One in every four older Americans with dementia or mild cognitive impairment lives alone, placing them at risk of dangerous driving, wandering outside the home, mixing up medications, and missing medical appointments.
Researchers led by UC San Francisco determined in a study published in JAMA Network Open, that the United States health system is ill-equipped to support patients living alone with cognitive decline, a group whose numbers are expected to grow as the population age.
According to lead author Elena Portacolone, PhD, MBA, MPH, of the UCSF Institute for Health and Ageing and the Philip R. Lee Institute for Health Policy Studies, living alone is a social determinant of health with an influence as severe as poverty, racism, and low education.
Researchers interviewed 76 healthcare practitioners, including physicians, nurses, social workers, case workers, home care aides, and others, for this qualitative study.
In California, Michigan, and Texas, participants worked in memory clinics, home care services, and social services, among other areas.
The providers raised concerns about patients missing medical appointments, failing to respond to follow-up phone calls from the doctor’s office and forgetting why appointments were made, leaving them vulnerable to falling off the radar. “We don’t necessarily have the staff to really try to reach out to them,” said a physician in one interview.
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Some patients could not assist their doctor with missing information on their chart, leaving the providers uncertain about the pace of their patient’s decline.
Many had no names listed as emergency contacts, “not a family member, not even a friend to rely on in case of a crisis,” according to a case manager.
These patients were at risk for untreated medical conditions, self-neglect, malnutrition and falls, according to the providers.
The researchers advocate for a system in which robust supports are made available by funding from expanded medical care.
This will become increasingly critical, said Portacolone, “because effective treatments to reverse the course of cognitive impairment are unavailable, childlessness and divorce are common, and older adults are projected to live longer and often alone.”