Table 4.

Quote Excerpts Illustrating Themes Identified in Qualitative Analysis

	Quote excerpt	Gender	Age at onset	Source
Q1	“Retired electrical engineer, never married...”	Male	80	ACT study handwritten comments
Q2	“Her husband of 8 months died in WWII and she never remarried…Lives alone (for now) since her sister’s death last Nov. Gets tearful when she talks about her – they lived together for 43 years….”	Female	89	ACT study handwritten comments
Q3	“TC [telephone call] - patient’s stepson calls to report that care givers at home where patient lives state that patient is becoming more confused and they worry about his degree of cognitive awareness- they suggested cognitive evaluation”	Male	91	Clinical chart notes
Q4	“Over the last one month pt has been feeling fatigued very easily, goes to sleep at the drop of the hat, and is also depressed that her nephew and his family have moved permanently to [town several hours drive from Seattle]. She does have a niece that lives in San Diego and the pt herself does not like San Diego.”	Female	86	Clinical chart notes
Q5	“One of her neighbors come[s] in the am & helps her get up, others take her to MD appts, cook, etc. She’s getting by.”	Female	88	ACT study handwritten comments
Q6	“TC from food bank director where pt volunteers. States that several employees have come to her over the past 2 mos expressing concern about pt. Pt has attended ‘super regularly for years’ but recently, co-workers have had to go to her house to check on her and she has been asleep and forgotten to come in.”	Female	79	Clinical chart notes
Q7	“Pt lives in senior housing and has mild dementia. Home health social workers addressed transportation issues and helped make patient aware of [publicly subsidized buses for seniors], [name of company] shuttle, volunteer transportation. Pt continues to attend her church in [name of suburb] and is active with classic car club.”	Female	73	Clinical chart notes
Q8	“pt is here for follow-up, accompanied by her POA for healthcare, from [name of agency] Guardians - pt is 40 minutes late to appt [appointment] -Depression. Pt is doing a bit better now that she has the support of guardian. Still overwhelmed by her living condition but is getting help…”	Female	76	Clinical chart notes
Q9	“Disheveled. Has difficulty with bathing, doing household chores, shopping, per questionnaire.”	Male	85	Clinical chart notes
Q10	“Spoke with patient by phone. He states that he understands why his medical team is recommending that he hire assistance with medication management but he does not want to do this. He states he is having trouble managing his blood sugar testing and insulin but does not want to hire anyone to assist.”	Male	86	Clinical chart notes
Q11	“The patient lives alone in her home but has a friend who helps her with some of her affairs such as keeping her book work, etc. …She admits to having some difficulty with her memory. … She also has had some financial problems in that some plumbers recently took advantage of her, charging her $11,000 for a plumbing bill.”	Female	88	Clinical chart notes
Q12	“Consult w/Social Worker: … M [male] widower who lives alone in his own apartment… His only relative is a nephew, who he reports lives 45 minutes away… He said he would call nephew to ask about transporting him to and from hospital...”	Male	86	Clinical chart notes
Q13	“TC - One of pt’s friends is calling to let the clinic know that pt is having a very hard time remembering things. She forgot an appointment last week and does not have the assistance of a family member or a legal POA. Friend is not available today, however, she wanted to let the MD know that pt is not aware of an appointment and that she needs some help”	Female	86	Clinical chart notes
Q14	“OV Right knee injured when she tripped over a small box in [grocery store] a few days ago. Fell directly onto the kneecap. Says she seems to have a tendency to falls.… Has thought of selling house, move to senior housing- [name of facility] -but that’s quite expensive.”	Female	83	ACT study handwritten comments
Q15	[#1, recorded 4 years before ACT diagnosis]: “She & spouse moved to AFH [adult family home] because he needed more care & it was easier for her to move w/him rather than going back & forth “ [#2, recorded year of ACT diagnosis]: “…pt currently lives in AFH… Pt’s husband passed away a few years ago – pt has no children - has designated AFH owner as her DPOA”	Female	96	#1 ACT study handwritten comments #2 Clinical chart notes

Notes: ACT = Adult Changes in Thought; DPOA = durable power of attorney; POA = power of attorney; pt = patient.