Caring for People Living With Dementia in Saudi Arabia: The Perspective of Nurses as Primary Caregivers

Abstract

Dementia is a progressive condition and an umbrella term used to describe a set of symptoms that affects many older adults. Older adults living with dementia often experience social stigma, which can impact their quality of life. Most people with dementia need the assistance of a caregiver in order to enhance their health. The present study seeks to explore the perspective of nurses as the primary caregivers of people living with dementia in Saudi Arabia, focusing on the challenges faced by nurses and their reactions to these challenges. A descriptive qualitative approach using semi-structured interviews with 10 nurses with experience caring for people living with dementia from 2 hospitals in Jeddah, Saudi Arabia. Using thematic analysis, 4 main themes were identified: (1) types of support, (2) challenges when caring for people living with dementia, (3) society’s views on people living with dementia, and (4) nurses’ perceptions of dementia. The nurses stated that people living with dementia do not receive sufficient support from their families. Most participants believed that public awareness about dementia is insufficient. Increased efforts to raise public awareness about dementia could include harnessing social norms around family structure and respect for elders to improve care provided to people living with dementia.

• What do we already know about this topic?

• Professional training focused on nurses as primary caregivers of dementia clients should be strengthened.

• How does your research contribute to the field?

• To date, minimal research has been published from the Arab world in general and Saudi Arabia, in particular, focusing on caregiver burden among Nurses caring for clients with Dementia. There may be cultural variations in caregiver burdens and challenges therefore, interventions should be tailored accordingly.

• What are your research’s implications toward theory, practice, or policy?

• The findings highlight the issue of limited support offered to people living with dementia, which is strongly associated with a poor quality of life. Educational programs should be implemented and campaigns organized among the general public to increase knowledge and awareness about people living with dementia and how they can be properly cared for.

Introduction

Background

Dementia, a neurological cognitive disorder, ¹ is a progressive condition and an umbrella term used to describe a set of symptoms, including a decline in memory, reasoning, communication skills, and a gradual loss of skills needed to perform activities of daily living. ² Alzheimer’s disease is the most common form of dementia.

The World Health Organization reported that 50 million people worldwide are diagnosed with dementia, and this number is rising. ³ By 2050, this number is estimated to be 130 million, making the disease a global health concern. Alzheimer’s disease affects 1 in 10 people and is considered a leading cause of disability as well as the fifth leading cause of death among older people. ⁴ In recent years, the Eastern Mediterranean population has become more cognizant of the prevalence of dementia, which is common in adults aged ≥70 years. ⁵ According to the Saudi Alzheimer’s Disease Association, 130 000 people are living with Alzheimer’s disease in Saudi Arabia. Additionally, the population aged >60 years is expected to exceed 25% in 2050. ⁶ Therefore, detection and early diagnosis of dementia are crucial to increasing the chances of receiving appropriate treatment and limiting its psychological, emotional, and economic consequences. ⁷

A review of 51 studies was conducted to examine worldwide evidence over the past 10 years regarding dementia-related stigma. ⁸ The results showed that individuals perceived being diagnosed with dementia as shameful. ⁸ Consequently, the responses of people with dementia ranged from ignoring the symptoms to covering up their behaviors. Additionally, healthcare professionals expressed a higher stigma compared with social workers, students, and the public ⁸ ; these perceived stigmatizing attitudes from healthcare professionals may lead to a delay in diagnosis and treatment.

A review explored dementia in Eastern Mediterranean countries and included studies conducted only in this region, ⁵ and revealed misconceptions of dementia among public perspectives, such as the belief that dementia is a normal part of aging. The prevalence of dementia in Arab people aged >60 years was higher than that in non-Arabs above 75 years, and the main risk factor for dementia was older age. ⁵ Furthermore, the studies in this review encompassed several aspects of stigma, burden, perception, consequences, and knowledge regarding dementia.

