Navigating aging can be especially challenging if you are single—whether divorced, widowed, or never married—without immediate relatives. Distance from children or the absence of children altogether can leave you largely alone in old age. While having children or relatives doesn’t guarantee automatic care in later years, the possibilities of a ‘solo’ journey in old age are real. Whether you outlive your spouse, children, live far from family, or are never married or childless, you may find yourself in a situation akin to being an ‘orphan’ in old age. Considering that a significant number of elders will require long-term care, planning becomes crucial, even though many might not initially think they will.
Entering old age without kids or a partner doesn’t signify doom, just as aging with family doesn’t guarantee an obstacle-free journey. We are all susceptible to isolation and the challenges of becoming elder orphans. While ‘aging in place’ is possible, living alone presents unique hurdles. Our experience with aging indicates that this growing population of ‘elder orphans’ lacks a built-in support system. Planning for a potentially ‘solo’ future is advisable to mitigate pain and distress. If you are entering the aging process alone, here are a few considerations to keep in mind.

  • Judith S Parnes, Sowmya Lakshmi

Ironically, Anand’s heart sank seeing Rao’s forlorn state, a stark contrast to the man he knew just a few years ago. Those familiar with Mr. Rao from earlier times struggle to reconcile his current plight with the successful corporate caterer who once served 10,000 meals. Venkateshwara Rao, once a respected figure in the catering industry, fell victim to personal chaos, transforming from a sought-after professional to an addict. The unexpected blow of his wife eloping with his nephew added an unthinkable and unheard-of dimension to his tragedy. Despite this, Rao finds solace in the fact that he could provide premier education and opportunities for his son and daughter to settle abroad. Sadly, influenced by their mother, the children never reciprocated his sacrifices.

Anand brought Rao to us for care, finding him in a heart-wrenching situation: shattered hopes, financial destitution, failing health, and no family or companion to offer support. Within our community, there are several individuals like Rao, Ganesan, or Arthur, dismissed as ‘mismanaged lives.’ The prevalence of older adults growing older alone raises concerns about aging solo, with family members—when they exist—often living too far away for meaningful emotional or logistical support. The number of older individuals living alone is on the rise, whether by choice or circumstance.

Consider the case of “Mr. DVR,” affectionately known as Rao, a 76-year-old man from Nellore. Described as a “prototypical elder orphan,” he arrived at our skilled nursing home after a suicide attempt, bearing cuts on his wrist, bed sores, dehydration, malnutrition, and depression. Anand, a former manager at Rao’s catering company, played the role of a Good Samaritan and rescued him from this dire situation.

many believe having children ensures a safety net in old age, Arthur Mendes shares a different and heartbreaking narrative. Having spent nearly 20 years working in the Middle East, he invested his earnings in his children’s education and a four-bedroom house in an upscale area. Tragedy struck when cancer claimed the lives of his wife and daughter, and the nightmare he endured is enough to move even a stranger to tears.

The misfortune didn’t end with cancer; it took a more traumatic turn with an indifferent son and daughter-in-law. Despite registering his house and flat in his wife’s name during his time in Kuwait, Arthur faced betrayal as his son influenced his wife on her deathbed to register a gift deed without his knowledge. This led to Arthur being ousted from his own home, robbed of all his possessions, and forced to live a lonely and despondent life in a remote rural village, 120 kms from Bangalore. Arthur’s story serves as a poignant reminder that aging with children and a partner doesn’t guarantee a trouble-free existence, and growing older without them doesn’t mean doom. We are all susceptible to isolation and the challenges of becoming elder orphans. As social gerontologists who have witnessed many traumatic endings, we advocate for caution and preparation to avoid situations like DVR’s and AM’s.

An increasing number of ‘elder orphans’ find themselves without a built-in support system. The question then becomes, what should you do if you find yourself in this situation? It’s common for people to believe that such a circumstance is someone else’s fate, but as social gerontologists, we approach this differently. In the later stages, the realisation dawns, “How will we take care of ourselves?” but often, it’s too late. So, what steps can you take when you step back from work or contemplate your future, recognising there’s no one to look after you as you age? It’s a daunting question, and the statistics highlight that many people today are grappling with this reality. Living alone has often been labeled as “pathological” by some Western social gerontologists, linking it to social isolation, psychiatric disorders, and antisocial behaviour. While these associations may hold true for a majority of older adults, they are also aspects that raise legitimate concerns.

