Living alone with mild-to-moderate dementia over a two-year period: longitudinal findings from the IDEAL cohort

Objectives: To compare the experiences of people with dementia living alone or with others and how these may change over two years. Design: We analysed longitudinal data from three assessment waves, one year apart, in the British IDEAL cohort. Setting: Participants with mild-to-moderate dementia were recruited through National Health Service providers, where possible with a family caregiver, and interviewed at home. Participants: The current analyses include 281 people with dementia living alone and 1244 living with others at baseline; follow-up data were available for 200 and 965 respectively at time 2 and 144 and 696 respectively at time 3. For those living alone, 140 non-resident caregivers contributed at baseline, 102 at time 2 and 81 at time 3. For those living with others, 1127 family caregivers contributed at baseline, 876 at time 2 and 670 at time 3. Measurements: Assessments covered: cognitive and functional ability; self-reported perceptions of health, mood, social engagement, quality of life, satisfaction with life and well-being; use of in-home and community care; and transitions into residential care. Results: People living alone tended to have better cognitive and functional ability and were more frequent users of in-home care. However, they experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time and rates of transition into residential care were higher. Conclusions: To facilitate continuing in place for people with dementia living alone, a dual focus on supporting functional ability and addressing psychosocial needs is essential in the context of an enabling policy framework.