People who have personal relationships with a person with dementia and older people are less likely to hold stigmatized attitudes toward them. In addition, younger people show fewer negative attitudes, discomfort, and stigma. ⁸ Moreover, research has shown that establishing a nurse–client relationship with older adults is easy, as older adults in Eastern cultures are talkative and easy to communicate with; thus, nurses hold positive attitudes toward them. ⁵ Nevertheless, the general population feels uncomfortable toward people with dementia. Further, stigma regarding dementia is linked to a lack of knowledge. Stigma was assessed on three dimensions: stereotypes, discrimination, and prejudice. ⁸

Cultural differences exist regarding family support; some cultures encourage support for family members, regardless of a dementia diagnosis.^8,5 Variations exist in each culture regarding how support and care is provided for people with dementia. Depending on cultural norms, people with dementia are affected by stigma and face challenges in receiving proper diagnosis and treatment. As Eastern Mediterranean countries share many cultural beliefs and a common history, similarities exist in the norms and attitudes toward people with dementia.

Older adults are highly respected in the Eastern Mediterranean culture, where social norms disapprove of institutionalizing older adults. Islamic values emphasize respect, honor, and care for older family members. Furthermore, the oldest members are considered to represent wisdom, love, faith and blessings, and their opinions are predominant within the family. ⁵ Therefore, family members provide care for older members with disabilities or those who are vulnerable. In addition, the autonomy and dignity of older adults are important aspects to consider. Owing to the influence of the social beliefs and cultural norms of the families, ⁵ if older adults require assistance, family members are likely to hire a caregiver at home; if they cannot afford one, a relative provides care for the older adults, as it is considered unacceptable to send older adults to care facilities. However, caring for older adults with dementia may lead to anxiety, fear, and shame in family members.

In Saudi culture, traditionally, older adults are seen as source of wisdom and mostly cared for by their family members. ⁹ However, on occasion, the challenges of caring for people with dementia and the lack of knowledge on this disease means that some families do send older adults with dementia to long-term facilities for nursing care. It is therefore important to understand the nursing perspective because this is a unique occurrence in which societal norms are subverted, and nurses represent a pivotal role and position in maintaining the honor ascribed to older adults, and ensuring that people with dementia are still treated with the love and respect afforded culturally. ¹⁰ Nurses may also be of importance in helping to educate and support family members in caring for older adults, which may help build or mend family relationships affected by dementia may fracture. There is no formal licensing of dementia nurses in Saudi and so nurses who provide dementia care are a new and growing group whose professional experience and expertise can help inform practice growth.

Research Problem

Older adults with dementia struggle with social stigma, which impacts their quality of life (QoL). According to a survey by Alzheimer’s Disease International in 2012, 24% of people with Alzheimer’s disease reported hiding their diagnosis because of the perceived stigma. ¹¹ Several studies have explored the consequences of stigma on people in the psychological, physical, and social domains. However, studies exploring nurses’ perspectives on people with dementia and the stigma associated with their condition are limited. Therefore, this study is significant because it aimed to explore the experiences of nurses caring for people with dementia. Existing literature on stigma toward people with dementia mainly includes studies in non-Arab contexts and contains only a few qualitative studies. The present study explored nurses perspectives as primary caregivers of people with dementia in Saudi Arabia, focusing on the challenges faced by nurses and their reactions to these challenges.

Materials and Methods

Design

This descriptive qualitative research conducted semi-structured interviews with nurses who cared for people with dementia. This was considered the most appropriate design to explore the subjective nature of a phenomenon and uncover the participants’ unique experiences. ¹²

Sample and Setting

This study was conducted at two hospitals in Jeddah: Hospital K (particularly in the ear, nose, and throat [ENT]; surgical; medical; and orthopedic units), and Hospital P, which has geriatric and psychiatric units. As there are no geriatric care centers or home care facilities in Jeddah, this study sampled nurses working at the two abovementioned hospitals with geriatric and extended medical wards. The researchers aimed to recruit participants and conduct interviews until data saturation. ¹³ A convenience sample of ten nursing staff working at hospitals K and P was used. Google Forms was used as another sampling strategy to reach out to nurses with experience in caring for people with dementia. The Google Forms survey collected information from potential participants. Nurses who responded to the advertisement, completed the survey, and met the inclusion criteria were contacted by the researchers to schedule an interview. The inclusion criteria were both male and female Saudi and non-Saudi registered nurses with >1 year of professional nursing experience in caring for people with dementia. Nursing practice and training is general in Saudi, and dementia nursing specialists are not yet a group. ⁵