Let’s turn to more reliable statistics from US census data, which reflects a broader trend globally. Approximately one-third of individuals aged 45 to 63 are single, with many having never married or experiencing divorce. This marks a substantial 50 percent increase since 1980. Additionally, about 15 percent of women aged 40 to 44 had no children in 2012, compared to around 10 percent in 1980, according to U.S. Census data. In the United States, nearly one-quarter of individuals aged over 65 face the risk of physical or social isolation, lacking a family member or similar support. The term fittingly coined for them is “elder orphans.” The consequences of such isolation can be profound and irreversible. In our view, older adults experiencing loneliness in old age are more prone to struggling with daily tasks, cognitive decline, coronary artery disease, and even mortality. Socially isolated individuals also face increased risks of medical complications, mental health issues, mobility challenges, and problems accessing healthcare.

Living alone can occur through various life trajectories. Some individuals may have never had a spouse or partner, while others may have lost theirs due to marriage dissolution, separation, or death. Certain older people cohabit with others but lead separate lives with distinct activities and identities. While some of these situations may be by choice, others may be unforeseen.

In our social gerontology practice, when we inquired why older individuals chose to live alone, the prevailing responses were centered around “freedom, choice, control, and independence.” Kamala Sivadasan, a widow for 14 years, succinctly captured it: “(living alone) allows me to do what I want, when I want, and how I want.” Clearly, this doesn’t portray a pathological state!

However, living alone can pose challenges, especially when declining health and increasing disabilities necessitate assistance. Diminished mobility may make it challenging for infirm elders to venture out, compounded by cognitive impairment. As a result, older individuals become more reliant on family, friends, and formal or informal services, diminishing the autonomy and control they relished while living alone and potentially fostering feelings of isolation and loneliness.

A less apparent drawback is shouldering the sole responsibility and burden of decision-making. Our interactions with numerous elders have revealed that they often lack face-to-face discussions when faced with critical decisions. Additionally, they shared concerns about potential exploitation by various entities when living alone, including financial abuse by family members, tradesmen, and falling prey to mail and phone scams or solicitations for donations.

Family dysfunction is unfortunately prevalent and particularly poignant in old age. Regardless of the number of children one has, there’s no assurance they’ll be willing or able to provide assistance and care when it’s needed most. Padmaja’s two sons reside in the US. Her elder son became estranged when he married against her wishes, and this hostility persisted for over 32 years without any contact. The relationship with the second son, Karthick, also involves a decade of love-hate dynamics, unlikely to change before Padmaja’s passing. Despite being a former bureaucrat’s wife with a decent family pension, Padmaja, now a full-blown Alzheimer’s patient in our advantAGE dementia care home, is mercifully unaware of her destitution.

Even if your children have a positive relationship with you, there’s no guarantee they’ll be geographically close. Many families are now scattered across continents, and family visits are becoming increasingly infrequent due to the long distances and hectic schedules. The presence of adult children does not guarantee companionship in old age, as many seniors and baby boomers find themselves alone, with adult children leading their own busy lives. Having a family doesn’t ensure an ideal setting in old age, as adult children may be physically or emotionally unable or unwilling to provide familial support.

At the age of 84, Mr. Issac resides in an apartment complex. A widower with no children and his infirm elder brother living in a distant city, he, however, enjoys the assurance that he won’t face loneliness as he ages and deals with inevitable health challenges. Recently undergoing prostate surgery, Issac experienced a supportive community; friends from his church took turns caring for him. With conviction and faith, he expressed, “Being alone doesn’t scare me because I know that I have friends.” Actively participating in the church group’s activities contributes to his sense of connection.

The key to alleviating the somber feelings of being alone in old age lies in love, connection, solidarity, and togetherness. Whether or not one is physically alone, maintaining hope, faith, and optimism plays a crucial role. Feeling loved doesn’t hinge on having family, just as a sense of connection isn’t solely dependent on biological children. Unity and companionship can be found beyond traditional family structures.

Ganesan, aged 76 and a retired army veteran, contrasts starkly with Issac’s situation. Having lost his wife, Ganesan moved in with his only son, only to face the harsh reality that his daughter-in-law refuses to be his caregiver in old age. Unwelcome in his son’s house, Ganesan reluctantly accepted his fate, expressing, “It’s just devastating, and I ended up in this substandard old age home.” His regret over the stay highlights the challenging predicament faced by many seniors: the uncertainty of who will care for them in their frail, declining years. While most hope for family support, an increasing number of seniors, whether estranged or without immediate family, find themselves alone as they age and health deteriorates.

