The surge in the ageing population globally is anticipated to result in an increased number of individuals facing cognitive decline. New research indicates that residing alone places this group in a precarious situation where they might forget appointments, confuse medications, and lack immediate assistance during emergencies. This study, published in JAMA Network Open, underscores that for individuals grappling with cognitive decline, living alone becomes a substantial social determinant of health, akin in impact to poverty, racism, and limited education.
Approximately one out of every four older Americans dealing with dementia or mild cognitive impairment resides alone, rendering them susceptible to risky behaviours such as unsafe driving, wandering away from their homes, medication mix-ups, and neglecting medical appointments. Elena Portacolone, affiliated with the University of California-San Francisco (UCSF) Institute for Health and Aging, asserted, “These findings cast a critical light on our healthcare system, which lacks the provision of subsidized home care aides for anyone other than those with the lowest incomes.”
The study entailed interviews with 76 healthcare providers
The study entailed interviews with 76 healthcare providers, encompassing physicians, nurses, social workers, case workers, home care aides, and others. Concerns were raised by these providers regarding patients missing medical appointments, disregarding follow-up phone calls from medical offices, and forgetting the rationale behind scheduled appointments, thus making them susceptible to falling off the healthcare radar.
One physician stated during an interview, “We are often stretched thin in terms of staff resources to proactively engage with them.” Certain patients were unable to provide essential information about their medical history, leaving providers in a state of uncertainty about the trajectory of their patients’ cognitive decline.
A striking observation was the absence of emergency contacts for many patients – not a single family member or friend was listed to rely on during times of crisis. Healthcare providers identified these patients as being prone to untreated medical conditions, neglect of self-care, malnutrition, and accidental falls.
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The lackluster support infrastructure for these patients culminated in their identification only after they were admitted to hospitals due to crises, such as falls or complications arising from mismanagement of medications.
Kenneth E. Covinsky, senior author from the UCSF Division of Geriatrics, emphasized, “As we witness Medicare allocating substantial funds for marginally beneficial newly approved drugs, it’s crucial to remember that Medicare and other payers often deny essential resources to offer necessary assistance for vulnerable individuals grappling with dementia, despite these interventions requiring considerably less funding.”