Data Collection Procedure and Instruments

The researchers collected the data between March 30 and April 23, 2022, using audio-recorded, semi-structured individual interviews conducted via Zoom, Skype, Facebook messenger, phone, or face-to-face, depending on participants’ preferences. Forty participants completed the initial survey recruitment form, but most did not respond later and did not provide any interview preference (method, date, or time). A total of 6 participants from Hospital P and one from Hospital K agreed to be interviewed. However, because of the slow process of completing the survey form and contacting participants, the researchers visited Hospital K and recruited three participants who had not received the advertisement and conducted the interviews on the spot.

One author developed the interview guide and questions, and another reviewed it. The interview was designed to explore nurses’ experiences of caring for people with dementia by examining the nursing routine, challenges nurses faced, families’ support for people with dementia, society’s views on people with dementia, and nurses’ messages to the public. The interview pilot was conducted with the first 2 participants to ensure clarity and understandability of the questions.

Four nursing students with basic training in qualitative research developed the topic guide (see Supplemental file—interview questions) which was reviewed by the study supervisors. The students conducted the interviews, nine of which were in Arabic, and one in English based on participants’ preference. The topic guide was used to direct the interview, with follow-up questions to probe further into answers. The nurses were given permission to complete the interviews during their shifts; however, this led to a limited timeframes, with most interviews lasting approximately 20 min. After completing the interviews, student researchers asked the participants whether they wished to offer any additional information or add any questions that they found important.

Data Analysis

This study used thematic analysis guided by Braun and Clarke’s 6-step reflexive process that directs the research team to acknowledge and reflect on their perspectives and beliefs as they interpret the findings. ¹⁴ As per Braun and Clarke’s methodology, the student researchers, under the supervision of faculty, conducted the following steps: (1) Familiarizing oneself with the data: all interviews were transcribed in Arabic and subsequently translated into English by the student researchers, as all the authors were fluent in both Arabic and English; for the non-Saudi participant, the interview was conducted in English and transcribed verbatim. (2) Generating initial codes: the ten interviews were independently reviewed by the researchers who assigned codes to the participants to maintain anonymity and identify and manage participant data. (3) Searching for themes: after independently coding the interviews, the researchers collaboratively crafted themes and assigned representative quotes to each prospective theme. (4) Reviewing themes: all authors reviewed the themes and chose the most inclusive and comprehensive ones that best represented the nursing experience of providing dementia care. (5) Defining and naming themes: after all the interviews were reviewed and analyzed, the research team discussed and confirmed the main themes and subthemes again and agreed on the final definitions and names. (6) Producing the report: the final report was written according to the previously specified themes and subthemes. All discrepancies during data analysis, as well as the themes and their names, were debated as a team, with the academic supervisors providing final decision-making based on their expertise.

Ethical Considerations

The Nursing Research Ethics Committee (NREC) of a governmental University accepted the research protocol on March 1, 2022. The Institutional Review Board provided ethical authorization to perform the study on March 29, 2022 (log no: A01347). Participants received a thorough explanation of the study’s purpose and the researchers’ responsibilities, including the protection of participants’ confidentiality, the potential risks and benefits of participating, and their right to withdraw from the study at any time and without any reason before the interview. Participants were also informed that members of the research team would have access to the participants’ interview transcripts. Each participant was adequately informed about the study’s purpose and agreed to participate. Participants also agreed to have their interviews audio-recorded. The student researchers created a Google Forms survey with complete information about the study, to reach as many potential participants as possible. Agreement to participate in the study and consent was implied by the completion of the Google Form survey by participants. Each participant was assigned an anonymous code, “registered nurse = RN,” followed by a unique identification number, based on the order in which the interviews were completed.

