Advancements in improving personal and community health status in the U.S. depend on successfully addressing various kinds of social determinants of health (SDOH). Demography plays an essential role not only in defining health and health-related social problems, but also in formulating satisfactory remedies. Factors pertaining to race and ethnicity have a major impact on the highly pertinent challenge of reducing health disparities among members of minority population sub-groups. A portion of the population worthy of increased attention consists of older individuals with dementia who live alone.
Based on an etiological perspective, living alone is associated with increased risk of developing dementia and lower likelihood of timely diagnosis, according to the results of a study (Clare, L. et al) published in the American Journal of Geriatric Psychiatry on June 6, 2024. Estimates range from under one in every five persons to half. Even if the correct figure is at the lower end of the spectrum, it still represents a substantial number of individuals managing life with dementia while living alone.
Results of a study published on August 18, 2023 in JAMA Network Open (Portacolone, E. et al) shed additional light. In the U.S., it is estimated that 4.3 million older adults (≥55 years) live alone with cognitive impairment (ranging from mild impairment to dementia), which represents 25% of older adults living with this mental health malady. They are likely to be female, poorer, widowed, or divorced and to have never been married. They also have an elevated risk for untreated medical conditions, self-neglect, malnutrition, and falls. Evidence suggests that negative health outcomes are associated with a lack of long-term services and supports from family members, friends, or formal caregivers (e.g., home-care aides). Additionally, older adults living alone with cognitive impairment often have limited access to long-term services and supports because they have less access to unpaid informal help from spouses and children, who provide most of these forms of assistance to such patients.
Moreover, only an estimated 21% of older adults living alone with cognitive impairment are covered by Medicaid, which leaves most of this group ineligible for publicly subsidized home-care aides and other services covered by that federal-state program. Providers have raised many concerns regarding this group of patients. Examples are: missing medical appointments, failing to respond to follow-up telephone calls, and even forgetting why appointments were made, thus leaving them vulnerable to disappearing from the radar. Related concerns are that these individuals were more likely to miss visits because they either forgot or preferred avoiding professionals. Also, serving patients with mental health impairments via telehealth often proved to be difficult owing to trouble navigating video conferencing without technical supports. Other multifactorial challenges include professional concerns about patient safety, such as “not eating,” “not taking care of personal hygiene,” “leaving gas stove on,” “mixing up medications,” “wandering off,” “driving motor vehicles,” and “financial abuse.”