In the Future, More Older Americans May Die Alone

Studies predict more Americans will both age and die alone

More American adults may die alone in the future, if recent studies are any indication.

Elderly man sitting alone on park bench symbolizing aging and loneliness.This would be largely due to the fact that Americans are much more independent nowadays compared to earlier generations. Roughly half of U.S. adults are single. Those that choose to get married are waiting longer to do so, and they’re also having smaller families.

A 2015 study conducted by the National Center for Family and Marriage Research compared the living situations of U.S. adults in 1990 and 2015. Thirteen percent of American adults lived alone in 2015, a rise of only one percent from 1990. However, different age groups had different living situations.

Those 65 and over are living alone less often than their counterparts from 1990. This is partly because of longevity, in that fewer older people are widowed. The percentage of people under 45 years who live alone did not change. What alarmed some researchers, though, is that more Americans aged 45 to 65 are living alone than in years past.

Graph showing percentage of American adults living alone by both age and year


Researchers are worried that this trend may mean that many older people will feel isolated as they age, particularly those with no close living relatives. Sociologists Rachel Margolis and Ashton Verdery penned a report earlier this year which attempted to calculate how many Americans fall into this category.

Analyzing data from 1998 to 2010, they found that 6.6 percent of U.S. adults 55 and older have neither a still-living spouse nor children. One percent have essentially no relatives to speak of, including a partner, children, parents or siblings.

Isolation Rates Expected To Rise

Those figures are expected to increase. Divorce rates nearly doubled for adults aged 55 to 65 from 1990 to 2015. People are also remarrying after divorce less often than they used to. Seniors in the future will also have fewer siblings and children to ask for help or interact with. Baby boomers and generations before tended to live in large families. However, women today are having fewer children (the fertility rate dropped 26 percent from 1970 to 2015), and single-child families are on the rise.

Margolis and Verdery predict that the rate of older Americans without any living kin will surge in the next 40 years or so. In a recently published study, they used more than 100 years of Census Bureau information to track American families. They predict that the number of non-Hispanic whites with no living close kin will double by 2060; the number for non-Hispanic blacks is expected to more than triple. (Lack of immigration data made it harder to study other racial groups.)

In order to tackle this issue, the U.S. needs better housing options for older adults, says New York University sociology professor Eric Klinenberg. Social attitudes may also need to change in order for older people to stay connected as they age.

“Our society is evolving quickly,” says Klinenberg, “but probably not quickly enough.”

Humans are social beings. Strong relationships boost our overall sense of happiness and well-being. In fact, an in-depth study from 2010 showed that humans with healthy social lives had a 50 percent better chance of survival than those who did not. With these ideas in mind, we need to think of ways to address isolation in older adults, a problem that will surely increase in the years to come.

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“The art of living lies in a fine mingling of letting go and holding on.”

- Henry Ellis
Letting go of a butterfly


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Dementia and Redefining Quality of Life

A mother-daughter journey into the unknown

Behind the door opening is quality of life

The idea of dementia or dependence appalled my mother. For many years, she declared, “If I ever get Alzheimer’s, take me out and shoot me!” Her definition of quality of life was firmly grounded in her ability to think and live independently.

Time has forced many changes, including that definition. After the death of her husband, my mother lost her home, the proximity of friends, her horses and her role as wife. Unable to live alone due to her dementia, she has been living in an adult care home for the past 3 years. She adjusted to her new life, often giggling with caregivers, and watching her favorite TV westerns while enjoying an endless supply of chocolate. I was surprised. Was her dementia a pathway to acceptance?

When my mother was hospitalized last year at the age of 90 due to a fracture from a fall, I understood the odds of this medical crisis resulting in a quick decline and death. Given her previous statements about what makes life worth living, I thought she might welcome the chance to leave this life. Because if I shared her definition, I knew I would!

Woman debating quality of life in bed

My mom in her hospital bed prior to surgery

Before her surgery, lying in her hospital bed, my mother stared into the empty space in front of her, joyfully
exclaiming, “I see you!” Recognizing she was experiencing a vision, I inquired who she was talking to. Although she was unable to tell me, the look on her face was joyful as she seemed to listen intently.

Drawing from my hospice experiences, I wondered if whoever had come to visit her would also ease her transition into the next realm. It felt like the door had opened to exit if she chose to do so.

Her surgery was completed without incident.

Back in her room again, my mother focused on the space in front of her again, mumbling and smiling. She then turned to me with sudden clarity and asked, “Is it OK if I leave?” Then she added, “It was easy for my mother. I’m ready for this to be over.”

I responded, “We will miss you….but” and she quickly cut me off with a disappointed “Oh, OK, I will stay.” I tried to tell her that that rest of the sentence was that she could “leave whenever she wanted to”, but she no longer heard me. Or perhaps she did not want to hear me.

I wondered, “Why did she wait until after the surgery to ask this?” If she was really, “ready for this to be over,” did she miss her window? Was she testing my desire to keep her on earth? Was I a bad daughter for wishing for her release from a life she had previously not wanted? Or was I imposing my own definition of quality of life on her now, not realizing hers had changed? Was this her new definition of quality of life?

It’s been over a year now since that hospital stay. Although my mother is wheelchair bound and requires total care, she is happy. She eats like a horse, and enjoys the attention of the staff who have become her family.

I admit to fluctuating between being surprised, sad, and happy for her. Due to her dementia, she is blissfully unaware of her limitations. She happily waits for the time when she can buy another house, drive her car, and take another trip to the Caribbean even though those dreams can never be fulfilled.

Butterfly in hand reflecting quality of life


Is it her dementia or her hope that has transformed her definition of quality of life?

