In the US, nearly 29% of the 46 million community-dwelling older adults live alone. About half of the community-dwelling oldest old (≥ 85 years) live alone. About 70% of older people living alone are women, and 46% of all women age ≥ 75 years live alone. Men are more likely to die before their wives, and widowed or divorced men are more likely to remarry than are widowed or divorced women.
Older adults who live alone are more likely to be poor, especially with advancing age. Many report feelings of loneliness (in 60% of those > 75) and social isolation. In those with health problems or sensory deficits, new or worsening symptoms may be unnoticed. Many have difficulty complying with prescribed treatment regimens. Because they have physical limitations and because eating is a social activity, some older people who live alone do not prepare full, balanced meals, making undernutrition a concern.
Despite these problems, almost 90% of older people living alone express a keen desire to maintain their independence. Many fear being too dependent on others and, despite the loneliness, want to continue to live alone. To help them maintain their independence, physicians should encourage them to engage in regular physical activity and social interactions and should provide social work referrals to help them do so.
Coordination and delivery of services during convalescence are difficult for patients living alone. Physicians should ensure that home care is available and recommend additional services as appropriate. A passive or individually activated emergency response device may reassure patients that help can be obtained if needed.