Factors influencing implementation of telemedicine in rural dementia care services in high-income countries: a scoping review.

BACKGROUND: Dementia care presents unique challenges in rural areas in high-income countries (HICs) due to limited access to specialised healthcare, fragmented services, and geographical isolation. Telemedicine has emerged as a promising solution, particularly accelerated by the coronavirus disease (COVID-19) pandemic. However, there remains a critical gap in understanding how telemedicine is operationalised within existing dementia care systems, particularly in rural contexts. The aim of this scoping review is to map and analyse existing evidence on the integration of telemedicine into dementia care systems in rural areas in HICs, with a specific focus on identifying barriers, facilitators, and strategies that shape effective implementation. METHODS: This scoping review followed Arksey and O'Malley's framework, refined by Levac et al. and reported in accordance with PRISMA-ScR guidelines. Searches covered MEDLINE, Embase, Web of Science and CINAHL for studies published from January 2014 to March 2025. Records were screened against predefined eligibility criteria. Studies were included only where telemedicine involved synchronous, real-time, video-mediated clinical interaction. Data were extracted using a standardised form and analysed through thematic analysis. Themes were subsequently mapped to the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0) to structure interpretation across implementation levels. RESULTS: Nine studies met the inclusion criteria across rural settings in the USA, Australia, Canada, Greece, and the United Kingdom. Telemedicine was delivered across home, facility, and community settings, with several studies using blended delivery models. Key barriers included limited connectivity, digital literacy, health impairments, and caregiver capacity. Key facilitators included trust and continuity in provider relationships, perceived practical advantages, and organisational support. Key strategies included training and capacity building, dedicated coordination roles, and co-design with caregivers and patients. CONCLUSION: The integration of telemedicine in rural dementia care systems in HICs is shaped by complex interdependencies between technological, organisational, and relational factors. Strengthening health system readiness requires investment in infrastructure, policy alignment, and inclusive design approaches that centre the needs of older adults with dementia, caregivers, and rural health systems.