Cognitively Impaired Older Adults Living Alone Have Worse Health Outcomes

Living alone is a social determinant of health among older patients with cognitive impairment, raising questions about how to provide appropriate care to this at-risk group, according to a study published in JAMA Network Open.

Approximately 25% of adults 55 years or older living in the United States have some form of cognitive impairment, ranging from mild cognitive impairment to dementia. Patients with cognitive impairment are at greater risk of self-neglect, falls, and untreated medical disorders. This state of affairs is exacerbated if patients do not receive support from caregivers or family/friends, noted the study authors led by Elena Portocolone, MBA, MPH, PhD.

The authors sought to assess how living alone with cognitive impairment impacts quality of care. They recruited professionals from different specialties (mostly based in California or Michigan) and interviewed them about their perspectives concerning older adults living alone with cognitive impairment. These interviews lasted for roughly an hour. They were asked semi-structured questions, such as their experience in caring for individuals with cognitive impairment and how living alone impacts care.

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The research team recruited 76 professionals who specialize in health care/social services. Together, they represent 20 professions, including clinicians, nurses, social workers, and home-care aides. The consensus among most participants was that providing care for older individuals living alone with cognitive impairment is a considerably greater challenge than caring for older individuals living with their counterparts.

Four important themes emerged during these interviews.

  1. Lack of an advocate. Older individuals living alone tend to lack someone who will be able to enact recommendations on diet, medications, and precautions. This can lead to a number of problems, including treatment non-adherence.
  2. Lack of a comprehensive medical history. Because the person lacks a companion or family member who can fill in the blanks of a medical history, clinicians are often unable to see the big picture and offer medical care accordingly.
  3. Risk of patients missing appointments, either because they forget or intentionally choose to stay home. This is exacerbated if patients live in rural areas.
  4. Challenge of intervening when patients are found to no longer have the capacity or the support system to live alone safely. The transition to other forms of living arrangements also becomes more complicated if patients are on their own.

Taken together, “participants’ insights suggested that older adults living alone with cognitive impairment are systematically destined to fall through the cracks of a health care system overly relying on unpaid caregivers, limited access to public home-care aides, and a reactionary, crisis-driven system,” the authors said.  These social forces may lead to the “negative health consequences observed for older adults living alone with cognitive impairment.”

Interventions and policies in helping older adults with cognitive impairment living alone “will become increasingly critical 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,” the authors of the study concluded.


Portacolone E, Nguyen TT, Bowers BJ, et al. Perceptions of the role of living alone in providing services to patients with cognitive impairment. JAMA Netw Open. 2023;6(8):e2329913. Published online August 1, 2023. doi:10.1001/jamanetworkopen.2023.29913


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