Older adults living alone with cognitive impairment — a growing and vulnerable population — face unique challenges. Elena Portacolone, assistant professor of Sociology at the University of California, San Francisco is leading a study, funded by the National Institute on Aging, to understand daily experiences, social networks, and decision-making ability of isolated seniors, with the aim of designing culturally sensitive interventions to improve their health, well-being, and social integration.
“Whereas most researchers of isolation study the personal traits and behaviors of isolated individuals, my research focuses on the role that structural factors (i.e., institutions, social policies, and ideologies) play in exacerbating the social isolation of vulnerable individuals,” Portacolone said. “For example, in my prior investigation of older residents of high-crime neighborhoods, who were mostly African-American older adults, a tension emerged between participants’ longing to participate in society and obstacles that made this participation difficult to attain.”
These structural obstacles included fear of being robbed, distrust of neighbors, limited availability of appropriate services, dilapidated surroundings, and limited meaningful and positive relationships. Having few friends or family members attuned to their concerns was another factor exacerbating social isolation. Study participants expressed a desire to be socially integrated, an idea that runs against the prevailing assumption that isolated older adults are alone by choice.
Similar patterns emerge in Portacolone’s ongoing investigation of older adults with cognitive impairment living alone. “One African-American study participant told me of her tendency to lock herself in the bathroom during family gatherings to cry and ‘let the tension out’ because her family members realize how concerned she is about her memory loss,” she recalled. “Other participants with Alzheimer’s disease noted that their friends were less eager to see them after they shared their diagnosis.”
Another structural obstacle is limited affordable services that address the specific needs of cognitively impaired people living alone. Home-care aides are seldom trained to support older adults with cognitive impairment, and their fees are often too high for most older adults on a long-term basis, Portacolone explained. In addition, some older adults with cognitive impairment have had their driver’s license revoked, but they do not get help with replacement transportation, which dramatically increases their isolation.
As a result, older adults with cognitive impairment living alone spend much of their time managing their household and their health, she said. They are often reluctant to show they need help because they fear being forced to move from their homes.
“The primary takeaway from this research is that interventions to increase older adults’ social integration should address not only their behaviors, but their overall surroundings,” Portacolone concluded. “We need to concentrate our attention on the influence of social policies, institutions, and ideologies in the everyday experience of isolated older adults.”
Information provided by the National Institute on Aging.