Living alone with Alzheimer's disease: cross-sectional and longitudinal analysis in the REAL.FR Study

OBJECTIVES: The purpose of this study was to examine the characteristics of Alzheimer's disease (AD) patients living alone and to describe the rate of cognitive and functional impairment after a one-year follow-up.

DESIGN AND SETTING: In a prospective longitudinal study conducted by the French network on Alzheimer's disease (the REAL.FR study), 677 older community-dwelling AD patients were interviewed and completed questionnaires and evaluation scales every 6 months during a one-year follow-up.

MEASUREMENTS: All patients were assessed by trained staff who collected data on neuropsychological status using the Mini Mental State Examination (MMSE), behavioural disturbances with the Neuropsychiatric Inventory (NPI) and nutritional status with the Mini Nutritional Assessment (MNA). Patients were assessed for current mobility and function in activities of daily living (ADL) and instrumental activities of daily living (IADL).

RESULTS: At inclusion, 28% of the 677 non-institutionalised individuals with AD lived alone. Those who lived alone were significantly older than those who did not, and among them the percentage of women was significantly higher. Patients living alone were at increased risk of malnutrition and were more likely to have a low income than those living with others. Persons with AD living alone made greater use of health services. Dementia stage evaluated by cognitive impairment (MMSE) and ADL disabilities was similar in both groups. At one-year follow-up, the mortality rate was significantly higher in AD patients living with others. Institutionalisation and hospitalisation rates were similar.

CONCLUSION: These results draw attention to the fact that elderly persons with AD living alone are a subpopulation with specific needs which require the development of targeted interventions. Further investigation of the factors associated with the lower mortality rate in AD patients living alone is necessary, and the results of long-term follow-up in this prospective study should shed light on this question.