Living alone puts people with cognitive decline -- a group whose numbers are predicted to swell as the population ages globally -- at high risk as they forget appointments, mix up medications and have no one to contact in an emergency, according to new research.
For such patients, living alone is a
social determinant of health with an impact as profound as poverty, racism and
low education, according to the study published in JAMA Network Open.
An estimated 1 in 4 older Americans with
dementia or mild cognitive impairment lives alone and is at risk of practices
like unsafe driving, wandering outside the home, mixing up medications and
failing to attend medical appointments.
“These findings are an indictment of our
health care system, which fails to provide subsidised home care aides for all
but the lowest-income patients,” said Elena Portacolone of the University of
California-San Francisco (UCSF) Institute for Health and Aging.
In this study, researchers interviewed
76 healthcare providers, including physicians, nurses, social workers, case
workers, home care aides and others.
The providers raised concerns about
patients missing medical appointments, failing to respond to follow-up phone
calls from the doctor's office and forgetting why appointments were made,
leaving them vulnerable to falling off the radar.
“We don't necessarily have the staff to
really try to reach out to them,” said a physician in one interview.
Some patients could not assist their
doctor with missing information on their chart, leaving the providers uncertain
about the pace of their patient's decline.
Many had no names listed as emergency
contacts, “not a family member, not even a friend to rely on in case of a
crisis”, according to a case manager.
These patients were at risk for
untreated medical conditions, self-neglect, malnutrition and falls, according
to the providers.
One consequence of the shaky
infrastructure supporting these patients was that they were not identified
until they were sent to a hospital following a crisis, like a fall or reaction
to medication mismanagement, the study noted.
“In an era when Medicare is going to
spend millions of dollars for newly approved drugs with very marginal benefits,
we need to remember that Medicare and other payers refuse to pay far less money
to provide necessary supports for vulnerable people with dementia,” said senior
author Kenneth E. Covinsky of the UCSF Division of Geriatrics.
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