US adults living alone may face higher risk of cancer death, study suggests

I've been living alone now for 12+ years. I can't see getting married, it would severely limit my traveling and social connections. But there are quite a few old college roommates which could work.

This problem is not going to happen to me, my social connections are vast.

Martha Gellhorn on her relationship with Ernest Hemingway

'I do very well without marriage
I'd rather sin respectably any day of the week
Ernest thinks, of course, that marriage saves you a lot of trouble and he is all for it,
I think sin is very clean, there are no strings attached to it'

The latest here:

US adults living alone may face higher risk of cancer death, study suggests

 

Adults living by themselves may have a higher risk of dying from cancer compared with those who live with others, a new study suggests, and the share of adults in the United States who live alone is on the rise.

The research, published Thursday in the journal Cancer, found that among 114,772 working-age adults who lived alone, 2.5% of them died of cancer during the study period. In comparison, among 358,876 adults who lived with others, a much smaller share — 1.6% — died of cancer in the study. Adults ages 18 to 64 were enrolled in the study and researchers found the strongest association was in those ages 45 to 64.

Loneliness or social isolation linked to serious health outcomes, study finds

“We found that working adults living alone had a 1.32 times higher risk of cancer death than adults living with others,” said Dr. Farhad Islami, an author of the study and senior scientific director of cancer disparity research at the American Cancer Society in Atlanta. That suggests that adults living alone have about a 32% higher risk of cancer death.

“Living alone is only one of the components of social isolation, and it may not capture other components like social networks or participation in social activities. But I should say also that living alone is still an important measure,” he said. “This is really important to think about finding ways to reduce the adverse effects of living alone and social isolation, to reduce mortality in this growing population.”

Being ‘socially frail’ comes with health risks for older adults

The proportion of people in the United States who live alone has climbed over decades. US Census Bureau data shows that the proportion of one-person households in the United States more than doubled from 1960, when 13% or about 7 million households were single, to 2022, when 29% or about 38 million households were.

The researchers, from the American Cancer Society and the US Department of Health and Human Services, analyzed data, from 1998 to 2019, on more than 470,000 adults from the National Health Interview Survey and the National Death Index, taking a close look at how many of the adults lived alone versus with others and how many died of cancer. The study did not control for the stage of cancer when diagnosed, specific cancer types or treatment regimens.

The adults, ages 18 to 64 when they enrolled in the study, were followed for up to 22 years, from the time they participated in the survey through December 31, 2019. About 24% of them lived alone.

The researchers also pointed out that there were higher proportions of one-person households among Black households than White, Asian and Hispanic households, among young adults and the elderly versus middle age adults, among females than males and among adults with higher education versus those with low education levels.

The male loneliness epidemic and how it affects fathers

But the association between living alone and cancer mortality persisted among non-Hispanic White adults and adults with higher education levels even after accounting for differences in a wide range of sociodemographic, behavioral, and health characteristics, according to the study.

“Our findings may suggest that stronger social support existed for communities from racial ethnic minority groups and people of lower socioeconomic status and that might have alleviated that association between living alone and cancer mortality in this group, but we need more research on reasons for these differences,” Islami said.

Compared with adults living with others, adults living alone were more likely to have fair or poor self-reported health status, activity limitation, serious psychological distress, severe obesity, smoke cigarettes, or consume alcohol, according to the study.

“These findings underscore the significance of addressing living alone in the general population and among cancer survivors, calling for interventions to reduce adverse effects of living alone and social isolation and further research to identify the underlying mechanisms for this association,” the researchers wrote in their study.

Alone and lonely are not the same

This isn’t the first time that research has found living alone to be associated with increased health risks. Separate studies have previously found that living alone may be associated with a higher risk of being diagnosed with cancer, or even any cause of death.

Surgeon general lays out framework to tackle loneliness and ‘mend the social fabric of our nation’

In May, US Surgeon General Dr. Vivek Murthy released an advisory describing loneliness and social isolation as an epidemic, but social connection can help, serving as a buffer to certain health risks while making communities more resilient.

But living alone does not necessarily mean that someone is lonely or isolated.

More research is needed to identify the exact underlying mechanisms to explain the association between living alone and cancer death, Kathrin Milbury, associate professor of behavioral science at The University of Texas MD Anderson Cancer Center, who was not involved in the new study, said in an email.

“Living with others gives one easy access to human contact. While being well, living alone may be less detrimental. However, people undergoing cancer treatment or dealing with the lasting side effects of treatment may not have the energy to reach out to others, feel uncomfortable going to public places due to appearance changes, or have impaired physical function that reduces their ability to be social. So, those who live alone may be vulnerable to social isolation,” Milbury said in the email.

