Many older Americans with dementia or mild cognitive impairment live alone, facing risks like wandering, medication confusion, and missing doctor’s appointments.
A recent study suggests that the U.S. health system is ill-prepared to cater to this growing demographic.
The Alarming Findings
Led by researchers from UC San Francisco and published in JAMA Network Open, the study presented a worrying picture of the challenges faced by those living alone with cognitive decline.
Elena Portacolone, the study’s leading author, equated the impact of living alone on these patients’ health to the influence of factors such as poverty, racism, and low education.
This extensive qualitative study drew insights from 76 healthcare providers across California, Michigan, and Texas. They highlighted concerns about:
- Patients skipping medical appointments and failing to recall their purpose.
- Lack of emergency contacts for many patients.
- Patients’ vulnerability to health hazards like malnutrition, untreated medical conditions, and falls.
- Late identification of these patients, often after a crisis.
- Discharging some patients without adequate support, sometimes just with a taxi voucher.
A particularly telling comment from a psychiatrist likened discharging a patient without support to “sending a kid out to play on the freeway.”
The Crux of the Issue: Lack of Home Care Aides
The research pinpointed a gaping hole in the health care system: the lack of subsidized home care aides.
In the U.S., around 79% of those with cognitive decline don’t qualify for Medicaid-subsidized home care aides due to their income, leaving them without crucial assistance.
Medicare typically provides aides post-acute episodes, such as hospitalizations, but only for fixed periods.
Many patients pay from their pockets for assistance, which can become financially unsustainable over the long duration of cognitive impairment.
The aides that are available through Medicaid often have limited training and are underpaid, making it challenging to offer quality care for dementia patients.
Looking Abroad for Solutions
Other countries offer a contrasting picture. For example, many European nations, Japan, and Canada provide subsidized home care aides to a much larger proportion of their elderly citizens.
These countries recognize the importance of caring for dementia patients living alone and have systems in place to ensure they receive the necessary assistance.
Kenneth E. Covinsky, the study’s senior author, urged for an overhaul in how we perceive and cater to dementia patients.
He lamented the vast sums Medicare is ready to spend on marginally beneficial drugs while neglecting the basic supports that dementia patients desperately need.
The Way Forward
The researchers advocate for a reimagined system where robust supports are funded by expanded Medicare and Medicaid.
As older adults are projected to live longer, often alone, and given the rising rates of childlessness and divorce, the need for such a system will become even more pressing.
We must prioritize funding and resources to ensure that older adults with cognitive impairment can live with dignity, safety, and the necessary care they deserve.
If you care about brain health, please read studies about how the Mediterranean diet could protect your brain health, and blueberry supplements may prevent cognitive decline.
For more information about brain health, please see recent studies about antioxidants that could help reduce dementia risk, and Coconut oil could help improve cognitive function in Alzheimer’s.
The study was published in JAMA Network Open.
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