Will you be old and ‘unbefriended?’

As the population of “elder orphans” grows, research is needed so that we can develop effective systems of public guardianship and care. (Shutterstock)

Will you be old and ‘unbefriended?’

For the first time in Canada’s history, more people are living alone or without children, according to the 2016 Census. Coupled with increasing life expectancy and geographic mobility, the chance of aging without a partner or children is significant.

Individuals who have no family caregivers are known as “elder orphans.” When they become incapacitated (often due to a dementia), they are known as the “unbefriended.”

In a new study, members of the pan-Canadian Translating Research in Elder Care (TREC) research program reviewed academic research and unpublished reports to understand what information was available on unbefriended older adults in Canada and the United States.

Public guardians

Since the unbefriended lack a willing or capable family support system, they often require a public guardian. Public guardians are case workers whose job is to make legal and personal decisions for people who are alone and incapacitated.

For many without a family caregiver, this protects against abuse and neglect.

Family members provide invaluable assistance to many elderly – from emotional support to making decisions about medical interventions. (Shutterstock)

However, the public guardianship system is plagued with challenges, including long wait times and large guardian caseloads. Unbefriended individuals are likely to live in long-term care (LTC) facilities.

Research from the United States estimates that between three to four per cent of LTC residents are unbefriended and this number is expected to grow.

Alarming lack of data

After reviewing thousands of abstracts and more than 100 papers, we found little information on this vulnerable group.

Studies from the U.S. indicated that unbefriended older adults were childless or had fewer children. They were more cognitively impaired than individuals with family guardians.

We found no Canadian studies or reports.

Our findings reveal an alarming lack of data on individuals who are unbefriended and living in LTC facilities. We do not know the consequences of public guardianship on their quality of care or quality of life.

Unbefriended older adults are exceptionally vulnerable to poor quality of care. Without family or friends who are familiar with their wants and needs, it is unclear if they receive treatment that is in line with their values and desires.

Researchers have questioned the quality of care these individuals receive, suggesting they are at risk of overtreatment or undertreatment.

A growing population

Since our review found no Canadian studies or reports on the characteristics or health of unbefriended older adults, we have no idea how Canada may or may not compare to the U.S.

As a result, we are conducting research to estimate the prevalence and the unmet needs of unbefriended older adults in LTC facilities.

Without the support of a family member, the elderly are at risk of medical decision-making that does not prioritize their goals or values. (Shutterstock)

One thing is clear: This population is likely to grow. Research on the health and care needs of unbefriended older adults, and the potential health impacts of public guardianship, are urgently needed. Without such studies, we are unable to adapt our continuing care system to meet the needs of this unique population.

We cannot solely rely on our children and other family members to care for us as we age. We need health and social systems that are prepared to care for our most vulnerable.

Further inquiry is imperative to examine guardianship services for older adults in Canada and around the world.