4 August 2016
We read with interest the article by Eichler et al.  that indicates that a high proportion of community-dwelling people with dementia live alone. The authors concluded that people with dementia living alone did not seem to be at an increased health risk, even if they lacked the support of an informal caregiver. We would like to comment on safety issues about living alone with dementia.
Firstly, as the authors reported their findings regarding depression, drug related problems, and falls were based on self-reports of the patients, especially if there was no formal caregiver. The authors reported findings about depression and falls in all 24 and drug-related problems in 21 of 24 subjects living alone without informal caregivers. As the stage of dementia advances, the likelihood of the patients to give accurate information about falls and drug related problems might decrease substantially. These subjects may forget about their falls and unsuitable use (such as skipped or falsely repeated doses). The authors used geriatric depression scale for the assessment of depression. However, these patients may not comprehend the questions they are asked in the geriatric depression scale, especially in more advanced stages of dementia. Furthermore, there are several other issues that might render these patients at significant risk for health problems. For example, it is clear that most of these patients lacked the support of somebody to help in case of emergency. As we consider the most common emergency problems in these patients such as myocardial infarction, pneumonia, and sepsis, even a few hours delay in treatment is associated with significantly worse prognosis. Thus, the rate of availability of help in case of emergency within 24 hours, which is reported as 29.2%, is very low in this context.
In conclusion, we suggest that it may be over-encouraging and potentially harmful to conclude that patients with dementia living alone are not at increased risk for health problems.
Fatih Tufan, Assoc. Prof., Gulistan Bahat, Assoc. Prof., Mehmet Akif Karan, Prof.
Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Fatih, P.B. 34093, Istanbul, Turkiye. Tel.: 0090 2124142000; E-mail: firstname.lastname@example.org
 Eichler T, Hoffmann W, Hertel J, Richter S, Wucherer D, Michalowsky B, Dreier A, Thyrian JR (2016) Living alone with dementia: prevalence, correlates and the utilization of health and nursing care services. J Alzheimers Dis 52, 619-629.