The Elder Orphan in Healthcare Settings: an Integrative Review

Abstract

The issues of older adults outliving family members and living alone with no family support or existing social networks raise concerns on the health and wellbeing needs of this particular population group. This article explores the concept of orphaned older adults within the healthcare context through an integrative review of literature. The review utilized online health databases and online publishing platforms for grey literature. Eight articles focusing on elder orphans within the healthcare literature were included in this review. Four emerging themes were identified: characteristics of the older adult orphan; healthcare and clinical oversight; older adult orphans’ support services; and ‘older adult orphan’ as an advocacy healthcare terminology. Elder orphans are vulnerable older adults who may have current stable health status, yet are at risk of health-related issues which could hinder their decision making ability in the future. The conceptualization of becoming orphaned in advanced age opens an important dialogue in the healthcare sector and encourages attention from health professionals to consider and to be more aware of this vulnerable population group among older people. It is important that the use of this otherwise non-clinical term defining orphancy in older age or even those at risk be more visible and accepted, for the purpose of clinical assessment and coordination of care for both acute and long-term/community settings. Health professionals and clinicians act as advocates when screening and assessment for older adult orphans are undertaken at all levels and across healthcare settings.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. Allen, R. S., & Wiles, J. L. (2013). How older people position their late-life childlessness: A qualitative study. Journal Of Marriage & Family, 75(1), 206–220. https://doi.org/10.1111/j.1741-3737.2012.01019.x.

    Article  Google Scholar 

  2. Bagshaw, D., Adams, V., Zannettino, L., & Wendt, S. (2015). Elder mediation and the financial abuse of older people by a family member. Conflict Resolution Quarterly, 32(4), 443–480. https://doi.org/10.1002/crq.21117.

    Article  Google Scholar 

  3. Bull, M. J., & Roberts, J. (2001). Components of a proper hospital discharge for elders. Journal of Advanced Nursing, 35(4), 571–581.

    Article  Google Scholar 

  4. Carney, M. T., Fujiwara, J., Emmert, B. E., Liberman, T. A., & Paris, B. (2016). Elder orphans hiding in plain sight: A growing vulnerable population. Current Gerontology and Geriatrics Research, 2016, 1–11.

    Article  Google Scholar 

  5. Ching-Yu, C. (2006). Living alone: The choice and health of older women. Journal of Gerontological Nursing, 32(9), 16.

    Article  Google Scholar 

  6. Christensen, K., Doblhammer, G., Rau, R., & Vaupel, J. W. (2009). Ageing populations: The challenges ahead. The Lancet, 374(9696), 1196–1208.

    Article  Google Scholar 

  7. Farrell, T. W., Widera, E., Rosenberg, L., Rubin, C. D., Naik, A. D., Braun, U., ... & Shega, J. (2017). AGS position statement: making medical treatment decisions for unbefriended older adults. Journal of the American Geriatrics Society, 65(1), 14.

  8. Geber S. (2018). Are you ready for Solo Agers and Elder Orphans? [Blog]. Retrieved from http://www.asaging.org/blog/are-you-ready-solo-agers-and-elder orphans#.WkT8TI4j5YQ.twitter? platform=hootsuite

  9. Hutchison, B. G. (1993). Critical appraisal of review articles. Canadian Family Physician, 39, 1097.

    Google Scholar 

  10. Ianzito, C. (2017) Elder Orphans: How to Plan for Aging without a Family Caregiver. [Blog] http://www.aarp.org/home-family/caregiving/info-2016/caregiving-tips-when-aging-alone.html?intcmp=CRC-FEED

  11. Johannesen, M., & Logiudice, D. (2013). Elder abuse: A systematic review of risk factors in community-dwelling elders. Age and Ageing, 42(3), 292–298.

    Article  Google Scholar 

  12. Johnstone, M. J. (2014). Caring about the unbefriended elderly. Australian Nursing and Midwifery Journal, 21(9), 20.

    Google Scholar 

  13. Lachs, M. S., & Pillemer, K. (2004). Elder abuse. The Lancet, 364(9441), 1263–1272.

    Article  Google Scholar 

  14. Lubitz, J., Cai, L., Kramarow, E., & Lentzner, H. (2003). Health, life expectancy, and health care spending among the elderly. New England Journal of Medicine, 349(11), 1048–1055.

