Elder Orphans Hiding in Plain Sight: A Growing Vulnerable Population

Abstract

Adults are increasingly aging alone with multiple chronic diseases and are geographically distant from family or friends. It is challenging for clinicians to identify these individuals, often struggling with managing the growing difficulties and the complexities involved in delivering care to this population. Clinicians often may not recognize or know how to address the needs that these patients have in managing their own health. While many such patients function well at baseline, the slightest insult can initiate a cascade of avoidable negative events. We have resurrected the term elder orphan to describe individuals living alone with little to no support system. Using public data sets, including the US Census and University of Michigan's Health and Retirement Study, we estimated the prevalence of adults 65 years and older to be around 22%. Thus, in this paper, we strive to describe and quantify this growing vulnerable population and offer practical approaches to identify and develop care plans that are consistent with each person's goals of care. The complex medical and psychosocial issues for elder orphans significantly impact the individual person, communities, and health-care expenditures. We hope to encourage professionals across disciplines to work cooperatively to screen elders and implement policies to prevent elder orphans from hiding in plain sight.

Family Health and Care of Older Adults: Universal Solutions to Unique Caregiving Challenges

“…Childlessness among older populations may increase up to 21% by 2040, when I would be 87 and almost 50% of my age-related peers would have only one or two children (Johnson, Toohey, & Weiner, 2007). The risk of becoming unmarried and childless, or with children out of contact may be as high as 22.6% (Carney, Fujiwara, Emmert, Liberman, & Paris, 2016).…”

“…I am not yet an elder orphan, the term used to describe older adults without children, spouses, or partners (Painter, 2016;Carney et al 2016), even though my own family is shrinking, with all parents, parents-in-law, and their siblings (our aunts and uncles) having passed on. My older siblings and siblingsin-law are for the most part independent despite accumulating chronic conditions.…”

Projections of white and black older adults without living kin in the United States, 2015 to 2060

“…Prior research has examined the increasing percentages and numbers of people who lack specific types of kin, such as the never married (24,25) or the childless (26,27), but few studies have put these factors together to consider the subpopulation that simultaneously lacks multiple types of close kin and is at elevated risk of social isolation, loneliness, and hardship (15,28). The first and second demographic transitions and the gender revolution suggest that the share of people who lack multiple types of close kin is increasing (29,30).…”

Living in the Community With Dementia: Who Receives Paid Care?

“…The nearly 6 million individuals living with dementia in the United States rely on an estimated 16 million family caregivers (eg, spouses, children, and friends), totaling over 18 billion hours of care per year with an estimated cost of over $221 billion . This current reliance on family caregivers is unsustainable; by 2050, the number of individuals living with dementia is expected to triple to 14 million, yet the pool of younger people to provide care is shrinking . Newer care models that shift the locus of long‐term care from institutions to the home and community to provide dementia care better aligned with personal preference may further exacerbate demand on family caregivers.…”

“…1 This current reliance on family caregivers is unsustainable; by 2050, the number of individuals living with dementia is expected to triple to 14 million, yet the pool of younger people to provide care is shrinking. 1,2 Newer care models that shift the locus of long-term care from institutions to the home and community to provide dementia care better aligned with personal preference [3][4][5] may further exacerbate demand on family caregivers. While paid caregivers, including home health aides, personal care attendants, and other direct care workers, may be able to provide additional care (eg, bathing, shopping, and companionship) that keeps those with dementia safe in the community, 6 most existing studies of paid caregivers focus on workforce concerns, including job satisfaction and retention, 7,8 and fail to consider the impact of paid caregivers on those they care for.…”