Barriers and Facilitators to Long-Term Services & Supports for Older Adults Living Alone With Cognitive Impairment

TL;DR

This study explores the challenges and supports for older adults with cognitive impairment living alone in accessing long-term care services.

Contribution

The study identifies specific barriers and facilitators to LTSS access for older adults with CI living alone, using a qualitative approach across diverse populations.

Findings

Barriers include unhelpful healthcare providers, unaffordable care, and rigid protocols.

Facilitators include attentive healthcare providers and transportation support.

Tailoring LTSS to the needs of this population is crucial for better outcomes.

Abstract

More than 4 million older Americans with cognitive impairment (CI) live alone. These individuals often face unique challenges due to limited or non-existent support from caregivers. Identifying the barriers and facilitators to accessing long-term services and supports (LTSS) is critical to preventing the adverse outcomes to which this population is particularly vulnerable, including self-neglect, untreated medical conditions, medication mismanagement, falls, and fires.

This qualitative study, conducted between May 2016-February 2024, included adults aged 55+ from diverse racial and ethnic backgrounds who were living alone with CI in California, Louisiana, and Michigan, as well as members of their social circle. Factors influencing LTSS access were identified via in-person, semi-structured interviews conducted in English, Spanish, Cantonese, or Mandarin. Transcripts were analyzed with combined inductive and deductive content analysis drawing from the micro-meso-macro framework.

A total of 119 older adults living alone with cognitive impairment (88 [71.5%] women; median age, 78 years [range, 57-103]) and 56 members of their social circle (45 [80.3%] women; median age, 45 years [range, 39-89]) were interviewed multiple times for a total of 558 interviews. Barriers to accessing LTSS included: healthcare providers being unhelpful, distrustful, dismissive, and unaffordable, with rigid protocols and long waiting periods; cognitive impairment itself in the context of living alone; limited resources.

having chronic medical conditions; “hunting” for services; information from attentive healthcare providers; support with transportation.

Findings underscore the importance of ensuring that critical LTSS are tailored around the needs of older adults living alone with CI.