Beyond person-centred discourse: dismantling ‘double violence’ in dementia care systems

Despite global policy commitments to person-centred care, people living with dementia (PlwD) continue to experience systemic exclusion, compromised agency, and diminished citizenship. This paper introduces the double violence framework—an integrative conceptual model synthesising two mutually constitutive forces: dementism, the psychosocial stigmatisation and denial of personhood; and structural fragmentation, the systemic devaluation and disjointed political economy of dementia care. We argue that these forces are reciprocally reinforcing: dementism provides the cultural legitimation for structural neglect, while fragmentation reproduces conditions that preclude person-centred practice. This dynamic explains why isolated reforms—whether workforce training or incremental funding increases—consistently fail to generate transformative change. To address this implementation gap, we propose a five-point transnational policy agenda centred on integrated, system-level reform: cross-sector accountability mechanisms, workforce professionalisation, and authentic co-production with PlwD. Meaningful change requires a unified strategy that simultaneously confronts the political economy of care devaluation and achieves deep cultural transformation within health and social care systems.