    Article  Google Scholar 

  15. Marak, C. (2017a). Elder Orphans’ Have a Harder Time Aging in Place. [Blog]. Retrieved from https://www.nextavenue.org/elder-orphans-harder-aging-place/?utm_source=sumome&utm_medium=twitter&utm_campaign=sumome_share

  16. Marak, C. (2017b). The Aging & Alone Care Needs & Preferences. Today's Caregiver, 22–23.

  17. McDaniel, J., & Clark, P. (2009). The new adult orphan: Issues and considerations for health care professionals. Journal of Gerontological Nursing, 35(12), 44–49. https://doi.org/10.3928/00989134-20090930-02.

    Article  Google Scholar 

  18. Moye, J., & Naik, A. D. (2011). Preserving rights for individuals facing guardianship. JAMA, 305(9), 936–937.

    Article  Google Scholar 

  19. Moye, J., Catlin, C., Kwak, J., Wood, E., & Teaster, P. B. (2017). Ethical Concerns and Procedural Pathways for Patients Who are Incapacitated and Alone: Implications from a Qualitative Study for Advancing Ethical Practice. In HEC Forum (pp. 1–19). Springer Netherlands.

  20. Penning, M. J., Liu, G., & Chou, P. H. B. (2014). Measuring loneliness among middle-aged and older elders: The UCLA and de Jong Gierveld loneliness scales. Social Indicators Research, 118(3), 1147–1166.

    Article  Google Scholar 

  21. Petersen, M., & Parsell, C. (2015). Homeless for the first time in later life: An Australian study. Housing Studies, 30(3), 368–391.

    Article  Google Scholar 

  22. Podnieks, E., Pillemer, K. N., Phillip, J., Shillington, T., & Frizzel, A. (1990). National survey on abuse of the elderly in Canada: The Ryerson study (Vol. 492). Toronto: Ryerson Polytechnical Institute.

    Google Scholar 

  23. Pope, T. M. (2014). Legal briefing: Elder orphans and the Unbefriended: Making medical decisions for unrepresented patients without surrogates. The Journal of Clinical Ethics, 26(2), 180–188.

    Google Scholar 

  24. Professional news. (2002). Bed blocking campaign could mean older people are dying alone. British Journal of Nursing, 11(17), 1117.

    Google Scholar 

  25. Revealed: Sad plight of the thousands of elderly left alone in homes 'without letters, visits or calls' in their final years (2010). Daily Mail Australia. Retrieved from http://www.dailymail.co.uk/news/article-1328425/Thousands-elderly-left-homes-letters-visits-calls-final-years.html

  26. Schlecht, A. (2018). More people aging alone as ‘elder orphans’. In The Olympian Retrieved from http://www.theolympian.com/news/local/article192820524.html.

    Google Scholar 

  27. Shaw, B. A., Fors, S., Fritzell, J., Lennartsoon, C., & Agahi, N. (2017). Who lives alone during old age? Trends in the social and functional disadvantages of Sweden’s solitary living older adults. Research on Aging, 01640275177.

  28. Soniat, B., & Pollack, M. (1994). Elderly orphans with Alzheimer's disease: Non-traditional support systems. Clinical Gerontologist, 14(1), 33–44.

    Article  Google Scholar 

  29. Torraco, R. J. (2005). Writing integrative literature reviews: Guidelines and examples. Human Resource Development Review, 4(3), 356–367.

    Article  Google Scholar 

  30. Varner, J. (2005). The elder orphans: Who are they? The Alabama Nurse, 32(3), 19.

  31. Walker, C., Hogstel, M., & Curry, L. (2007). For CE credit: Hospital discharge of older elders. The American Journal of Nursing, 107(6), 60–71.

    Article  Google Scholar 

  32. Whittemore, R., & Knafl, K. (2005). The integrative review: Update methodology. Journal of Advanced Nursing, 52(5), 546–553.

    Article  Google Scholar 

  33. World Health Organization (2016). World health statistics 2016: Monitoring health for the SDGs sustainable development goals. World Health Organization.

  34. Ziettlow, A. & Cahn, N. (2015). The future of elder orphans [The Blog of the Institute of Family Studies]. Retrieved from https://ifstudies.org/blog/the-future-of-elder-orphans

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jed Montayre.

Ethics declarations

Conflict of Interest

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Montayre, J., Montayre, J. & Thaggard, S. The Elder Orphan in Healthcare Settings: an Integrative Review. Population Ageing 12, 515–532 (2019). https://doi.org/10.1007/s12062-018-9222-x

Download citation

Keywords

  • Elder orphans
  • Health and social support services
  • Caregiving
  • Older adult assessment