The research team included two experts in the mental health field and four student researchers who had completed and passed the national committee of bioethics training course. The student researchers collected the data and performed the preliminary analysis, while the lead authors supervised the research project’s conception and conceptualization.

Results

Participant Characteristics

Ten registered nurses responded to the interview call: 6 from the psychiatric and geriatric units of Hospital P and 4 from Hospital K’s ENT, surgical, medical, and orthopedic units. Table 1 summarizes the participants’ characteristics. All participants from Hospital P were male, with 6 to 12 years of professional experience. All participants from Hospital K were female, with 2 to 6 years of experience. There was one non-Saudi participant from Hospital K. The oldest participant was 42 years old, and the sample was representative of the average age range of nurses in Saudi. ¹⁵

Table 1.

Participants’ Characteristics.

Registered nurse (RN) identifier	Age in years	Gender	Nationality	Hospital	Years of work experience
RN1	42	Male	Saudi	P	10
RN2	32	Male	Saudi	P	6
RN3	36	Male	Saudi	P	7
RN4	30	Male	Saudi	P	7
RN5	38	Male	Saudi	P	12
RN6	39	Male	Saudi	P	10
RN7	29	Female	Saudi	K	2
RN8	33	Female	Indian	K	6
RN9	32	Female	Saudi	K	2
RN10	35	Female	Saudi	K	2

Four main themes and 8 subthemes emerged from the interviews, as demonstrated in Figure 1. The main themes were (1) support types, (2) challenges when caring for people with dementia, (3) society’s views on people with dementia, and (4) nurses’ perceptions toward dementia. For the data extract with an extensive list of quotes, please refer to Table 1 and Supplemental Appendix A.

Figure 1.

Structural representation of the main themes and subthemes in the study.

Theme 1: Support Types

During the interviews, the nurses were asked about the types of available support, including support received by the nurses (as primary caregivers) and by people with dementia. Two subthemes were identified: organizational and family support for people with dementia.

Subtheme: Organizational support for nurses

Nurses who provided care for people with dementia received support from other nurses in challenging cases. As a nurse stated, “Honestly, they (other nurses within the unit) helped me. Some Alzheimer’s patients are a little burdensome, but the nurses are very cooperative” (RN3). Another nurse said, “They (other nurses within the unit) are cooperative, encouraging, and responsive. When I need any information or service, they always support me” (RN5). Furthermore, other healthcare providers (non-geriatric nurses) valued this profession, as reported by one of the nurses: “They treat me with appreciation; they also understand the difficulty of the work and the pressure that I face as a caregiver for people with Alzheimer’s” (RN10).

Subtheme: Family support for people with dementia

Most participants stated that people with dementia received minimal or no support from their families. As reported by one nurse:

Unfortunately, sometimes the family support for Alzheimer’s patients is not enough. Take, for example, that I am currently caring for three patients, and it has been six months or even a year with no visitors or a call from the family or relatives to these patients. Family support is minimal! (RN6)

The person’s condition may worsen if they experience a lack of support, as a nurse explained: “The patient will relapse more. I mean, if the Alzheimer’s patient did not receive support, and if he has no one with him to follow up with him, he will surely relapse” (RN3).

Furthermore, aggressive behavior was commonly observed in people with little family support and chaperoning. One of the nurses noted, “Well, mostly they are aggressive, a little, like he refuses to be touched alone; there must be a family member, or at least if he hears their voices” (RN9). One nurse also emphasized that lack of support led to depression and isolation: “With a lack of support for Alzheimer’s patients, they will get more aggressive, they feel like they are isolated or get depressed” (RN8). Moreover, the nurses highlighted that greater support from families significantly contributed to better outcomes for people living with dementia: “If he received support, his condition would get better and decrease the stress on him and on the family” (RN10).

