Trends in Intentions to Remain Childless in the United States

Protective role of parenthood on age-related brain function in mid- to late-life

The experience of parenthood can profoundly alter one's body, mind, and environment, yet we know little about the long-term associations between parenthood and brain function and aging in adulthood. Here, we investigate the link between number of children parented (parity) and age on brain function in 19,964 females and 17,607 males from the UK Biobank. In both females and males, increased parity was positively associated with functional connectivity, particularly within the somato/motor network. Critically, the spatial topography of parity-linked effects was inversely correlated with the impact of age on functional connectivity across the brain for both females and males, suggesting that a higher number of children is associated with patterns of brain function in the opposite direction to age-related alterations. These results indicate that the changes accompanying parenthood may confer benefits to brain health across the lifespan, highlighting the importance of future work to understand the associated mechanisms.

Perceptions of the Role of Living Alone in Providing Services to Patients With Cognitive Impairment

Importance

The potential role of living alone in either facilitating or hampering access to and use of services for older adults with cognitive impairment is largely unknown. Specifically, it is critical to understand directly from health care and social services professionals how living alone creates barriers to the access and use of supportive health care and social services for racially and ethnically diverse patients with cognitive impairment.

Objective

To identify the potential role of living alone in the access and use of health care and social services for diverse patients with cognitive impairment by investigating professionals' perceptions of caring for such patients who live alone in comparison with counterparts living with others.

Design, Setting, and Participants

This qualitative study of 76 clinicians, social workers, and other professionals used semistructured interviews conducted between February 8, 2021, and June 8, 2022, with purposively sampled professionals providing services to diverse patients with cognitive impairment in Michigan, California, and Texas.

Main Outcomes and Measures

Clinicians, social workers, and other professionals compared serving patients with cognitive impairment and living alone vs counterparts living with others. An inductive content analysis was used to analyze the interview transcripts.

Results

A total of 76 professionals were interviewed (mean [SD] age, 49.3 [12.7] years); 59 were female (77.6%), 8 were Black or African American (11%), and 35 were White (46%). Participants included physicians, nurses, social workers, and home-care aides, for a total of 20 professions. Participants elucidated specific factors that made serving older adults living alone with cognitive impairment more challenging than serving counterparts living with others (eg, lacking an advocate, incomplete medical history, requiring difficult interventions), as well as factors associated with increased concerns when caring for older adults living alone with cognitive impairment, such as isolation and a crisis-dominated health care system. Participants also identified reasons for systematic unmet needs of older adults living alone with cognitive impairment for essential health care and social services, including policies limiting access and use to public home-care aides.

Conclusions and Relevance

In this qualitative study of professionals' perspectives, findings suggest that living alone is a social determinant of health among patients with cognitive impairment owing to substantial barriers in access to services. Results raised considerable concerns about safety because the US health care system is not well equipped to address the unique needs of older adults living alone with cognitive impairment.