ASNA INDEPENDENT STUDY

Alabama Nurse, Sep-Nov 2005 by Varner, Joyce

The Elder Orphans: Who Are They?

Authored by: Joyce Varner, MSN, RN, GNP-BC, GCNS; Clinical Assistant Professor, Gerontological Nurse Practitioner Track, University of South Alabama

Objectives: At the conclusion of this activity the learner should be able to:

1. Define the term "elder orphan".

2. Discuss ways an elder may become an orphan

3. Develop a plan for identification of elders at risk for experiencing this phenomenon.

4. Discuss ways primary care providers and nurses can assess elders and assist with identifying the best living arrangements for the elder

5. Identify different types of housing options available to elders who are financially stable and those who are not.

6. Identify and discuss three things primary care providers can do to demonstrate political awareness regarding elder orphans.

Directions: Read the article carefully. Return the answer sheet and evaluation printed at the end of this article and fill out all sections carefully. Mail to the address provided with appropriate fee. A continuing education Certificate of Completion will be mailed upon successful completion of both the post-test and completion of the evaluation. You must score at least 80% to pass. Should you fail the test you will be notified and offered an opportunity to retake the test. All retakes will require an additional $5 fee.

Contact Hour and Accreditation: This 1.5 contact hour activity is provided by the Alabama State Nurses Association which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center (ANCC) and the Alabama Board of Nursing.

A Well Kept Secret

Elder orphans are not a new phenomenon, but they are increasing in number as our society ages. Elder orphans are, by definition, elders who have outlived family and friends and have no one to turn to for support or protection in their later years. It is estimated that the number of Americans between the ages of 70-85 without a spouse, children or stepchildren, and without siblings will total more than 2.5 million by the year 2030. These elders may have been orphans from birth, only children, widowed, or. are the last surviving members of their family. This can be a sudden, overwhelming fact for individuals, who for the first time in their life may be forced to make decisions on their own. Decisions such as where to live, how to plan for the future, and/or make final arrangements for themselves. Sometimes, simultaneously they need to grieve for the loss of their last family or friend. This can lead to a state known as bereavement overload where the elder simply withdraws and is unable to function.

As primary care providers and nurses we see many patients like this, who are sitting on the fence, so to speak, with only one relative living who is in bad health, and simply waiting for the other shoe to drop. When that spouse or friend dies the survivor becomes an elder orphan immediately. This problem is particularly bad in our society since isolation seems to have become a hallmark of the current era. It is also estimated that as much as 60% of nursing home residents have no regular visitors. With home care increasingly the long-term care option of choice, being an elder without close relatives in the future won't necessarily lead to the frequency of nursing home admission that it once might have, but these elders may fall below the radar for primary care providers and nurses. As a society this will necessitate paying much closer attention to the social needs of growing numbers of elders with little or no support.

How Did This Happen

Historically our society saw many intergenerational ties that meant elders had children and grandchildren nearby or in the same house to assist them during the last years of their lives. Today, children and grandchildren tend to live far away and be involved in their own lives, leaving the elder to function alone. Many elders wish to remain independent and try to avoid becoming what they see as a 'burden' to their family. Another factor increasing the isolation of elders may be divorce. With roughly half of the marriages in this country ending in divorce, the number of elders without support will increase. As a society we see a greater number of elders divorcing than ever before in history, leaving them alone if they are childless. This may lead to social death for the elder by extinction of long-term relationships. For a childless couple, the spouse who is in the best state of health but caring for a spouse with serious health problems may feel overwhelmed with necessity forcing them to take over household decisions that they have never had to deal with in the past. This may be as simple as knowing how to cook, perform home repairs, balance a checkbook, or shop. This can cause a downward spiral if the surviving elder does not have a support network for help. If the existing support network has disappeared to death, this leads to escalation of the issues and quickly becomes a serious problem for the survivor.