Theme 2: Challenges When Caring for People Living With Dementia

Caring for people living with dementia exposes nurses to various challenges that affect them and the care they provide. Two subthemes based on challenge type and nurses’ emotional responses were derived from the interviews:

Subtheme: Types of challenges

Nurses described different types of challenges when caring for people with dementia, including the hospital environment; as described by one nurse: “In psychiatric hospitals in Saudi Arabia, the first thing is the environment; hospitals are not prepared or equipped for these kinds of patients” (RN3). Furthermore, as the condition affects their memory, people living with dementia face communication difficulties; a nurse reported, “People with Alzheimer’s disease show slower processing and response rates than other people, and some of them have fears. So, we must simplify our words to meet their level of understanding” (RN4). Another nurse added, ”Alzheimer’s patients face communication difficulties; as a result of the difficulties, they experience difficulty remembering things; thus, they sometimes forget the words they want to say” (RN10).

People with dementia were also reported to experience mood swings, which affected the provision of nursing care. As noted by a nurse, “Providing nursing care for the patient would take five minutes if the patient was cooperative and in a good mood, but the next day it would take one hour because of their mood swings” (RN6).

In addition, stigma by association was found within the family, as stated by one of the nurses: “Some families hide the fact the one of their family members has Alzheimer’s disease, because of the stigma” (RN10). The family’s financial condition also affected the support for people with dementia: “Also, their (the family’s) financial condition is poor, and they work a lot during the day, so they try to get rid of them and make them stay in the hospital as much as they can” (RN3).

Subtheme: Nurses’ emotional response to challenges

Nurses were asked to express their feelings about the challenges they face while caring for people with dementia. They reported disappointment with the hospital environment and lack of preparation and resources: “It’s really something upsetting, especially if the hospital environment is not prepared” (RN3). Nurses emphasized the importance of being patient while facing these challenges: “Our first weapon is patience. I expect that one needs to be patient enough to give the patient his time, even if he refuses, and they should understand him” (RN6). However, one nurse had a very different view of these challenges: “I do not feel it (nursing care for the patient) as challenging as much as I feel it is the core of my job and I feel Allah (God) will reward me” (RN4).

Theme 3: Society’s Views on People With Dementia

Nurses shared their opinion of society’s perception of people with dementia, leading to 2 subthemes regarding people’s behavior toward individuals with dementia and the level of awareness in society.

Subtheme: Behavior toward people with dementia

Nurses suggested that the Saudi Arabian society holds false-negative perceptions about people with dementia, which affects their behavior toward them. One nurse stated, “They say he is crazy; he does not understand anything; he does not know what he says” (RN2). These negative views lead to the idea that people living with dementia are like children, as a nurse observed: “They always believe they are incompetent like children” (RN10). In addition, as the most well-known symptom of dementia is memory impairment, one of the nurses shared that society believes “that he is an old person who has lost his memory” (RN1). Another nurse explained that society views people with dementia as follows: “The community’s perspective here focuses only on the forgetfulness of the patient. . .” (RN3). Consequently, the society views them as incapable and disregards them, as reported by a nurse: “They would treat them carelessly; additionally, they often look down on them” (RN10).

Subtheme: Level of awareness in society

Nurses were asked to express their opinion about the level of dementia awareness in the society. Most nurses believed that awareness was inadequate: “Society first needs education; they need to know more about this disease” (RN5). Another nurse stated: “I think people do not have enough awareness about how to deal with Alzheimer’s patients. When someone in their family is diagnosed with Alzheimer’s, they consider this disorder to be the end of their life” (RN6). Nevertheless, some nurses believed that certain people are capable of taking care of those with dementia: “To be honest, there are people who know how to deal with Alzheimer’s patients” (RN7). Another nurse noted that there is more awareness now compared to in the past: “But now there is some knowledge. In the past, no one was aware of this disorder, but now there is awareness” (RN2).

Theme 4: Nurses’ Perceptions Toward Dementia

Each nurse had unique experiences and different nursing routines when caring for people with dementia. Thus, they developed different perceptions. Hence, 2 subthemes were revealed: nurses’ routines and nurses’ messages to society.

