Mapping the dementia care system: a causal loop diagram of demand and supply

Dementia care systems face increasing pressure from ageing populations, shrinking informal caregiver availability, and constrained formal care capacity. These dynamics are deeply interconnected, yet health systems research on dementia rarely makes the feedback structures between demand, supply, and workforce explicit. Causal Loop Diagrams (CLDs), developed through Group Model Building (GMB), offer a participatory method to surface these interdependencies. Two GMB sessions were conducted with researchers and patient organisations. Session 1 produced a preliminary CLD of the Dutch dementia care system, mapping variables influencing care demand and supply. Session 2 extended the model through scenario analysis, identification of time delays, and bottleneck mapping. The CLD was lastly refined through expert validation interviews. The CLD maps five interconnected system domains: upstream risk factors and (secondary) prevention; care needs and care demand; informal care and caregiver burden; formal care capacity; and unmet care. Two reinforcing feedback loops were identified as critical: caregiver overload amplifying unmet care, and unmet care further increasing care burden. Scenario analysis showed that rising dementia prevalence and declining informal caregiver availability act as compounding stressors. Key system delays were found in workforce training, prevention uptake, and caregiver burden accumulation, all with significant implications for system responsiveness and policy timing. The CLD proved a valuable tool for making implicit health system dynamics explicit and actionable. Unmet care and caregiver burden are structural bottlenecks that cannot be resolved without coordinated intervention on both the demand side (secondary prevention, reduced stigma) and supply side (workforce investment, caregiver support, technology). The resulting CLD provides a shared framework for researchers and policymakers to reason about system-level trade-offs in dementia care.

Key messages

• GMB and CLDs make implicit dementia care system dynamics explicit, giving researchers and policymakers a shared framework to reason about system-level trade-offs.

• Unmet care and caregiver burden are structural bottlenecks in dementia care that require coordinated intervention on both demand and supply side