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Alone and confused

Community-residing older African Americans with dementia

Alzheimer's Disease Research Center, and the Program in Occupational Therapy and Department of Neurology,Washington University, St. Louis, MO, USA, dfedwards{at}education.wisc.edu

John C. Morris

Alzheimer's Disease Research Center, and the Department of Neurology,Washington University School of Medicine, St. Louis, MO, USA, morrisj{at}abraxas.wustl.edu

Despite significant increases in the number of adults who live alone, little is known about adults with cognitive impairment who live without co-resident caregivers. In this study, we examined demographic, cognitive, and functional characteristics and service use patterns of a sample (N = 343) of older community-residing African Americans with dementia who were referred for assessment. Of this group, 52 percent (179) lived alone. Adults who lived alone were compared with those who had co-resident caregivers to determine differences in cognitive and functional status and formal service use. Comprehensive multidisciplinary assessment included diagnosis and staging of dementia, status evaluation of activities of daily living and instrumental activities of daily living, and informal and formal support. Adults living alone had significantly more caregivers than those with co-resident caregivers. Neighbors and friends were more common primary care providers for live-alone adults. A significant proportion of adults had inadequate care, given their cognitive and functional deficits. Although formal service use was low in both groups, live-alone adults were more likely to receive social services than were adults with a co-resident caregiver. Predictors of formal service use included the presence of a caseworker, Medicaid certification, mild dementia, and living alone. Our results indicate the need for better identification of, and supportive services for, older African Americans with dementia who live alone.

Key Words: Alzheimer's disease • formal service use • functional impairment

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