PhotoYou normally think of orphans as children who have no parents or other close relatives who can care for them. But there's another kind of orphan and there are more of them every day -- elderly people who have no children, no spouse and no other close relatives to look out for them.

You can thank the Baby Boom generation for the rising tide of "elder orphans." It's estimated that 22% of Americans over age 65 either already are or are at risk of becoming elder orphans.

This adds a whole new dimension to the potential cost -- financial, emotional and otherwise -- of caring for the Boomers as they slip into the age-related diseases likely to render them dependent on their families or, in the case of orphans, society.

"We have a sense that this will be a growing population as society ages and life expectancy increases, and our government and society need to prepare how to advocate for this population," said Dr. Maria Torroella Carney, MD, chief of geriatric and palliative medicine at the North Shore-LIJ Health System on New York's Long Island.

Carney and colleages recently completed a study that zeroes in on the staggering data on the prevalence and risks elder orphans.

Hidden in plain sight

"There is potentially no structure to address this population as this population is hidden right before us," added Dr. Carney, who calls the group elder orphans because they are aging alone and unsupported, with no known family member or designated surrogate to act on their behalf. "Our goal is to highlight that this is a vulnerable population that's likely to increase, and we need to determine what community, social services, emergency response and educational resources can help them."

Dr. Carney and her team highlighted the case of "HB," a 76-year-old man living alone who presented at North Shore University Hospital in Manhasset, N.Y., after a failed suicide attempt for a multi-disciplinary approach to his pain and suffering.

With his only existing family across the country in California, HB's case was complicated and prolonged by delirium, unclear decision-making capacity and lack of social support. He was discharged to a nursing facility for likely eventual long-term placement.

"This is a population that can utilize expensive healthcare resources because they don't have the ability to access community resources while they're well but alone," Carney said. "If we can provide earlier social services and support, we may be able to lower high healthcare costs or prevent the unnecessary use of expensive healthcare. With greater awareness and assessment of this vulnerable population, we can then come up with policies to impact and manage better care for them."

Study details

A literature search and review estimating the prevalence of elder orphans and their risks was done using Google Scholar, PubMed, CINAHL, and Health Reference databases.

U.S. Census data from 2012 showed that about one-third of Americans aged 45 to 63 are single, a 50% increase from 1980; nearly 19% of women aged 40 to 44 have no children, as compared to 10% in 1980.

Additionally, the University of Michigan's Health and Retirement Study (HRS) indicated that 22% of people over age 65 currently are, or at risk to become, elder orphans. This group is vulnerable to a wide range of negative outcomes that include functional decline, mental health issues and premature death, Dr. Carney said.

An abstract of Dr. Carney's paper is scheduled for presentation at The American Geriatrics Society's 2015 Annual Scientific Meeting, which will take place in Washington, DC, from May 15-17.


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