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Lowers J, Brus K, Smith C, Kavalieratos D, Hepburn K, Perkins MM. "How do You Take that Much Time for One Person's Life?" Experiences of Dementia Caregivers Who are Not Immediate Family. J Appl Gerontol 2024:7334648241265197. [PMID: 39046368 DOI: 10.1177/07334648241265197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
One in three people with Alzheimer's or other dementias lives alone, without a spouse/partner or nearby children (i.e., is aging solo), yet most dementia caregiving research has focused solely on spouses or children. This study examined the experiences of friends, neighbors, siblings, and others providing unpaid care for someone with dementia. We conducted semi-structured interviews with 14 caregivers (100% female; age 54-85, mean 71; 93% white, 7% black; 29% friend, 29% sibling or in-law, 21% neighbor, 21% church congregant). Participants balanced three priorities: the person living with dementia's quality of life, the person's safety and well-being, and the caregiver's resources. Caregivers described tensions when these priorities conflicted, such as the person with dementia's goal to live alone versus risks to their physical safety. These findings and future research can inform policies and programs to support non-family dementia caregiving.
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Clare L, Gamble LD, Martyr A, Henderson C, Knapp M, Matthews FE. Living Alone With Mild-to-Moderate Dementia Over a Two-Year Period: Longitudinal Findings From the IDEAL Cohort. Am J Geriatr Psychiatry 2024:S1064-7481(24)00352-X. [PMID: 38897833 DOI: 10.1016/j.jagp.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 05/15/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES To compare the experiences of people with dementia living alone or with others and how these may change over two years. DESIGN We analysed longitudinal data from three assessment waves, one year apart, in the British IDEAL cohort. SETTING Participants with mild-to-moderate dementia were recruited through National Health Service providers, where possible with a family caregiver, and interviewed at home. PARTICIPANTS The current analyses include 281 people with dementia living alone and 1,244 living with others at baseline; follow-up data were available for 200 and 965 respectively at time 2 and 144 and 696 respectively at time 3. For those living alone, 140 nonresident caregivers contributed at baseline, 102 at time 2 and 81 at time 3. For those living with others, 1,127 family caregivers contributed at baseline, 876 at time 2 and 670 at time 3. MEASUREMENTS Assessments covered: cognitive and functional ability; self-reported perceptions of health, mood, social engagement, quality of life, satisfaction with life and well-being; use of in-home and community care; and transitions into residential care. RESULTS People living alone tended to have better cognitive and functional ability and were more frequent users of in-home care. However, they experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time and rates of transition into residential care were higher. CONCLUSIONS To facilitate continuing in place for people with dementia living alone, a dual focus on supporting functional ability and addressing psychosocial needs is essential in the context of an enabling policy framework.
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Affiliation(s)
- Linda Clare
- University of Exeter Medical School, University of Exeter, (L.C, A.M), Exeter, UK; NIHR Applied Research Collaboration South-West Peninsula, (L.C), Exeter, UK.
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, (L.D.G, F.E.M) Newcastle, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, (L.C, A.M), Exeter, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, (C.H, M.K), London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, (C.H, M.K), London, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, (L.D.G, F.E.M) Newcastle, UK; Institute for Clinical and Applied Health Research, Hull York Medical School, (F.E.M), University of Hull, Hull, UK
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Lowers J, Datcher I, Kavalieratos D, Hepburn K, Perkins MM. Proactive Care-Seeking Strategies Among Adults Aging Solo With Early Dementia: A Qualitative Study. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae020. [PMID: 38375541 PMCID: PMC11128765 DOI: 10.1093/geronb/gbae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES People living with dementia need increasing care over time, but 1 in 3 adults with cognitive impairment lives alone. The goal of this study was to explore the self-identified strengths and resources for future care needs of adults aging solo with early dementia. METHODS Semistructured interviews with 15 adults not living with a partner and with no children in the same state, who self-identified as having early dementia or mild cognitive impairment; hybrid inductive/deductive reflexive thematic analysis using a successful aging framework. RESULTS Participants placed a high value on maintaining independence and expressed concerns about preserving selfhood and becoming a burden to others. These values influenced how participants appraised financial and social resources available to address future care needs and strategies to preempt or respond to needs such as transportation, help with finances, or activities of daily living. DISCUSSION Adults without close family are heterogeneous and have variable resources available to address care needs associated with dementia progression. Common values of retaining independence and minimizing burden to others may be helpful in motivating adults aging solo to undertake planning and help-seeking early.