Our insights as social gerontologists indicate that relying solely on having biological children doesn’t necessarily guarantee companionship in old age. The conventional expectation is that children will provide old-age security, but more often than not, this expectation goes unmet. Various uncertainties come into play – what if your child faces persistent physical or chronic health issues from birth? What if, unexpectedly, you outlive your child? What if divorce occurs, and your child aligns more with your ex-spouse? Additionally, even if your son or daughter is willing to provide support, their spouses may disapprove. The question persists: Who will care for me? (Below is an excerpt from a recent letter we received.)

I am Molly Mathew, writing to you from Kochi, Kerala. With 32 years of nursing service in Kuwait, I retired and chose a solo path after an early divorce, opting not to pursue another marriage. Settling back in Kochi five years ago at the age of 65, I began contemplating ageing alone, particularly after caring for my parents. Witnessing my mother’s struggles with arthritis and heart problems and my father’s battle with Alzheimer’s was both tough and heart-wrenching. About a year after my father’s passing, a crucial question dawned on me: “Who will care for me?”

While the prospect can be stressful, I believe that dwelling in fear only exacerbates the problems and disempowers us. I strive to maintain a positive outlook on being alone. Whenever I feel lonely, I reach out to someone, visit my sibling or friend, and enjoy meals together. Having a clear understanding of how I want to live and the compromises I am willing to make outlines my strategy for ageing alone. I am determined to stay in my house for as long as possible, mirroring my health. My concerns are focused on the potential disabled years, similar to my parents. Despite having a cordial relationship with my brother, I prefer not to involve him in my affairs.

Primarily, she inquired about our advantAGE skilled nursing facility. Although there are numerous care homes available in Kochi, she is inclined towards the more salubrious weather of Bangalore. Ms. Molly serves as a perfect example of a senior citizen who actively plans for her later years, avoiding uncertainties and not leaving anything to chance.

To avoid disappointment in your twilight years, it’s essential not to wait until society deems you unfit for companionship. Middle age serves as the opportune time to initiate friendships and build lasting ties that extend into your later years. Instead of relying solely on kin, foster connections with individuals who you envision as your chosen family. This “new family” can be cultivated through shared hobbies, clubs, churches, interests, communities, etc. Non-family relationships often offer broad acceptance and ease without the baggage of familial history.

While the challenges of longer life expectancy and living alone may seem daunting, numerous creative solutions can enhance your life’s enjoyment. Recognising that there’s no one-size-fits-all solution, you, as the best judge of your strengths and shortcomings, can decide what works best for you. Coping with the fear of ageing alone is significantly aided by proactive preparation, similar to the approach taken by Ms. Molly. Early preparation allows you to acknowledge shortcomings in later life and adapt well to this new phase.

Look inward, thoroughly understand yourself, and delve into your family history to determine when you should commence planning. A family history riddled with Alzheimer’s, Parkinson’s, heart disease, or other serious conditions may warrant earlier planning compared to those without such indications. Regardless of your family tree, it’s never too early to initiate long-term care planning, analogous to car or fire insurance—you may never need it, but you’ll be thankful if you do!

Ensure you talk to someone every day, be it a neighbour, family member, or friend. Regular communication helps you feel connected and less alone. If in-person meetings are possible, that’s excellent, but if not, reach out through phone calls or emails. Isolation when living alone without regular conversations can lead to negative feelings and a sense of worthlessness.

Your social connections extend beyond companionship; they can assist with various errands and practical healthcare needs, such as driving you to the doctor when necessary. These connections also play a crucial role in fending off depression, a concern for nearly 20 percent of the 65-and-older population. The more social activities and friends you have, the better you can keep your body and mind active—your strongest defence against depression or mental illness.

Embracing technology, even later in life, can be daunting but is undoubtedly worthwhile. If you’re not familiar with computers, ask someone to teach you to use a smartphone or tablet and help set up social media accounts like Facebook and Instagram. Social media enables you to stay connected with friends and family, especially those who live far away. If security concerns arise, seek assistance to implement security controls. In today’s age, video conferencing options are increasingly popular for families to connect and see each other, providing an additional way to stay in touch.

Many older adults often harbour a sense of mistrust and skepticism. It’s crucial to acknowledge that, at some point, you may need to delegate important decisions to a person you trust. Identify someone you trust implicitly while you’re healthy and ask them to serve as the keeper of your personal information in case of an emergency. Ensure they have comprehensive details, including insurance, medications, and bank information. Regularly revisit this information together to keep it updated with any changes.

As a proactive step before cognitive decline, consider appointing a friend or relative as your power of attorney for health care or financial decisions. If no suitable person comes to mind, consult a reputable elder care law specialist like us by seeking recommendations or researching online for highly-rated professionals. Legal experts in this field possess the expertise to handle legal matters related to aging.

