Medication Management Among Older Adults Living Alone With Cognitive Impairment

Importance More than one-fourth of older individuals in the US with cognitive impairment live alone. These individuals often lack support for medication management and face a high risk of medication-related harm. Objective To elucidate barriers and facilitators to medication management experienced by older adults living alone with cognitive impairment and their social contacts. Design, Setting, and Participants This qualitative study was conducted between May 2016 and February 2024 among adults of diverse racial and ethnic backgrounds aged 55 years or older living alone with cognitive impairment in California, Louisiana, and Michigan (ie, participants), along with their social contacts, defined as family members or other familiar persons. Data were analyzed between February 2024 and March 2025. Main Outcomes and Measures As part of the Living Alone With Cognitive Impairment Project, participants’ and social contacts’ perspectives regarding barriers and facilitators were elicited via semistructured interviews conducted in English, Spanish, Cantonese, or Mandarin. Participants were interviewed a mean of 4 times (486 interviews total), mostly in their homes. Combined inductive and deductive thematic analysis was used to examine discussions specific to medication management. Results A total of 116 older adults living alone with cognitive impairment (median range age, 74 57-103 years; 86 females 74.1%) and 54 social contacts (median range age, 59 29-89 years; 44 females 81.5%) were interviewed. At an individual level, barriers to medication management included a lack of reminders to take medications due to a lack of cohabitants, fear of experiencing adverse effects while alone, and stress related to managing complex medication regimens with inadequate support. At an interpersonal level, barriers included difficulty in verifying medication behaviors without cohabitants, distrust of health care professionals related to a desire to maintain independence, and communication barriers. At a system level, barriers included difficulty navigating health system logistics without advocates. Participants received crucial but intermittent support with medication management from noncohabiting social contacts. Both groups suggested potential solutions to barriers, but they nevertheless conveyed a sense of precarity related to medication management. Conclusions and Relevance This qualitative study involving racially and ethnically diverse participants from 3 states highlights the substantial barriers older adults living alone with cognitive impairment experience in managing their medications. Identification of cognitive impairment in older adults who live alone should spur targeted efforts to overcome medication-related challenges. In addition, more home- and community-based services are needed to provide medication management support to individuals living alone with cognitive impairment.