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Living alone with dementia: lack of awareness adds to functional and cognitive vulnerabilities

Published online by Cambridge University Press:  18 May 2010

Susan W. Lehmann ,
Betty S. Black ,
Andrew Shore ,
Judith Kasper  and
Peter V. Rabins
Susan W. Lehmann*
Affiliation:
The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A.
Betty S. Black
Affiliation:
The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A. The Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, U.S.A.
Andrew Shore
Affiliation:
The Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, U.S.A.
Judith Kasper
Affiliation:
The Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, U.S.A.
Peter V. Rabins
Affiliation:
The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A. The Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, U.S.A.
*
Correspondence should be addressed to: Susan W. Lehmann, M.D., Department of Psychiatry and Behavioral Sciences, Meyer 279, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287-7279, U.S.A. Phone: +1 410-955-6736; Fax: +1 410-614-1094. Email: slehman@jhmi.edu.
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Abstract

Background: Approximately 25% of individuals with dementia live alone, yet little is known about the cognitive and functional factors that impact detection of impairment.

Methods: Subjects with dementia (n = 349) from a community study of dementia management were administered the Mini-mental State Examination (MMSE) and were asked to rate their cognitive status. Each participant's knowledgeable informant (KI) was interviewed to provide information about the subject's mental health and levels of cognitive and functional impairment. Subjects with dementia living alone (n = 97, 27.8%) were compared to subjects living with others (n = 252, 72.2%) regarding functional impairment, psychiatric symptoms, cognitive functioning, and dementia recognition.

Results: While subjects with dementia living alone had significantly fewer ADL impairments (p < 0.0001) and less cognitive impairment (p < 0.0001) than subjects with dementia who were living with others, nearly half of subjects living alone had two or more IADL impairments. Both knowledgeable informants (p < 0.001) and primary care physicians (p < 0.009) were less likely to detect dementia in subjects living alone, while 77.3% of subjects with dementia living alone rated their cognitive abilities as “good” or “a little worse”. Subjects with dementia living alone and those living with others had similar rates of psychosis (p = 0.2792) and depressive symptoms (p = 0.2076).

Conclusions: Lack of awareness of cognitive impairment by individuals with dementia living alone as well as their knowledgeable informants and physicians, combined with frequent functional impairment and psychiatric symptoms, heightens risk for adverse outcomes. These findings underscore the need for increased targeted screening for dementia and functional impairment among older persons living alone.

Keywords

living alonedementiafunctional impairmentcommunity
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 5 , August 2010 , pp. 778 - 784
Copyright
Copyright © International Psychogeriatric Association 2010

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