Supporting “Orphan” Elders

April 25, 2016

Orphan elders lack a protective network of family and friends. How can those who serve them provide the support they need?

“Orphan elders” is a term meant to describe the coming wave of childless and unmarried Baby Boomers and seniors who are aging essentially alone. Orphan elders may have no surviving spouse, may never have had children, or may have lived long enough to have no surviving close friends or family. Because of health or financial reasons, they may be socially isolated, either completely or partially.

Although this is not a new issue, research presented at the 2015 American Geriatrics Society’s Annual Scientific Meeting1 gained wide television and print media coverage. The research was conducted as a case study and literature review by principal author Maria Torroella Carney, MD, Chief of Geriatric and Palliative Medicine at the North Shore-LIJ Health System. “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,” observes Dr. Carney. “There is potentially no structure to address this population, as this population is hidden right before us. 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,” she states.

One-quarter of all Americans over age 65 are already part of or are at risk to join this group, according to a recent University of Michigan Health and Retirement Study.2 This group of orphan elders is aging without the support of any known family member or designated surrogate to act on their behalf. One result is that by 2030, about 5.3 million older adults will be living in nursing homes, compared to about 1.3 million Americans in 2012.3

Awareness, Identification, and Coordination

There are hard facts behind this growing phenomenon. For instance, the 2012 U.S. Census data4 showed that about one-third of Americans aged 45 to 63 are single, which is up 50 percent from 30 years ago in 1980. Another contributing factor in the increasing number of orphan elders is the increased number of couples deciding to remain childless. In fact, between 1980 and 2012, the number of childless women aged 40 to 44 doubled. Other factors contributing to the growing number in this group are advances in medical care leading to longer life spans, and geographical separation of family and friends due to employment commitments. With no family member or friend available to help, orphan elders require heightened awareness by those with whom they do come in contact. These contacts may include their physician, nursing home and hospital personnel, attorneys, and even lay members of the surrounding community who are in a position to identify those who are at risk. After a person is identified as being at risk, there will need to be an enhanced networking solution to prevent the person from slipping between the cracks, and to make sure their physical and emotional needs are being addressed.

This is a gargantuan task because of the array of services that have to be coordinated across the public-private spectrum, and because of the massive numbers of people who require help.

Up until now, this highly vulnerable group’s needs have been addressed in a piecemeal fashion without applying a “blue sky” approach to the problems involved. Unfortunately, neglect is the most common form of abuse being experienced by orphan elders (about one-half of abuse suffered), followed by physical, emotional, and financial abuse.5 The group is vulnerable to many other negative outcomes that include functional decline, mental health issues, and premature death.

Social isolation at any age has long been a known public health problem. Research has demonstrated a strong correlation between social isolation and diminished physical and mental health. Those who are isolated and ill have worse surgical and medical outcomes. Growing evidence from studies of stress and the immune system suggest that loneliness can contribute to disease processes by increasing an individual’s stress levels. Other studies show that having a limited social network or infrequent contact with others results in diminished health. The flip side is that having regular contact and connections to a community leads to better health in older adults, including lower mortality rates, delayed functional decline, and reduced risk of cognitive problems.6

In addition to awareness, identification, and coordination of services, advance planning is key if time is available. Among the recommended measures to take are:

• Recognition by health care providers and advisors;

• Locating an advocate to help in case of emergency;

• Identifying and appointing agents for finances and health care;7

• Evaluating housing options;

• Putting into place estate planning documents, and health care powers of attorney and advance directives; and

• Locating and analyzing the insurance, retirement benefits, and any social services that will be available.8

About the Author
Amy Acheson, Esq., Pittsburgh, Pa., is a member of the NAELA News Editorial Board.


1 M. Toroella Carney, Abstract #C199, p. 237, Journal of the American Geriatrics Society Abstracts Supplement (2015).

2 University of Michigan, Institute for Social Research, supported by the National Institute on Aging, Growing Older in America: The Health and Retirement Study,

dex.php?p=dbook (2007).

3 Face the Facts USA, The High Cost of Nursing Home Care, (Dec. 20, 2012); Varner, J., The Elder Orphans: Who Are They?, Ala Nurse 2005 Sep-Nov; 32(3): 19-20.

4 U.S. Dept. of Health and Human Services, Administration on Aging, Aging Integrated Database (AGID): 2008-2012, ACS Special Tabulation on Aging, (last visited Dec. 21, 2015).

5 Statistic Brain Research Institute, Elderly Abuse Statistics, (Oct. 22, 2015). Compiled from data available at National Center on Elder Abuse, Bureau of Justice Statistics,

6 See, e.g., K. V. Paris, et al., Relationships Matter: The Importance of Friendships Among Residents of Independent Living Communities, Seniors Housing & Care Journal, Vol 23, No. 1 (2015).

7 Particularly where there is no family available, health care advance directives become increasingly significant and essential. One recent study of cancer patients found that from 2000 to 2012, there was no increase in the percentage of patients who had advance directives (living wills). This is a major reason why the number of patients who had received “all care possible” rose from 7% to 58%, the study found. Efforts to limit or withhold treatment near the end of life were associated with living wills and end-of-life discussions. Making advance directives may be crucial for orphan elders when they become unable to decide important health issues themselves. Amol Narang, Trends in Advance Care Planning in Patients With Cancer: Results From a National Longitudinal Survey, Jrnl. of Am. Med.Ass’n., Oncology, (July 9, 2015).

8 The New York Academy of Medicine and the North Shore-LIJ Health System published an instructive study relating to fulfilling the actual needs of the elderly population on Long Island. It includes extensive information relating to “orphan elders” and explanations of opportunities for service coordination. R. Finkelstein, D. Block, P. Schafer, An Opportunity to Innovate: The Aging of Eastern Queens and Nassau County, The New York Acad. of Med. (2014).