Service-level and practitioner-level recommendations for better care of people with dementia who live alone and have no informal caregivers
- 1Department of Primary Care and Population Health, University College London, London, United Kingdom
- 2School of Medicine, Keele University, Keele, United Kingdom
Abstract
Context: A substantial proportion of people with dementia live alone without informal caregivers, yet services often assume family involvement, increasing risks of unmet need and adverse outcomes. Objective: This study aimed to generate service-level and practitioner-level recommendations to best support people with dementia who live alone and lack informal caregivers. Methods: A qualitative phenomenological co-design workshop was conducted with seven practitioners from statutory, voluntary, and private-sector roles across England. Prompts informed by earlier qualitative work were used as a template to stimulate reflection and develop recommendations for practice through inductive thematic analysis and input from a study advisory group including people with lived experience of dementia. Findings: Practitioners recommended some service-level and practitioner-level recommendations. Service-level recommendations included flexible care pathways and sufficient time to build rapport in the absence of informal support. Practitioner-level recommendations, approaching the client with personability, humanity, warmth, respect, and humility, and adopting a sensitive yet honest communication, were essential for meaningful engagement and supporting autonomy. Curiosity and creativity helped practitioners understand behavioural motivations and tailor interventions. Experience underpinned all these competencies, with supervision and shadowing seen as vital for developing relational skills. Limitations: The study sample was small, although it included a diverse range of practitioner backgrounds. No people living with dementia participated directly in the study, although people with lived experience of dementia were involved in the study advisory group. Implications: High-quality support for people with dementia who live alone requires service structures that enable good practice from practitioners. Embedding flexibility, time investment, and relational practice within dementia services is essential to enable effective, person-centred care, particularly where formal systems must compensate for the absence of informal caregivers. These prerequisites are critical conditions to ensure equitable support for people with dementia who live alone.
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BibTeX
@article{lorito2026servicelevel,
title = {{Service-level and practitioner-level recommendations for better care of people with dementia who live alone and have no informal caregivers}},
author = {Claudio Di Lorito and Fiona Aspinal},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0358131},
url = {https://doi.org/10.1371/journal.pone.0358131},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Service-level and practitioner-level recommendations for better care of people with dementia who live alone and have no informal caregivers
AU - Claudio Di Lorito
AU - Fiona Aspinal
PY - 2026
DA - 2026/10/09
JO - PLOS One
DO - 10.1371/journal.pone.0358131
UR - https://doi.org/10.1371/journal.pone.0358131
AB - Context: A substantial proportion of people with dementia live alone without informal caregivers, yet services often assume family involvement, increasing risks of unmet need and adverse outcomes. Objective: This study aimed to generate service-level and practitioner-level recommendations to best support people with dementia who live alone and lack informal caregivers. Methods: A qualitative phenomenological co-design workshop was conducted with seven practitioners from statutory, voluntary, and private-sector roles across England. Prompts informed by earlier qualitative work were used as a template to stimulate reflection and develop recommendations for practice through inductive thematic analysis and input from a study advisory group including people with lived experience of dementia. Findings: Practitioners recommended some service-level and practitioner-level recommendations. Service-level recommendations included flexible care pathways and sufficient time to build rapport in the absence of informal support. Practitioner-level recommendations, approaching the client with personability, humanity, warmth, respect, and humility, and adopting a sensitive yet honest communication, were essential for meaningful engagement and supporting autonomy. Curiosity and creativity helped practitioners understand behavioural motivations and tailor interventions. Experience underpinned all these competencies, with supervision and shadowing seen as vital for developing relational skills. Limitations: The study sample was small, although it included a diverse range of practitioner backgrounds. No people living with dementia participated directly in the study, although people with lived experience of dementia were involved in the study advisory group. Implications: High-quality support for people with dementia who live alone requires service structures that enable good practice from practitioners. Embedding flexibility, time investment, and relational practice within dementia services is essential to enable effective, person-centred care, particularly where formal systems must compensate for the absence of informal caregivers. These prerequisites are critical conditions to ensure equitable support for people with dementia who live alone.
SN - 1932-6203
ER -