The Invisible Population: Older Adults with Cognitive Impairment Living Alone
Sociologist Elena Portacolone was taken aback by the number of older adults in San Francisco she visited at home for a research project who were confused when she came to the door. Many had forgotten the appointment or couldn’t remember speaking to her. It seemed clear they had some type of cognitive impairment. Yet, they were living alone.
The Ongoing Crisis
Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing? When she reviewed the research literature more than a decade ago, there was little there. "I realized this is a largely invisible population," she said.
Estimating the Numbers
The Living Alone With Cognitive Impairment Project at UCSF estimates that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States. About half have trouble with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, according to their research. But only 1 in 3 received help with at least one such activity.
The Challenges
Compared with other older adults who live by themselves, people living alone with cognitive impairment are older, more likely to be women, and disproportionately Black or Latino, with lower levels of education, wealth, and homeownership. Yet only 21% qualify for publicly funded programs such as Medicaid that pay for aides to provide services in the home. "We realized this population is destined to fall through the cracks," Portacolone said.
The Consequences
Imagine what this means. As memory and thinking problems accelerate, these seniors can lose track of bills, have their electricity shut off, or be threatened with eviction. They might stop shopping (it’s too overwhelming) or cooking (it’s too hard to follow recipes). Or they might be unable to communicate clearly or navigate automated phone systems. A variety of other problems can ensue, including social isolation, malnutrition, self-neglect, and susceptibility to scams. Without someone to watch over them, older adults on their own may experience worsening health without anyone noticing or struggle with dementia without ever being diagnosed.
Conclusion
For those living alone with cognitive impairment, the consequences can be devastating. Without adequate support, they may struggle to maintain their independence, lead to health complications, and experience social isolation. It is crucial that more attention is paid to this population, and that resources are dedicated to helping them live safely and with dignity.
Frequently Asked Questions
Q: How many older adults with cognitive impairment are living alone in the United States?
A: At least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States.
Q: What are some of the challenges faced by these individuals?
A: They may experience difficulty with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, and may have trouble communicating or navigating automated phone systems.
Q: Who is most affected by this issue?
A: Those living alone with cognitive impairment are more likely to be women, Black or Latino, with lower levels of education, wealth, and homeownership.
Q: What can be done to help?
A: It is crucial that health care providers ask "Who do you live with?" to identify who may need more help. Additionally, publicly funded programs such as Medicaid should be expanded to provide services in the home.
