Beyond the intervention: how physical, social, and organisational contexts trigger wellbeing for minority ethnic residents with dementia: a realist synthesis

Background As populations age and diversify, the need for culturally responsive dementia care in residential settings is urgent. Minority ethnic (ME) residents often face barriers to equitable care, and a ‘one-size-fits-all’ approach risks overlooking what matters most for their wellbeing. This review investigates how culturally tailored interventions improve wellbeing for ME residents with dementia. Methods A realist synthesis was conducted to explain how, why, and under what conditions interventions work. The protocol was registered with PROSPERO (CRD42024581293). Six databases were searched for studies published between 2013 and 2024. Using the Integrated Model of Place as a framework, data were analysed to develop Context-Mechanism-Outcome configurations (CMOCs). Findings were validated with stakeholders from 10 care homes. Results Seven studies were included. Analysis revealed that effective interventions are those aligned across three contextual domains/environments: the physical (culturally familiar sensory cues), the social (native-language communication, shared activities), and the organisational (supportive leadership, staff training, structured routines). When aligned, these contexts trigger mechanisms of familiarity, emotional memory, trust, and identity affirmation. This leads to outcomes of reduced agitation, improved mood, enhanced communication, and stronger family-staff relationships. On the other hand, interventions lacking this integration, such as those without language support, failed to engage residents and families. Conclusion Wellbeing for ME residents is not achieved by interventions alone but through care environments that are holistically culturally responsive. Culturally attuned physical, social, and organisational contexts must be synergistically aligned to activate essential wellbeing mechanisms. This synthesis provides a practical framework for designing and implementing inclusive dementia care.

Citation

Lim, J.N.W., Ramezani, N., Lindner, H. (2026) Beyond the intervention: how physical, social, and organisational contexts trigger wellbeing for minority ethnic residents with dementia: a realist synthesis. Age and Ageing, 55(2), afag035.

Type

Journal article

Language

en

Description

© 2026 The authors. Published by OUP. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1093/ageing/afag035

ISSN

0002-0729

EISSN

1468-2834

Collections

Faculty of Education, Health and Wellbeing