Understanding service demand for respite care among informal carers of people with Dementia: A Scoping Review

The growing global prevalence of dementia has placed immense and prolonged caregiving burdens on informal carers, who often face physical exhaustion, psychological distress, and social isolation in their long-term care roles. Respite care, as a critical support service encompassing home-based temporary care and adult day care programs, offers carers much-needed relief by providing short-term care for people with dementia (PWD). However, existing evidence indicates a significant disparity between the demand for respite care and its actual utilization—while a large number of informal carers have unmet respite needs, services such as adult day care (utilization rate: 16.6%) and respite care (utilization rate: 4.5%) remain underused (Dietzel, 2022; Keefer, 2025). Merely expanding the quantity of respite services is insufficient to address issues of accessibility and appropriateness, as the mismatch between carers’ specific needs and service provision persists (Grogan, 2025). To bridge this gap, a clear conceptualization and systematic assessment of informal carers’ respite care needs are essential. Need is an inherently subjective construct, requiring explicit clarification of which stakeholder perspectives should be prioritized in service planning and which needs are actually addressed by existing services (Carver, 2008). Bradshaw’s (1972) taxonomy of needs provides a valuable sociological framework for distinguishing different types of needs by centering the perspective of the individuals experiencing them—an approach particularly relevant to understanding the multifaceted demands of dementia carers (Carver, 2008). This model categorizes needs into four dimensions: felt need (self-reported health and care needs), expressed need (needs reflected through service utilization, such as waiting times for existing services), normative need (needs defined by experts based on research and professional judgment), and comparative need (needs identified by comparing service availability across different settings). Each dimension addresses unique limitations of conventional need assessment—for example, felt need captures authentic subjective but may be constrained by limited knowledge, while normative need risks overlooking carers’ diverse circumstances due to its expert-centric nature. Despite the recognition that dementia carers have substantial unmet needs, there is little consensus on how to conceptualize and measure these needs (Bangerter, 2019). A review of 26 studies identified key themes in existing assessment methods, including variability in methodological rigor, reliance on proxy indicators, dual assessment of carers and PWD, and third-party evaluations, highlighting the need for more theoretically grounded classification of carers’ needs (Bangerter, 2019). Previous research using tools such as the Dementia Assessment of Service Needs (DEMAND), Carer's Needs Assessment for Dementia (CNA-D), and Carer Needs Directed Assessment in Dementia (CANDID) has identified common unmet needs among carers, including counseling and emotional support (31.5%-92%), lack of dementia-related knowledge, legal assistance, and barriers to healthcare access (Ayisi-Boateng, 2022; Du Preez, 2023; Keefer, 2025). These unmet needs are further intertwined with social support requirements, such as financial aid, caregiving resource access, family network support, and policy-related service access. However, current research primarily focuses on carers’ experiences with respite care and the barriers or facilitators to service utilization, with a notable gap in understanding the specific processes through which carers form preferences for particular respite services. Little is known about whether there are differences in carers’ service choices, or the factors driving such differences. To address this research gap, this scoping review aims to apply Bradshaw’s need taxonomy to systematically explore the service demand for respite care among informal carers of PWD. By unpacking carers’ needs across the four dimensions of Bradshaw’s model, this review seeks to clarify the priority of specific respite care needs, identify discrepancies between perceived and actual service provision, and provide evidence-based insights to enhance the utilization and quality of respite care services.