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

  • Susan W. Lehmann (a1), Betty S. Black (a1) (a2), Andrew Shore (a2), Judith Kasper (a2) and Peter V. Rabins (a1) (a2)...

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.

Corresponding author
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:
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Black, B. S. et al. (2003). Identifying dementia in high-risk community samples: the memory and medical care study. Alzheimer Disease and Associated Disorders, 17, 918.
Canadian Study of Health and Aging Working Group (2001). Disability and frailty among elderly Canadians: a comparison of six surveys. International Psychogeriatrics (Suppl. 1), 159–167.
Chatfield, M., Matthews, F. E. and Brayne, C. (2007). Using the Mini-mental State Examination for tracking cognition in the older population based on longitudinal data. Journal of the American Geriatrics Society, 55, 10661071.
Cummings, J. L. et al. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
Eaton, W. W. et al. (1997). Natural history of Diagnostic Interview Schedule/DSM-IV major depression: the Baltimore Epidemiologic Catchment Area follow-up. Archives of General Psychiatry, 54, 993999.
Ebly, E. M., Hogan, D. B. and Rockwood, K. (1999). Living alone with dementia. Dementia and Geriatric Cognitive Disorders, 10, 541548.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Kasper, J. D., Shapiro, S., Guralnik, J. M., Bandeen-Roche, K. J. and Fried, L. P. (1999). Designing a community study of moderately to severely disabled older women: the Women's Health and Aging Study. Annals of Epidemiology, 9, 498507.
Katz, I. and Ford, A. (1963). Studies of illness in the aged: the index of ADL, a standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185, 914919.
Kim, S. Y. H., Karlawish, J. H. T. and Caine, E. D. (2002). Current state of research on decision-making competence of cognitively impaired elderly persons. American Journal of Geriatric Psychiatry, 10, 151165.
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179186.
Lopponen, M., Raiha, I., Isoaho, R., Vahlberg, T. and Kivela, S. L. (2003). Diagnosing cognitive impairment and dementia in primary health care: a more active approach is needed. Age and Ageing, 32, 606612.
McGuire, L. C., Ford, E. S. and Ajani, U. A. (2006). Cognitive functioning as a predictor of functional disability in later life. American Journal of Geriatric Psychiatry, 14, 3642.
National Center for Health Statistics (2009). Older Americans 2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging Related Statistics. National Center for Health Statistics, Health Data Interactive. Available at: Last accessed 17 August 2009.
Nourhashemi, F., Amouyal-Barkate, K., Gillette-Guyonnet, S., Cantet, C., Vellas, B; REAL.FR Group. (2005). Living alone with Alzheimer's disease: cross-sectional and longitudinal analysis in the REAL.FR Study. Journal of Nutrition, Health, and Aging, 9, 117120.
Nygard, L. and Starkhammar, S. (2007). The use of everyday technology by people with dementia living alone: mapping out the difficulties. Aging and Mental Health, 11, 144–55.
Prescop, K. L., Dodge, H. H., Morycz, R. K., Schulz, R. M. and Ganguli, M. (1999). Elders with dementia living in the community with and without caregivers: an epidemiological study. International Psychogeriatrics, 11, 235250.
Rabins, P. V. (1994). The validity of a caregiver-rated brief Behavior Symptom Rating Scale (BPRS) for use in the cognitively impaired. International Journal of Geriatric Psychiatry, 9, 205210.
Scanlan, J. M., Binkin, N., Michieletto, F., Lessig, M., Zuhr, E. and Borson, S. (2007). Cognitive impairment, chronic disease burden, and functional disability: a population study of older Italians. American Journal of Geriatric Psychiatry, 15, 716724.
Sibley, A. et al. ; Consortium to Investigate Vascular Impairment of Cognition (2002). The effect of the living situation on the severity of dementia at diagnosis. Dementia and Geriatric Cognitive Disorders, 13, 4045.
Stata 6. (1999). Intercooled Stata 6.0 for Windows 95/98/NT. College Station, Texas: Stata Corporation.
Tierney, M. C., Charles, J., Naglie, G., Jaglal, S., Kiss, A. and Fisher, R. H. (2004). Risk factors for harm in cognitively impaired seniors who live alone: a prospective study. Journal of the American Geriatrics Society, 52, 14351441.
Tombaugh, T. N. and McIntyre, N. J. (1992). The Mini-mental State Examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922935.
Webber, P. A., Fox, P. and Burnett, D. (1994). Living alone with Alzheimer's disease: effects on health and social service utilization patterns. The Gerontologist, 34, 814.
Wechsler, D. (1981). WAIS-R Manual. San Antonio, TX: Psychological Corporation.
Welsh, K. A., Butters, N., Mohs, R. C. et al. ; The Consortium to Establish a Registry for Alzheimer's Disease (CERAD): V. (1994). A normative study of the neuropsychologic battery. Neurology, 44, 609614.
West, S. K. et al. (1997). Function and visual impairment in a population-based study of older adults: the SEE project (Salisbury Eye Evaluation). Investigative Ophthalmology and Visual Science, 38, 7282.
Wilkins, C. H., Wilkins, K. L., Meisel, M., Depke, M., Williams, J. and Edwards, D. F. (2007). Dementia undiagnosed in poor older adults with functional impairment. Journal of the American Geriatrics Society, 55, 17711776.
Yaffe, K. et al. (2002). Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA, 287, 20902097.
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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
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