Two fundamental practices for maintaining health as you age are regular exercise and a balanced diet. Make mindful choices about your food intake, as certain foods contribute significantly to chronic conditions. Lack of exercise is also a major factor. Additionally, keep your brain sharp by engaging in challenging activities such as playing cards, solving crossword puzzles, reading, learning a new language, or exploring new hobbies. Remember, the age-old adage “If you don’t use it, you lose it” holds true.

Ensuring safety takes precedence when living alone. Although basic safety measures won’t avert all crises, they significantly minimise risks and their impact. Advance directives are integral to staying secure. Despite the health care system’s lag in incorporating them into medical records, having a health care surrogate is vital for someone to advocate for you during a health crisis or enact your wishes when you cannot. Part of this planning involves ensuring your family or friends possess all your health information, including physicians, medications, and medical conditions.

Preventing falls is crucial as it is one of the most debilitating conditions for the elderly. Falls impact functioning, independence, and overall quality of life. The consequences extend to their self-confidence and social life, making them prone to low mood or depression. Simple measures like decluttering, removing throw rugs, ensuring adequate lighting, and having medical check-ups can minimise this risk. Structural changes such as installing handrails, stairlifts, and appropriate floor modifications in toilets are also necessary.

While locking doors and securing gas stoves and geysers may seem obvious, older adults often overlook these precautions. Safeguarding important documents in a fireproof safe or a secure bank vault, with duplicates stored in multiple locations, is crucial. Communicating the location of these documents to family members is equally important.

On a mission to create a life free from transportation dependence, Molly is exploring the possibility of moving to a more walkable city like Bangalore. She envisions staying engaged with activities like mentoring nursing students, aiming to avoid living alone and isolated in the later stages of aging. When considering your geographical location for the later stages of aging, ponder on factors like ease of access, support systems, and your preferred living environment.

Before embarking on the later stages of aging, it’s crucial to consider your geographic location. Regardless of where you choose to spend your remaining years, establishing a support team comprising friends, neighbours, and family members who are consistently available and willing to help is essential. As elder care experts, we recommend seeking assistance from professional financial advisors, accountants, or lawyers for estate planning and creating a will. This becomes especially crucial if you are single and childless. Finding a senior-friendly area while you’re still young makes the relocation process much less stressful. Once settled, you can relax and savour your senior years.

Aging without a spouse or adult child requires solo agers to construct a support team, comprising extended family, reliable friends, and hired professionals. This team assists with financial matters, makes medical decisions in case of incapacity, and helps prevent isolation during the aging process.

Solo agers require a healthcare support network comprising friends, extended family members, a geriatric care manager, a healthcare proxy, and comprehensive medical insurance. Social gerontologists, like us, play a role in assisting with insurance paperwork, reviewing medications, connecting solo agers with home health aides, and assessing long-term care facilities. Additionally, we can recommend other professionals such as lawyers, CPAs, and financial planners to address various needs.

In conclusion, we advise you to embrace your situation and cultivate a love for your own company. Vanaprashta marks the third stage in life. It commences after individuals fulfil their familial responsibilities. Traditionally, during this stage, people detached themselves from family life and material pursuits by moving to the forest. This shift allowed them to dedicate more time to spiritual practices, living among fellow seekers of solace, knowledge, peace, and freedom. In contemporary times, the practice of retiring to the forest has waned, with many opting to contribute more to their communities while deepening their spiritual pursuits.

Hindus may engage in activities such as volunteering, reading scriptures, embarking on pilgrimages, and, for some, residing in ashrams. The overarching aim is to commit oneself to spiritual practices with a dedication to Seva (selfless service) and the pursuit of moksha (liberation). Dr. Shenoy has entered the Vanaprashta phase after retiring as the medical director of a government-run mental hospital and ing with the charity hospital. During this stage, he has shifted his focus toward spiritual activities as well, emphasising his preparation for the subsequent phase, ‘Sanyasa.’ Another friend of ours has followed a similar path, choosing pilgrimage as a means of spiritual engagement. Subramonian finds immense pleasure and peace in visiting temples across India.

In Hindu religion, the last phase is the ‘Sanyasa’ phase, signifying a life of renunciation after completing all worldly affairs in the previous three stages and awaiting moksha. This phase is characterised by peace and quiet, which might seem intimidating if you’re not accustomed to it. However, once you learn to embrace the solitude and tranquility, you may discover that you actually enjoy it.