Living Alone With Mild-to-Moderate Dementia Over a Two-Year Period: Longitudinal Findings From the IDEAL Cohort

•What is the primary question addressed by this study?How do people with dementia living alone differ from those living with others, both cross-sectionally and longitudinally over a two-year period?•What is the main finding of this study?People living alone had better cognitive and functional ability than those living with others but experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time, and they were more likely to move into long-term care.•What is the meaning of the finding?To facilitate continuing in place for people with dementia living alone requires a dual focus on supporting functional ability and addressing psychosocial needs, in the context of an enabling policy framework. To compare the experiences of people with dementia living alone or with others and how these may change over two years. We analysed longitudinal data from three assessment waves, one year apart, in the British IDEAL cohort. Participants with mild-to-moderate dementia were recruited through National Health Service providers, where possible with a family caregiver, and interviewed at home. The current analyses include 281 people with dementia living alone and 1,244 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 nonresident caregivers contributed at baseline, 102 at time 2 and 81 at time 3. For those living with others, 1,127 family caregivers contributed at baseline, 876 at time 2 and 670 at time 3. 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. 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. To facilitate continuing in place for people with dementia living alone, a dual focus on supporting functional ability and add ressing psychosocial needs is essential in the context of an enabling policy framework.