Subtheme: Nurses’ routines

Many different nursing routines can be used for people with dementia. Most nurses emphasized that people with dementia need help with everything: “At the psychiatric hospital, we start the day with the patients; we wake them up, help them with taking a shower, and after that, they go to eat breakfast and take their medication” (RN6). Another nurse stated, “We give them clothes because they always depend on someone who is with them” (RN2). However, one nurse explained the routine differently: “We try to let the Alzheimer’s patient meet his needs by himself with minimal help. . .” (RN10). Additional daily activities and encouraging patients to socialize was part of the nursing routine: “Encourage him to participate in daily activities, such as workouts and social interactions” (RN5). Although social interaction for people living with dementia is limited, they can socialize with the nurses in the unit: “We will talk to them, listen to them; the thing is that we will listen, we will not argue with them” (RN8).

Subtheme: Nurses’ messages to society

Nurses’ messages to society can be summarized as follows: provide psychological support for people with dementia; family support is important; be patient with people with dementia; learn more about dementia; do not exhibit negative attitudes toward them and try to understand them. One nurse emphasized: “I think my message to society is that it is now the time to stand for them and be their memory as we are their source of strength after Allah (God)” (RN6). Another nurse stressed that it is important to understand the condition itself: “It is important to understand that the changes that happen in the patients are due to the Alzheimer’s disease itself. So, we must make sure that we do not make a bad judgement toward Alzheimer’s patients. . .” (RN10).

Discussion

Our findings provide powerful insights into the experiences of nurses as primary caregivers for people with dementia, particularly within the Saudi Arabian context. The comparison with recent dementia studies highlights both consistencies and disparities between different cultures, emphasizing unique cultural and societal nuances that influence caregiving practices and perceptions.

Our study corroborates existing literature regarding the lack of familial support for individuals with dementia. ¹⁰ This is consistent with studies in the Eastern Mediterranean region, where familial care is deeply ingrained. However, families in Saudi Arabia may struggle to provide adequate support owing to stigma and misconceptions about dementia. ⁵ Notably, stigma associated with dementia within families, which sometimes leads to secrecy and shame, resonates with findings in other contexts, such as Uganda and Germany.^8,16

Although healthcare workers in our study expressed support for nurses caring for people with dementia, contrasting perspectives were noted in studies from Turkey and France, where healthcare workers also experienced stigma related to dementia care.^4,7 This variance underscores the complex interplay of cultural, institutional, and individual factors shaping attitudes toward dementia within healthcare settings.

The nurses reported facing challenges while caring for people with dementia, including the hospital environment, as most hospitals are not well-prepared to treat people living with dementia. Improving the hospital environment and building separate facilities for people with dementia can help overcome this challenge. ⁶ Additionally, as memory impairment is the most well-known sign of dementia, nurses reported communication difficulties and behavioral disturbances, which aligned with previous studies. ⁶ The nurses explained that, in this situation, people living with dementia feel frustrated and afraid. Another study conducted in Saudi Arabia also highlighted the need to find another way to communicate while providing patients with simplified instructions using very simple words. ⁶ Behavioral disturbance is also expected in people living with dementia; for instance, becoming agitated, stubborn, and refusing treatment, which has also been noted in several studies. ^6,8,16 Strategies identified in our study, such as simplifying communication and exercising patience, echo recommendations from previous research conducted in Saudi Arabia and beyond.^6,17 Additionally, the emphasis on patience as a fundamental aspect of dementia care aligns with the evolving understanding of person-centered approaches in nursing practice.

Therefore, nurses learned to act patiently while caring for people with dementia, referring to patience as their “first weapon.” Caring for people with dementia increased the nurses’ level of patience and their knowledge; they reported gaining more experience from caring for people living with dementia. Thus, nurses emphasized the importance of being patient and calm while caring for people with dementia. ¹⁷

Moreover, the integration of Islamic values and beliefs into caregiving practices, as highlighted in our study, adds a distinctive dimension to dementia care in Saudi Arabia. The belief among nurses that their work is rewarded by God reflects the intersection of religious and professional identities, which may serve as a source of resilience and motivation in the face of caregiving challenges.

