Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Jan Mutchler

Second Advisor

Nina Silverstein

Third Advisor

Charles Drebing


For community-dwelling older adults, the effects of living alone and cognitive impairment (CI) on the use of medical services and long-term services and supports were examined. Three questions were addressed: 1) Are people living alone with CI different from people living alone without CI in terms of types of services used? 2) Do people with CI who live alone use different types of services than people with CI who live with others? 3) Are severity of CI and living alone independent predictors of service use? The sample of 2,103 people aged 65 and older was drawn from the 1999 National Long-term Care Survey.

Overall, the results provide modest support for each of the hypotheses. Among the respondents that live alone, there were no between-group differences in the type of services used. The finding that CI is not associated with service use was partially supported by the multivariate analysis. This finding holds true for all services except doctor’s visits where cognitive impairment was associated with reduced probability of having a doctor’s visit in the past month. Among respondents with CI, living alone is positively associated with Home Delivered Meals service. For research question three, multivariate analyses indicated that living alone and CI are independent predictors of service use. Respondents that live alone are less likely to use homemaker services and more likely to use visiting nurse and home delivered meal services. Respondents with moderate to severe cognitive impairment are less likely to report hospitalization in the past 12 months compared to respondents without CI.

The findings from this study modestly suggest that living alone is a driving force behind service use and that severity or level of CI does not add to the probability of using long-term support and services. However, it may be that people with CI that live alone do not advocate for themselves to receive the services examined in this study. Previous literature has found that people with CI need support to be safe. The data analyzed here, however, are not capable of measuring self-advocacy. More research is needed that works towards examining this problem using different methodology for data collection.


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