common tools (e.g., MMSE, 10/66 battery) are not well validated for South Africa’s diverse populations. Dementia care is inconsistent: medication is available in specialist centres, but community and primary care programs are limited. Most ongoing care is provided by families and NGOs. There is no national dementia strategy, and policy integration is weak. Conclusions: Currently, dementia in South Africa is often undiagnosed, care is not equally accessible, and primary health care has a limited role. Most support comes from families and NGOs. In rural areas, caregivers face major challenges, balancing daily responsibilities with caring for relatives with dementia, often without professional help. The following steps are to establish national monitoring, adapt screening tools for all cultures, integrate dementia into primary health care, increase caregiver support, and develop a national dementia plan.