The types of nursing routines provided to people with dementia vary; however, most nurses agreed that it is important to meet patients’ needs. Nonetheless, despite providing help, people with dementia were also encouraged to meet their needs by themselves. In addition, some nurses reported arranging an activity within the unit to allow people with dementia to participate in social activities and avoid social isolation and rejection. People living with dementia and their caregivers experience social rejection and isolation.^4,18 Nurses were divided in their responses regarding society’s perception toward people with dementia. They reported that those who either had a family member with dementia or a background in the field appreciated and respected the nurses. Particularly, they felt happy when they saw that people with dementia were being taken care of and believed that God will reward them for their hard work. However, nurses also believed that the society lacks information about dementia and has negative misconceptions and perceptions about people with dementia, referring to them as “crazy,” “incompetent,” and “child-like.” ⁴

The discrepancy between the traditional familial support for older adults in Eastern Mediterranean culture and the reported lack of family support for hospitalized patients with dementia in our study highlights a significant issue. This gap suggests a disconnect between cultural norms and the realities of dementia care in healthcare settings, warranting further exploration. Possible reasons for this disparity include challenges in balancing caregiving responsibilities and managing dementia-related behaviors in a hospital environment. Additionally, cultural attitudes toward dementia and perceptions of institutional care may influence family involvement. ¹⁰ Addressing these issues requires a nuanced understanding of cultural dynamics and tailored interventions to support both patients and their families effectively.

The nurses felt that there is insufficient awareness regarding dementia in the society. Thus, most of the nurses highlighted the importance of increasing awareness and education in the society. The nurses’ messages to the Saudi Arabian public were to create special facilities for people with dementia, become educated, be patient and calm with such people, accept them, and include them by making them an active group within the society.

Discussing caring policies for people with dementia within the Saudi Arabian context can provide practical insights into how healthcare systems and institutions can better support both patients and caregivers, despite the lack of national Saudi policies for dementia. By implementing comprehensive caring policies tailored to the cultural and societal nuances of Saudi Arabia, including standardized protocols for dementia care, training programs for healthcare professionals, and support services for caregivers, healthcare facilities can ensure that people with dementia receive optimal care and support throughout their journey. Additionally, policies aimed at promoting dementia-friendly environments within healthcare settings in Saudi Arabia can help enhance the QoL of individuals with dementia and create a more inclusive and supportive environment.

Implications for Future Research and Practice

Our findings highlight the issue of limited support offered to people with dementia, which is strongly associated with a poor QoL. Educational programs should be implemented and campaigns should be organized among the general public to increase knowledge and awareness about people with dementia and how they can be properly cared for.

Global migration continues, and the needs of people in Saudi Arabia will influence care in other parts of the world; there is an implication for cross-pollination of cultural practices that builds richness in understanding, and tailoring of care to address cultural nuances to meet patient and family care needs.

Recommendations

Our study underscores the importance of societal awareness and education regarding dementia, highlighting the urgent need for public education initiatives to dispel misconceptions and foster inclusion. Recommendations from nurses to create special facilities for people with dementia and actively involve them in society align with global efforts to promote dementia-friendly communities. ¹⁰ Additionally, it is recommended to develop national policies for caring for people with dementia and develop a career path for nurses to be specialized in dementia care. ¹⁰

According to the our findings, society needs to be educated about dementia to increase their understanding of the disease, reduce negative perceptions, and emphasize the need for support systems for such people. This study demonstrated the importance of providing holistic care, including psychological support, for people with dementia; moreover, nurses must include family members of people with dementia in the care process to avoid mistrust, depression, and isolation. Organizational support for people with dementia and their families is recommended. Future research should gather data from families who care for people with dementia to explore their perspectives, as family caregivers may experience different challenges and have other messages that they would like to share. Future studies should also focus on ways to minimize stigma against dementia.

Conclusions

This study aimed to explore nurses’ perspectives as primary caregivers for people with dementia. The findings underscored the need for culturally sensitive and holistic approaches to dementia care in Saudi Arabia and beyond. More research is needed to expand nurses’ experiences of caring for people with dementia, including suggestions to enhance care facility environments, which play a crucial role in the QoL of individuals with dementia.