By Robyn Stone
A national team of researchers is studying ways to support older people living alone with cognitive impairment. Housing providers can help, writes Robyn Stone.
Elena Portacolone has always been interested in older people who live alone.
For her, it’s personal.
Elena lives alone. Her grandmother, who also lived alone, lost her balance after dinner one evening and lay on the kitchen floor for hours before help arrived. Her father died after an asthma attack found him unprepared and alone in the middle of the night.
At a relatively early age, Elena learned a difficult lesson that shaped her career as an academician and a researcher. She knew from experience that living alone offered a welcome sense of freedom to a healthy younger person like herself. But her family history taught her just how precarious this housing choice could become for people as they aged.
While working on her doctoral dissertation at the University of California San Francisco (UCSF), Elena interviewed 47 older adults she met while serving as a Meals on Wheels volunteer in San Francisco. She aimed to identify the challenges all older people encounter while living alone. But she soon made a troubling discovery: for at least 30% of her interviewees, the challenges of living alone were exacerbated by some degree of cognitive impairment.
Alarmed by this statistic, Elena refined her research to focus on the invisible population of older people with cognitive impairment who are living alone without support from family caregivers. Through more than 700 interviews conducted over the past several years in California, Michigan, and Louisiana, Elena has learned about the unique challenges facing older adults of diverse races and ethnicities who are living alone with cognitive impairment. She’s also discovered the dearth of research about these older adults and the lack of public resources and services available to help them live independently.
Elena, an associate professor in the Institute of Health and Aging at UCSF, carried out her last 400 interviews while serving as the principal investigator for the five-year Living Alone with Cognitive Impairment (LACI) project, which is funded by the National Institute on Aging. I’m part of the project’s research team and co-lead its policy advisory group with Elena. The project is now completing its fourth year.
At one level, the LACI project seeks to focus attention on the estimated 4.3 million older adults in this country who have cognitive impairment and live alone. These individuals often do not receive a timely diagnosis of cognitive impairment that could connect them with much-needed services. Most lack access to home care aides who could help them manage their households, assist them with activities of daily living, reduce their isolation, and offer them encouragement and emotional support.
The LACI project has another—and equally important—goal that resonates with me. The interdisciplinary team of scientists participating in this project is firmly committed to translating our research findings into public policy so that life actually gets better for older people who have cognitive impairment and live alone.
This applied research approach aligns perfectly with the mission of the LeadingAge LTSS Center @UMass Boston. It aligns with the LTSS Center’s current work to test the implementation of an intervention to support long-distance caregivers of people living with dementia. Most importantly, it aligns with the work of many LeadingAge member organizations, especially members who provide affordable housing and those who serve a moderate-income population living in market-rate housing communities.
What can housing providers do to support this invisible and highly vulnerable population? I have three suggestions.
First, take a good look at your community’s resident population. Recognize that many of those residents are living with cognitive impairment. Don’t assume these residents have a family member who serves as their care partner. Chances are that many residents with cognitive impairment are walking this road alone.
Second, do what you can to connect these residents with community-based services that can help them manage their day-to-day challenges. Consider helping residents with low incomes apply for Medicaid if they are not already covered.
Third, visit the LACI website to learn more about people with cognitive impairment who live alone. Consider how you can help advance the policy goals outlined in our three policy briefs. Reach out to Elena or me to learn how you can get involved in this effort.
The population of people living alone with cognitive impairment will stay hidden and underserved until we as a nation truly see these individuals, acknowledge their challenges, and step forward to help. I hope you will join us in bringing about the change they desperately need.
Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.