One in every four older Americans with dementia or mild cognitive impairment lives alone, putting them at risk of risky driving, wandering outside the home, mixing up medications, and failing to attend medical appointments. In a study publishing in JAMA Network Open on Aug. 18, 2023, researchers led by UC San Francisco concluded that the United States health system is poorly equipped to serve patients living solo with cognitive decline, a group whose numbers are predicted to swell as the population ages.

For these patients, living alone is a social determinant of health with an impact as profound as poverty, racism and low education, said first author Elena Portacolone, PhD, MBA, MPH, of the UCSF Institute for Health and Aging and the Philip R. Lee Institute for Health Policy Studies. In this qualitative study, researchers interviewed 76 health care providers, including physicians, nurses, social workers, case workers, home care aides and others. Participants worked in memory clinics, home care services and social services and other places in California, Michigan and Texas.