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Affiliation(s)
- Jane Lowers
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Ivree Datcher
- School of Public Health, University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Dio Kavalieratos
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Ken Hepburn
- Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Molly M Perkins
- Department of Geriatrics, Emory University, Atlanta, Georgia, USA
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Angel JL, López-Ortega M, Chiu CT, Rote SM, Cantu P, Antequera F, Chen CA. Loss of Autonomy: Likely Dementia and Living Arrangement Transitions Among Mexicans and Mexican Americans. THE GERONTOLOGIST 2024; 64:gnad083. [PMID: 37392451 PMCID: PMC10825852 DOI: 10.1093/geront/gnad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To examine the role of probable dementia on changes in living arrangements and mortality among very old Mexicans and Mexican Americans in 2 different nations. RESEARCH DESIGN AND METHODS We employ the Hispanic Established Population for the Epidemiologic Study of the Elderly and the Mexican Health and Aging Study, 2 comparable longitudinal data sets, to identify predictors of changes in living arrangements using multinomial logistic regression, controlling for cognitive status, demographic characteristics, and resources. RESULTS In Mexico, women with dementia who lived alone at baseline were more likely to become part of an extended family household than men with similar levels of cognitive impairment. A similar pattern emerges for the oldest Mexican-American women. Spousal loss increases the likelihood of living alone for women in the United States regardless of dementia. Although dementia elevates the risk of mortality for men living alone in the United States, in both countries, women in their 90s who lived alone with dementia had a lower risk of mortality relative to men. DISCUSSION AND IMPLICATIONS Longer life spans increase the risk of living alone with dementia in both countries, especially for women. Older individuals in both countries face financial hardships. Mexicans have limited formal options in dementia care. Mexican Americans with dementia continue to live alone despite low income although, unlike the Mexicans, they have access to Medicaid long-term care. For Mexico and the United States, the growing number of older individuals with dementia represents a growing public health concern.
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Affiliation(s)
- Jacqueline L Angel
- LBJ School of Public Affairs and Center on Aging and Population Sciences, The University of Texas at Austin, Austin, Texas, USA
| | | | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Sunshine M Rote
- Kent School of Social Work and Family Science, University of Louisville, Louisville, Kentucky, USA
| | - Phillip Cantu
- Department of Internal Medicine—Geriatrics, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Felipe Antequera
- LBJ School of Public Affairs, The University of Texas at Austin, Austin, Texas, USA
| | - Ching-An Chen
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
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Portacolone E, Nguyen TT, Bowers BJ, Johnson JK, Kotwal AA, Stone RI, Keiser S, Tran T, Rivera E, Martinez P, Yang Y, Torres JM, Covinsky KE. Perceptions of the Role of Living Alone in Providing Services to Patients With Cognitive Impairment. JAMA Netw Open 2023; 6:e2329913. [PMID: 37594759 PMCID: PMC10439475 DOI: 10.1001/jamanetworkopen.2023.29913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023] Open
Abstract
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.
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Affiliation(s)
- Elena Portacolone
- Institute for Health & Aging, University of California, San Francisco
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Tung T. Nguyen
- Division of General Internal Medicine, School of Medicine, University of California, San Francisco
| | | | - Julene K. Johnson
- Institute for Health & Aging, University of California, San Francisco
| | - Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | | | - Sahru Keiser
- Institute for Health & Aging, University of California, San Francisco
| | - Thi Tran
- Institute for Health & Aging, University of California, San Francisco
| | - Elizabeth Rivera
- Institute for Health & Aging, University of California, San Francisco
| | - Paula Martinez
- Institute for Health & Aging, University of California, San Francisco
| | - Yulin Yang
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kenneth E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
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Yang Y, Swinnerton K, Portacolone E, Allen IE, Torres JM, Duchowny K. Difficulties with Activities of Daily Living and Receipt of Care Among Older Adults with Cognitive Impairment: Differences Between Those Living Alone and Those Living with Others. J Alzheimers Dis 2022; 89:31-37. [PMID: 35871333 PMCID: PMC10117199 DOI: 10.3233/jad-220172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared the prevalence of reporting difficulty with basic and instrumental activities of daily living without help received for persons with cognitive impairment living alone versus those living with others. We used data on 13,782 community-dwelling participants aged 55+ with cognitive impairment in the Health and Retirement Study (2000–2016). Models were stratified by gender and race/ethnicity. Among cognitively impaired older adults, those living alone were more likely to report difficulty without help received than those living with others. Results were similar by gender and race/ethnicity. Providers and policymakers might focus their efforts on ensuring the adequate provision of home and community-based services for older adults living alone with cognitive impairment.
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Affiliation(s)
- Yulin Yang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kaitlin Swinnerton
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Elena Portacolone
- Institute for Health & Aging, University of California, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kate Duchowny
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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