{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:53:13Z","timestamp":1791568393989,"version":"4.3.4"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR ARC North Thames"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Context<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to generate service-level and practitioner-level recommendations to best support people with dementia who live alone and lack informal caregivers.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Implications<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0358131","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:21:48Z","timestamp":1791566508000},"page":"e0358131","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Service-level and practitioner-level recommendations for better care of people with dementia who live alone and have no informal caregivers"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8953-0117","authenticated-orcid":true,"given":"Claudio","family":"Di Lorito","sequence":"first","affiliation":[{"name":"University College London","place":["London, United Kingdom"],"department":["Department of Primary Care and Population Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3170-7570","authenticated-orcid":true,"given":"Fiona","family":"Aspinal","sequence":"additional","affiliation":[{"name":"University College London","place":["London, United Kingdom"],"department":["Department of Primary Care and Population Health"]},{"name":"Keele University","place":["Keele, United Kingdom"],"department":["School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"pone.0358131.ref001","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1017\/9781108918954.008","article-title":"Informal care for persons with dementia: Characteristics and evidence-based support interventions.","volume-title":"Dementia and Society","author":"A Declercq","year":"2022"},{"key":"pone.0358131.ref002","article-title":"Impact of dementia on informal care: A systematic review of family caregivers\u2019 perceptions","volume":"14","author":"P Lindeza","year":"2020","journal-title":"BMJ Support Palliat Care"},{"issue":"12","key":"pone.0358131.ref003","article-title":"Roles and experiences of informal caregivers of older adults in community and healthcare system navigation: a scoping review","volume":"13","author":"B Kim","year":"2023","journal-title":"BMJ Open"},{"issue":"7","key":"pone.0358131.ref004","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1177\/1471301221990504","article-title":"Home care in dementia: The views of informal carers from a co-designed consultation","volume":"20","author":"EL Dalgarno","year":"2021","journal-title":"Dementia (London)"},{"key":"pone.0358131.ref005","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1093\/geroni\/igad104.1898","article-title":"Supporting persons living alone with dementia: Findings from a pilot study","volume":"7","author":"A Gibson","year":"2023","journal-title":"Innovation in Aging"},{"issue":"1","key":"pone.0358131.ref006","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13643-025-03002-y","article-title":"Living alone with dementia is a neglected source of inequality: Findings from a scoping review of research evidence","volume":"15","author":"L Clare","year":"2025","journal-title":"Syst Rev"},{"issue":"6","key":"pone.0358131.ref007","first-page":"821","article-title":"The demography of aging without children: Implications for care in later life","volume":"62","author":"SM Albert","year":"2022","journal-title":"The Gerontologist"},{"key":"pone.0358131.ref008","unstructured":"The King\u2019s Fund. Key facts and figures about adult social care. 2025. Available from: https:\/\/www.kingsfund.org.uk\/publications\/adult-social-care-key-facts-and-figures"},{"issue":"3","key":"pone.0358131.ref009","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1177\/14713012251363090","article-title":"The psychosocial needs of people with dementia living alone: A narrative synthesis systematic review","volume":"25","author":"T Cheung-Cook","year":"2026","journal-title":"Dementia (London)"},{"key":"pone.0358131.ref010","article-title":"Professional perspectives on supporting people with dementia who live alone and have no informal support: A qualitative study","author":"C Di Lorito","year":"2026","journal-title":"Dementia (London)"},{"key":"pone.0358131.ref011","unstructured":"Di Lorito C, Aspinal F. What are the factors that affect engagement of people living with dementia with support services? 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