Recently a 76-year-old man known as HB, whose health had been deteriorating, tried to take his own life and was admitted to North Shore University Hospital on Long Island.
Doctors decided that HB would not be able to go back to living by himself because of his condition and complications while in the hospital. With his only family across the country and no social support in the area, the man was placed, possibly permanently, in a nursing home.
The experience of HB is not unusual. His story is a case study of the problem of “elder orphans.” These seniors are single or widowed; they have no children, at least in the area, and no support system. And they find themselves alone with no one to help care for them when they need it.
Although the problem of elder orphans has been known for a while, new research suggests just how bad it is. About 22% of Americans 65 years and older are in danger of becoming, or already are, in this situation. As of 2012, there were 43 million people over 65 in the U.S., up from 35 million in 2002.
Dr. Maria Torroella Carney, who is chief of geriatric and palliative medicine at North Shore-LIJ Health System, treated HB. She estimates that nearly a quarter of all elderly Americans could be orphans based on articles that have been published in medical and nursing journals looking at the prevalence of childless or friendless elders at the local level. She presented the findings at the American Geriatrics Society’s annual meeting May 15-17.
The outlook for the future is not any brighter. Based on 2012 U.S. Census data, about one third of Americans age 45 to 63 are single, and in a position to become orphans as they age.
“This is something I’ve dealt with over the years,” Carney said. “This population is likely going to increase and we don’t understand them well enough.”
“I wanted to bring awareness, like a call to action, to state and federal governments,” Carney said. She hopes that the current research will spur the U.S. Department of Health and Human Services and other agencies, to determine the actual prevalence of this vulnerable population.
Dr. Kenneth Brummel-Smith, professor of geriatrics at the Florida State University College of Medicine, agrees that the number of elder orphans will probably rise as Baby Boomers, the generation born between 1946 and 1964, age. The oldest Baby Boomers turned 65 in 2011; the youngest are projected to require health care through about 2060.
There have been very few studies looking at why so many members of the so-called “Silver Tsunami” are at risk of becoming elder orphans, Carney said.
The decision to remain childless is probably contributing. “My generation was one of the first that elected not to have children,” said Dr. Joyce Varner, professor and director of the Adult-Geron Primacy Care NP track program at the University of South Alabama, which teaches nurse practitioners how to provide primary care, especially for the elderly.
“I began to see this problem in the 1990s as a nurse practitioner,” Varner said. “I see a lot of sadness and regret on the part of the elderly people who decided not to have children,” she said. “A lot of fear. ‘How are we going to get care? Is there going to be anyone with me at the end of life?'”
Based on her own research, Varner estimates that about 60% of nursing home residents do not have regular visitors.
Varner calls the new study “wonderful, strictly from the standpoint of making people more aware of the problem.”
“I am going to be an elder orphan, too,” said Varner, who is 59 years old. She and her husband have decided not to have children, although they have prepared financially and built up a network of friends, both in their age group and younger, to help them when they need it. She advises people to do the same if they can.
Carney hopes that her research, along with leading to a better idea of the prevalence of elder orphans, will get experts talking about new programs that could be created to support these elders, as well as caregivers and their families.
It is estimated that by 2030 about 5.3 million seniors will be living in nursing homes, which include hospital, rehabilitation and hospice facilities. That is up from about 1.3 million Americans in 2012. Varner worries that there may not be enough nursing homes and assisted-living facilities for all the people who need one.
Brummel-Smith thinks that part of the answer could be to bring caregivers into the homes of elder orphans. For example, Money Follows the Person is a Medicaid-funded program that helps younger adults with disabilities stay in the home; it could also help elder orphans, he said.
Carney thinks that crises such as the one that HB experienced could be prevented if seniors, and their health care providers, relatives and friends, established connections with support programs and facilities in the area. “If we had known he was an elder orphan, we could have intervened earlier,” she said.