Dementia: New study suggests that living alone can put people with cognitive decline at risk

Affecting more than 55 million people globally, according to the World Health Organization, dementia is currently the seventh leading cause of death and one of the major reasons for disability and dependency among the elderly population.
According to a new study published in the Journal of the American Medical Association Network Open (JAMA), one in every four older Americans with dementia or mild cognitive decline live alone, putting them at risk of risky driving, wandering outside the home, mixing up medications, and failing to attend medical appointments.
“…older adults living alone with cognitive impairment are systematically destined to fall through the cracks of a health care system overly relying on unpaid caregivers, limited access to public home-care aides, and a reactionary, crisis-driven system. These social forces may be associated with the demonstrated negative health consequences observed for older adults living alone with cognitive impairment,” the team of researchers from UC San Francisco said.
For this, researchers studied 76 clinicians, social workers, and other professionals through interviews, who compared serving patients with cognitive impairment who stayed with others vs. such patients who stayed alone.

“Findings suggest that living arrangements are a social determinant of health among patients with cognitive impairment because those living alone are more likely to experience gaps in services and they are harder to serve than counterparts living with others,” the researchers said.

What exactly is dementia?
Dementia is a broad term used to describe a set of cognitive impairments that significantly interfere with an individual’s ability to perform daily activities and maintain independence, as per Dr P.N. Renjen, Senior Consultant, Neurology, Indraprastha Apollo Hospitals. It is not a specific disease, but rather a syndrome caused by various underlying conditions, the most common being Alzheimer’s disease.

Affecting more than 55 million people globally, according to the World Health Organization, dementia is currently the seventh leading cause of death and one of the major reasons for disability and dependency among the elderly population.

Dr Anand Kumar, professor and head, Dept. of Neurology, Amrita Hospital, Kochi said, “Commonly associated with ageing, dementia progresses gradually — making it tough for people to recall information and complete tasks they used to manage effortlessly. Imagine it as a fading of mental connections, leading to confusion, alterations in personality, and challenges in even the simplest of activities. As dementia advances, it often requires increasing support and care from loved ones or caregivers.”

Concurring with the findings of the study, Dr Natasha Tipnis Shah, consultant, Neurology, Jaslok Hospital & Research Centre, Mumbai told indianexpress.com that “living alone deprives the brain of sensory input”.

“When a person lives alone, they meet fewer people, and their interactions are limited, thereby leading to less conversational language use. Additionally, other experiences such as participating in festivals, going out for social events, and celebrating important days, get significantly reduced. Medically speaking, domains of language, emotions, social adaptability, semantic memory, and procedural memory get severely impacted when we live alone,” she said.

While various studies have established a connection between social isolation and significant health conditions, including dementia, Dr Kumar said that it’s important to note that not everyone with fewer social interactions will develop dementia.

People living with dementia eventually become dependent on caregivers. (Source: Freepik)
Dementia brings a host of challenges for those affected.

Memory loss hits hard, making recent events and names slip away. Confusion adds a layer of disorientation — complicating daily tasks. “Trouble concentrating becomes frustrating, while personality shifts and withdrawal from loved ones create emotional hurdles. Feelings of depression and anxiety often loom large, accompanied by the loss of once-familiar skills. Communication becomes an uphill battle, leaving both the person with dementia and their loved ones feeling isolated. Recognising even close faces becomes a struggle, and mobility issues and safety concerns heighten in later stages,” said Dr Kumar.

Apart from this, people living with dementia eventually become dependent on caregivers. “It is a difficult task to be a caregiver, which can cause frustration, anger and even burnout,” Dr Shah noted.

Here are some tips to help become a better caregiver for people living with dementia, according to Dr Vishal Sehgal, president, Portea Medical:

Education: The first step to support is to learn and be aware of the specific type of dementia your loved one has, its progression, and associated behaviours to better understand their needs.

Practicing empathy and reassuring presence: Maintain a calm and reassuring demeanour while interacting with the person. Listen attentively to their concerns and frustrations, acknowledging their emotions and trying to understand their feelings, whether it’s anger or fear. Be patient with communication, as it might take time for the person to express themselves. Show empathy and validate their feelings.

Empowerment and respect: Allow the person as much autonomy as possible in their daily life. Respect their personal space and preferences, fostering a sense of control and dignity.

Structured routine: Establish a structured routine that includes both quiet times and engaging activities. This helps create a sense of predictability and reduces confusion. Maintain regular routines for tasks like bathing, dressing, and eating. Use written lists or calendars to assist with remembering appointments and tasks.

Familiar objects: Keep cherished objects and photographs around the living space to provide comfort and familiarity. Such items can help the person feel more secure and connected.

Medication management: Implement reminders or systems for medication schedules. Ensure medications are taken regularly and as prescribed.

Safety and supervision: Safety is paramount for dementia patients who might be prone to wandering, falls, or other accidents. Create a safe environment by removing hazards and implementing security measures to prevent accidents or fall. Keep a close look so that they don’t wander outside the house and might get lost. If possible, keep the local communities informed.

Bathing safety: Use a sturdy shower chair to prevent falls during bathing. Clearly communicate each step of the bathing process, ensuring the person feels respected and informed.

Self-care: Caregivers should prioritise their own well-being to avoid burnout. Seek support from friends, family, or support groups.

Professional help: Consider involving healthcare professionals, such as doctors and therapists, to address medical and psychological needs.

Concluding, Dr Shah said, “Most important, take breaks and rejuvenate yourself. It is not possible to pour from an empty cup”.