Living Alone Puts 25% of Americans with Cognitive Impairments at Risk, Study Finds
August 18, 2023 | 12:06 PM
By Jane Herz
New research published in the Journal of the American Medical Association Network Open reveals that living alone is endangering the lives of 1 in 4 Americans. The study, conducted by researchers at the University of California San Francisco, focused on the estimated 25% of US citizens who have dementia or other mild cognitive impairments. It found that these individuals are at risk of various dangers, including mixing up medications, unsafe driving, wandering outside the home, and even forgetting medical appointments.
The study authors concluded that the current health system in the United States is ill-equipped to provide adequate care for individuals living alone with cognitive decline. Lead author Dr. Elena Portacolone from the UCSF Institute for Health and Aging and the Philip R. Lee Institute for Health Policy Studies stated that “for these patients, living alone is a social determinant of health with an impact as profound as poverty, racism, and low education.”
The researchers warn that as this population group continues to age, the numbers will only increase, comparing the situation to “sending a kid out to play on the freeway.” During the study, 76 healthcare providers were interviewed, including physicians, nurses, home care workers, and social workers. These providers expressed concerns about their patients who lived alone, noting that some were unable to remember why certain appointments were made or didn’t answer follow-up phone calls.
Furthermore, some of these individuals did not have an emergency contact listed on their charts, lacked a friend to call in a crisis, or were unable to provide missing medical information or paperwork. This places them at increased vulnerability and makes it difficult for doctors to understand the rate of their decline. The healthcare providers highlighted the risks of untreated medical conditions, self-neglect, malnutrition, and falls among these patients.
The study revealed instances where patients were sent home with just a taxi voucher or discharged from the hospital without a support system in place. According to Portacolone, these findings reflect the shortcomings of the nation’s healthcare system, as it fails to provide subsidized home care aides for all but the lowest-income patients. She stated that an estimated 79% of people with cognitive decline in the United States have an income that makes them ineligible for Medicaid subsidized home care aides in long-term care.
Currently, Medicare is available for adults over the age of 65, but subsidized home aides are usually only provided in cases of acute episodes, such as hospitalizations. Senior author Dr. Kenneth Covinsky from the UCSF Division of Geriatrics criticized the healthcare system, stating that “in an era when Medicare is going to spend millions of dollars for newly approved drugs with very marginal benefits, we need to remember that Medicare and other payers refuse to pay far less money to provide necessary supports for vulnerable people with dementia.”
This study adds to existing research highlighting the negative effects of being alone. Previous studies have found that loneliness can be worse than some health issues like depression and smoking for patients with diabetes. Additionally, research from the American Cancer Society suggests a link between cancer survival rates and having a strong support network.
The findings of this study emphasize the urgent need for improved healthcare services and support systems for individuals living alone with cognitive impairment in the United States. Without appropriate interventions, the lives and well-being of this vulnerable population are at risk.
Sources: Journal of the American Medical Association Network Open, UCSF Institute for Health and Aging, Philip R. Lee Institute for Health Policy Studies, Tulane University, American Cancer Society.