How many people do you live with in your household? Around the world, it’s common for people to live with an extended circle of relatives, especially for older adults, according to a Pew Research Center study.
However, for seniors in the United States, living with others is far less common. The U.S. Administration for Community Living reported in 2020, more than half (61%) of people aged 65 and older lived with a spouse, but nearly 14.7 million (27%) of all older adults lived alone.
Those numbers are only expected to increase in the coming years, especially because nearly 50% of adults are unmarried, adult children move away for professional job opportunities, and more people are putting off the move into assisted living or a nursing home for longer than they used to.
Dangers and impacts of living alone
Marc Rothman, MD, a geriatrician and chief medical officer at Signify Health, told Seasons that living alone can have mental, social and physical impacts on an individual and their overall well-being.
“Loneliness, isolation and boredom are highly prevalent in society today, but the impact on seniors can be devastating,” he said. “Without face-to-face human contact and stimulation, people tend to stop doing the things they used to do and enjoy, and this can lead to depression, malnutrition and deconditioning. For most seniors, exercise is a social activity, and so is eating.”
Dan Levitt, a gerontologist and chief executive officer of British Columbia-based KinVillage, told Seasons when people lack regular contact and engagement with others, basic things often stop being done—from getting dressed, showering, cooking a meal and doing housework. He adds older adults who lose a partner can have increased levels of depression, anxiety and loneliness.
“When a male friend of mine lost his wife, he had never cooked a meal since he was in college. He had to learn all of that,” he said. “I know widows who had to learn how to do their own banking because they had never really handled their financial matters … No longer having that person around could lead to depression and impacts on your mental state, physical state and almost that willingness to live.”
However, Rothman believes the biggest danger for older adults, whether they live alone or not, is a fall, which happens to more than one out of four older adults every year.
“This is far and away the greatest near-term risk for any older adult living alone. Reducing the chances of a fall starts with a medical and functional evaluation, in the home when possible,” Rothman said. “Does the person have adequate lower body strength and balance to recover if they begin to fall? Would modifying an environment be helpful? Grab bars and removing throw rugs are examples that can make a big difference.”
Signs to stay aware of
Many caregivers and family members will eventually have to come face-to-face with difficult questions: How do I know if it’s safe for my relatives to live on their own? Are they able to care for themselves?
Levitt and Rothman both said it all comes down to monitoring for shifts in their behavior, appearance and living conditions, such as:
- Changes in hygiene (body odor, unwashed clothing, etc.)
- Social isolation (not leaving home regularly to participate in social events, community activities, etc.)
- Memory loss
- Poor mobility (difficulty getting out of bed, using the restroom, making dinner or bathing)
- Unclean living space
“You have to ask yourself: Are they shopping and buying groceries? Are they cooking for themselves and getting out of the house? Connecting with other people? Participating in activities they were doing before? Are they hoarding? Are they doing self-neglect or self-harm?” Levitt said. “That’s what I would be concerned about. I think it’s our responsibility to support people living alone so they can live life to the fullest and avoid potential harm to themselves.”
While many caregivers or family members feel the burden to keep track of every detail and make the decisions about their loved ones, Rothman said having a larger support community can help.
“It takes a community to ensure that older adults who live alone get eyes on them and have the support they need. A neighbor, a grandchild who can commit to visiting once a month, the physician and pharmacists they visit, a friend who goes grocery shopping with them every few weeks, maybe a case manager involved in their care,” Rothman said. “The more you communicate with each other about what you’re seeing, the earlier any sign of memory loss or dementia will be noticed and brought out into the open.”
Living arrangement options
If it’s no longer safe for an older adult to live alone, caregivers and families can consider a few options depending on health status, mobility and need for home care.
If a senior’s medical needs are minimal, several types of support services promote independent living. Rothman said families can add services and hire support like home-health aides or medical professionals who allow older adults to age in place.
“Friends and families do the lion’s share of the care, and often the ultimate decision of when someone can’t live alone anymore depends on whose caregivers have exhausted themselves beyond measure,” Rothman said. “Caregiving is both an honor and a sacred act of kindness, but sometimes the sacrifices they make can be extreme.”
If home care isn’t an option, families can consider senior housing or independent living communities—apartments exclusively for people over 55 who can live independently with social activities and transportation typically provided.
Assisted living communities, continuing care retirement communities and nursing home options are also available for seniors who may have difficulty living alone and may need daily support.
“If you do decide it’s time to seek assisted living for your loved one, understand that it’s a big transition and it may take some time for the senior to adjust,” Rothman said. “It’s important to continue to visit and engage them, encourage them to participate in community activities, and show them consistent love and support.”