Bulgaria does not have a long history of immigration. The first immigrants without a Bulgarian background were refugees from Armenia (1915-1917). From 1989, immigration increased and large groups from China and Arab-speaking countries came to Bulgaria. After Bulgaria joined the EU in 2007, the number of immigrants from the former Soviet Union and former Yugoslavia increased¹. In 2013, the largest migrant groups were from the Russian Federation (19,700), Romania (6,400), Ukraine (6,200), Greece (5,200), and Turkey (4,200)². Between 1990 and 2019, the migrant population (born abroad) has increased almost eightfold (21,500 to 168,500)³.

There are 21,000 people with a migration background aged 60 or older. Of those, approx. 800 are estimated to exhibit some form of dementia. Calculations show the most affected migrant groups presumably originate from Romania (approx. 200), the Russian Federation (approx. 100), Greece (approx. 100), Serbia (approx. 60), and Ukraine (approx. 40)⁴.

In February 2015, Alzheimer Bulgaria published a report on national policies and practices in Bulgaria. This report contains information about dementia diagnosis, treatment, and care services concerning the main barriers for adequate care of people with dementia. There is also a draft with basic goals for a national dementia strategy⁵ and the ‘National Consensus on Early Diagnosis and Treatment of Alzheimer's Disease and Other Forms of Dementia’. The 2015 published consensus includes the topics socio-medical significance of dementias, principles of the dementia diagnostic, diagnostic activity in outpatient conditions, diagnostic activity in hospital conditions, and medicines used for the treatment of dementia⁶. However, none of these documents refer to migration.

According to two interviewed experts, people with a migration background with dementia are only partly included in the healthcare system in Bulgaria. One expert stated that there is neither information with a special focus on the needs of people with a migration background with dementia nor any state-supported services providing information on dementia in other languages. Services for inpatient and outpatient care for people with dementia have almost nationwide availability for people with a migration background since they are entitled to the same healthcare and social rights as non-migrants in Bulgaria. The experts agree that existing services are suitable for people with and people without a migration background.

The experts assume that administrative staff and professional care providers might not be qualified on culturally sensitive care. Additionally, there seems to be no training in intercultural care available. According to both experts, service providers play an important role in supporting family caregivers. The second expert assumed no differences in information and services for family caregivers of people with dementia with and without a migration background. However, this expert identified a very high need for specialised services for family caregivers.

1. Nikolova NN: Migration policies of Bulgaria and the European Union towards third-country nationals: Opportunities for Institutional Development.
2. United Nations: Migration Profiles: Bulgaria; 2013.
3. International Organization for Migration: Total number of international migrants at mid-year 2019: Bulgaria; 2019.
4. National statistical institute: Sonderanfertigung; 2011.
5. Alzheimer Europe: National Dementia Strategies: a snapshot of the status of National Dementia Strategies around Europe. [https://www.alzheimer-europe.org/Policy-in-Practice2/National-Dementia-Strategies]. (2017). Accessed 01 Jun 2019.
6. Bulgarian Society of Dementia: National Consensus for early detection and treatment of Alzheimer Disease and other forms of Dementia; 2015.