Will I have also experience a redefinition of quality of life with graceful acceptance one day?

I wonder.

If so, will my sons also wonder as I do now?

And will they take this same transformational journey with me?

About Tani

Tani Bahti, RN, CT, CHPN, offers practical guidance to demystify the dying process. A RN since 1976, Tani has been working to empower families and healthcare professionals to enable the best end-of-life experience possible through education and the development of helpful tools and resources. The current owner of Pathways, Tani is also the author of “Dying to Know, Straight Talk About Death and Dying,” a book that SevenPonds considers one of the most helpful books on the subject available today. Founder Suzette Sherman says, “This is the book I will have at the bedside of my dying parents some day, hopefully, a very long time from now.”

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Monday Hearts for Madalene

Page Hodel creates beautiful hearts as a tribute to enduring love
A handmade heart made of fruits and vegetables

I will be forever thankful for you

It’s an honor for SevenPonds to share with our readers the story of the Monday Hearts for Madalene project, a true account of the power of enduring love.The project began in 2005, when Page Hodel first met Madalene Rodriguez and fell “instantly, dizzyingly in love with her.” Soon afterwards, Page began leaving handmade hearts on Madalene’s doorstep every Monday.

“To start her week with a visual reminder of our beautiful love.”

Just seven months later, Madalene was diagnosed with ovarian cancer. She died on June 20th, 2006. To remember her, Page continues to make a heart every Monday in celebration of her life.

To learn more about Page and the Monday Hearts for Madalene Project, please visit her website, Monday Hearts for Madalene.

See more Monday Hearts for Madalene here.

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“Time may be a great healer, but it’s a lousy beautician.”

- Anonymous
An elderly woman wearing glasses smoking a cigar


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How Important is Touch at the Bedside of the Dying?

An interview with Everflowing director and educator Irene Smith, Part One

Today SevenPonds speaks with Irene Smith, founder and director of Everflowing, an educational program centered around creating a more supportive environment for hospice patients and their healthcare providers. Smith has three decades of experience as an educator and practitioner, focusing primarily on the benefits of touch at the end of life. As an author, she has also published a number of works, including “Touch Awareness In Caregiving,” “The Emotional Impact Of Working With The Dying” and “Providing Massage in Hospice Care.” Today, her goal is to teach others how to perform mindful touching and to bring a sense of humanity back into the healthcare profession. 

Editor’s note: This interview has been edited for clarity and length. 

Irene smith teaches the value of touchMarissa Abruzzini: Thank you for joining us, Irene. Let’s start with your background. What inspired you to get involved in this work? 

Irene Smith: I originally received a massage license in 1974, but I put it to no therapeutic use at the time. That was until I met Elisabeth Kübler-Ross in 1978. I spent a year working with her and learning from her, and at the end of my time, she wrote me a reference letter, and encouraged me to work with the dying with my massage therapy. I decided to take my massage practice to a hospice facility in 1981, by offering massage to people who were dying. 

Marissa: Was there any specific certification for this work at that time, or was this a brand new field? 

Irene: They actually only introduced this as a specific modality in massage about four years ago. There was absolutely nothing like it when I began. And this practice was a difficult one to pioneer, because the AIDS epidemic was just beginning. So many people at the time refused to give education or training on massage for people who had HIV/AIDS. In 1982, I founded a non-profit called Service Through Touch, which offered therapeutic massage to people around the world who have HIV/AIDS. But this type of service was still largely ignored for about 18 years.

It wasn’t until after the AIDS epidemic that massage in hospice became more mainstream. Oncology in particular was what made it mainstream. People who were on hospice care began receiving massage as part of their cancer treatments. And today, most major healthcare corporations have massage teams on-staff.

But, massage is not the intention of my work today. My work goes much deeper than massage. My real work is as a touch educator, not a massage therapist.

Irene Smith holds a patient's hand in a hospice facility showing the value of touch

Irene and Evee Mills, Zen Hospice Project, 2010, Photo by Alan Waugh

Marissa: Tell me more about that. 

Irene: Today, massage has become a corporate modality of care, which has been incredibly wonderful for many people. But healthcare professionals need to understand that their quality of touch is the core vibration that every patient responds to. Whether they’re bathing someone, or transferring someone from one bed to another, nurses and doctors are often taught to touch patients as little as possible. Touch isn’t included in any paradigm.

So, my mission is to assist healthcare providers and family to recognize the value of the care that they provide. I want to show them that they don’t need to separate entirely from the people they care for. They need to learn how to touch skillfully. And this benefits everyone in the process. Right now, about 85 percent of the time, healthcare providers are working with people without having training on this necessary core skill. They need to appreciate the value of touch.

Irene Smith teaches touch to a caregiver

Credit: Irene Smith/LinkedIn

Marissa: Interesting! How do you teach caregivers this skill? 

Irene: I actually just came back from Connecticut to train 14 staff members on touch awareness. When I teach someone about touch awareness, the most important thing to remember is that touch isn’t really a “technique.” It’s more like an all-encompassing sense. Touch has power beyond the physical. Let me give you an example; if someone loses the opportunity to form coherent sentences, this causes a gap in communication. With touch, this person can bridge the gap between despair and hope. They can communicate without using words.

The main problem with how healthcare providers treat touch today is that they move too fast, or in an unskillful way that tells their patients “I don’t have time for you.” This produces anxiety in people. The provider may not understand that their touch is a delivery system, and that it holds value. There is value in just holding someone’s hand. Sometimes, it takes a full year to gather the confidence to perform just one act of human kindness like that.

This concludes the first part of our interview with Irene Smith. Join us again next week for part two of our interview, where we talk to Irene about the benefits of touch, and how all of us can become better caregivers. 

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