Living Alone with Dementia - A Case Study Approach to Understanding Risk

Author(s): Helen Gilmour, Faith Gibson and Jim Campbell
Document Type: Article
Year: 2003
Title of Publication: Dementia: The International Journal of Social Research and Practice
Publisher: Sage Publications
Place of Publication: London
Volume: 2 (3)
Pages: 403-420
Subject Area(s): Social Care, Community Care, Health
Client Group(s) : Carers

Abbreviations: CarenapD - Mutli-Disciplinary Assessment Tool, GP - General Practitioner

Background to the Research

  • Over the last decade there has been a growing body of research relating to dementia, some of which focuses on people who live alone. However, few studies focus on the area of risk associated with the subsection of people living alone with dementia.

Research Approach

  • The current research selected 33 out of 69 people living alone who had been identified in a study carried out earlier in 2003. Using data from the Social Science Computer Package, the next of kin, social worker (or social worker assistant), district nurse and GP were interviewed using a semi-structured interview schedule. CarenapD was used to gather background information on the needs of people with dementia living in the community and their carers.

Main Findings

  • The 33 people living with dementia had a Global Deterioration Score of 4-5, indicating that the degree of dementia was 'moderate or moderately severe.
  • One year on, of the 33 people who lived alone only 11 remained living in their own homes in the community, 2 had died, 6 now lived with relatives and 14 had moved into residential or nursing homes.
  • Of the 11 living alone, 2 men and 8 women with dementia were included in this study; their average age was 83.3 years (age range 74-93).
  • Five people lived in a main town, 3 in villages and 2 in remote country areas. All but 2 had family living within the same geographic area and had daily contact with them. Nine had care packages managed by social workers employed by local social services. Six had been comprehensively assessed and were care managed.

People with dementia

  • Six people indicated frustration with their memory and the majority appeared accepting of care staff involvement.
  • Many people's comments indicated a desire for structure and meaning to their daily lives and some expressed appreciation of family support.

Family carers

  • All of the family members indicated that these people faced risks, the main types identified were dealing with heating, falling, managing money, road safety, getting lost and cooking.

Care staff

  • Care staff tended to emphasize the importance of locality in terms of assessing and managing risk; people were felt to be at less risk because they knew their local areas well and were well known to members of the community in their local areas.
  • Care staff appreciated that other professionals accepted a level of risk existed where people lived alone with dementia.

General practitioners

  • All GPs indicated that the person with dementia ideally should remain in his/her own home, despite the risks posed.

District nurses

  • Falling was the most common problem identified by nurses, adequate nutrition for their clients was a concern for 3 of the nurses. Some nurses were keen to establish rules about risk management.

Social workers

  • Social work staff echoed the types of risks raised by family members. Some social workers indicated a lack of communication/trust between themselves and family members.

Conclusions

  • The research points to the invaluable and often unacknowledged contribution of family members, neighbours, care staff and members of the community in supporting people living alone with dementia. Future development of services should take these into account.
  • The study emphasizes the importance of close working together within primary care in relation to assessing and managing risk; developing the social work attachments to primary care may help this.
  • Additional resources invested in training and staff development may be necessary to attain skill and confidence in order that all interested parties may work together more effectively.

 

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