Providers’ perceptions of the role played by living alone in providing services to diverse patients with cognitive impairment in the US

Abstract

AbstractBackgroundThe potential moderating role of living alone in either facilitating or hampering access to services to older adults with cognitive impairment is largely unknown. Given the estimated 4.3 million older adults from diverse racial/ethnic backgrounds who are living alone with cognitive impairment in the United States, it is critical to understand directly from providers of healthcare and social services whether living alone creates barriers to supportive services for racially/ethnically diverse patients with cognitive impairment. The objective of this study was to identify the potential moderating role of living alone in the use of healthcare and social services for patients with cognitive impairment by eliciting providers’ perceptions of caring for diverse patients with cognitive impairment living alone, in comparison to counterparts living with others.MethodThis qualitative study used semi‐structured interviews conducted between March 2021 and June 2022 with purposively sampled providers of services to diverse patients with cognitive impairment in Michigan, California, and Texas. An inductive content analysis was used to analyze the data.ResultThe majority of the 76 interviewed providers belonged to communities of color and cared for racially/ethnically diverse patients with cognitive impairment. Providers included physicians, nurses, social workers, home care aides, for a total of 20 professions. Providers elucidated specific factors that made serving people living alone with cognitive impairment (PLACI) more challenging, as well as specific factors that increased their concerns when serving PLACI, including a crisis‐dominated healthcare system. Providers also elucidated reasons for systematic unmet needs of PLACI for essential healthcare and social services, such as policies limiting access to home‐care aides.ConclusionThe vast majority of providers underscored the critical, yet understudied, role of living alone in moderating access to essential healthcare and social services among patients with cognitive impairment. Findings suggest that living arrangement are a social determinant to health among patients with cognitive impairment because patients with cognitive impairment who live alone are more likely to experience gaps in services because they are more challenging to serve than counterparts living with others and the healthcare system is not designed to address these challenges.