Barriers and facilitators to healthcare access for older ethnic minority adults in the UK: a scoping review
Abstract
Introduction
The number of people aged 60 years and over from ethnic minority backgrounds in the United Kingdom has increased by approximately 80% since 2011. Despite the principle of universal access within the National Health Service (NHS), this population experiences persistent inequalities in diagnosis, prevention and specialist care. Evidence addressing the intersection of ageing and ethnicity remains fragmented. This review mapped barriers and facilitators to healthcare access for older ethnic minority populations in the UK.
Methods
A scoping review was conducted using the Arksey and O’Malley framework and reported in line with PRISMA-ScR guidelines. Three databases (PubMed, Embase and Scopus) and grey literature were searched for UK-based studies published between 2010 and 2025 involving ethnic minority adults aged ≥60. Data was synthesised using Levesque et al.’s conceptual framework to systematically map system and patient-level access barriers and facilitators.
Results
From 1,158 records identified, 21 studies met the inclusion criteria. Of these, 12 focused on dementia or mental health services. Barriers were identified across all five access dimensions, most frequently in approachability, acceptability and availability. Key barriers included low health literacy, limited awareness of services, language barriers, digital exclusion and inconsistent access to professional interpreters. Several studies reported delayed diagnosis and lower rates of timely referral to memory and mental health services among ethnic minority older adults compared with White British patients. Facilitators were less frequently reported, most involving trusted community organisations and co-produced, culturally tailored support models.
Conclusions
Healthcare access for older ethnic minority populations in the UK is limited by systemic misalignment between service design and patient needs, extending beyond language barriers. The dominance of dementia and mental health-focused evidence highlights significant gaps in preventative and physical healthcare. These findings underscore the need for more culturally responsive geriatric pathways and greater integration of community-led models within mainstream service provision.
Comments
Interventions
This was really interesting to read - did you come across any interventions to improve access to care and had they been evaluated?
Thank you for your question…
Thank you for your question!
I found that the most effective interventions were those that were community-led and co-produced, such as bilingual workshops for advanced care planning or using 'trusted intermediaries' from local organisations to navigate the system.
Regarding evaluation, a key finding was that many of these facilitators are currently small scale, localised and often dependent on short term funding. While they show promise in improving immediate engagement, there is a clear lack of robust, large scale evaluation.
Framework
Thank you for your great work, just out of interest, what made you pick the Arksey and O’Malley framework as opposed to the Joanna Briggs Institute guideline? Thank you.