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“The biological mechanisms of social isolation are not fully understood; however, humans are social beings, and being isolated creates a state of biological stress that is detrimental to our health when chronically experienced,” Milbury said. “The other mechanism I believe is related to being in a relationship with others, beyond benefiting just from their presence, but receiving their support, care and advocacy.”

Elderly People Who Live Alone at Increased Risk of Cognitive Decline

I've been living alone now for 12+ years. I can't see getting married, it would severely limit my traveling and social connections. But there are quite a few old college roommates which could work.

This problem is not going to happen to me, my social connections are vast.

Martha Gellhorn on her relationship with Ernest Hemingway

'I do very well without marriage
I'd rather sin respectably any day of the week
Ernest thinks, of course, that marriage saves you a lot of trouble and he is all for it,
I think sin is very clean, there are no strings attached to it'

The latest here:

 

Elderly People Who Live Alone at Increased Risk of Cognitive Decline

Summary: A startling study unveils a critical deficiency in the U.S. healthcare infrastructure: about 1 in 4 older Americans with dementia or cognitive impairments live solo, confronting increased hazards such as unsafe driving, medication mishaps, and overlooked medical appointments. This issue looms large, especially when juxtaposed against the backdrop of an aging demographic that’s set to grow exponentially.

The current health system seems ill-prepared to cater to these vulnerable seniors, particularly when benchmarked against systems in Europe, Japan, and Canada that provide comprehensive supports for such populations. As the U.S. grapples with these findings, the imperative for system enhancements becomes unmistakably clear.

Key Facts:

1. An estimated 1 in 4 older Americans with cognitive decline lives alone, vulnerable to a range of risks including missed medical appointments and medication errors.
2. The U.S. health system struggles to support this demographic, leaving many without proper care and interventions until they face serious crises.
3. While regions like Europe, Japan, and Canada offer more extensive subsidized home care assistance, the U.S. largely does not, resulting in out-of-pocket expenses and inadequate support for these patients.

Source: UCSF

An estimated 1 in 4 older Americans with dementia or mild cognitive impairment lives alone and is at risk of practices like unsafe driving, wandering outside the home, mixing up medications and failing to attend medical appointments. 

In a study publishing in JAMA Network Open on Aug. 18, 2023, researchers led by UC San Francisco concluded that the United States health system is poorly equipped to serve patients living solo with cognitive decline, a group whose numbers are predicted to swell as the population ages. 

For these patients, living alone is a social determinant of health with an impact as profound as poverty, racism and low education, said first author Elena Portacolone, PhD, MBA, MPH, of the UCSF Institute for Health and Aging and the Philip R. Lee Institute for Health Policy Studies.

While Medicare is available to adults over 65, subsidized aides are generally only provided after acute episodes, like hospitalizations, for fixed hours and for limited durations, she said. Credit: Neuroscience News

In this qualitative study, researchers interviewed 76 health care providers, including physicians, nurses, social workers, case workers, home care aides and others. Participants worked in memory clinics, home care services and social services and other places in California, Michigan and Texas 

The providers raised concerns about patients missing medical appointments, failing to respond to follow-up phone calls from the doctor’s office and forgetting why appointments were made, leaving them vulnerable to falling off the radar. “We don’t necessarily have the staff to really try to reach out to them,” said a physician in one interview. 

 Discharging a patient is like ‘sending a kid out to play on freeway’

Some patients could not assist their doctor with missing information on their chart, leaving the providers uncertain about the pace of their patient’s decline. Many had no names listed as emergency contacts, “not a family member, not even a friend to rely on in case of a crisis,” according to a case manager.
 
These patients were at risk for untreated medical conditions, self-neglect, malnutrition and falls, according to the providers. A house service coordinator also noted that calls to Adult Protective Services were sometimes dismissed until a patient’s situation became very serious. 

One consequence of the shaky infrastructure supporting these patients was that they were not identified until they were sent to a hospital following a crisis, like a fall or reaction to medication mismanagement.

Some were discharged without a support system in place. In one case, a patient was sent home with a taxi voucher, a situation that a psychiatrist likened to “sending a kid out to play on the freeway.”

These findings are an indictment of our health care system, which fails to provide subsidized home care aides for all but the lowest-income patients, said Portacolone. 

“In the United States, an estimated 79% of people with cognitive decline have an income that is not low enough to make them eligible for Medicaid subsidized home care aides in long-term care,” she said, adding that the threshold for a person living alone in California is $20,121 per year. 

While Medicare is available to adults over 65, subsidized aides are generally only provided after acute episodes, like hospitalizations, for fixed hours and for limited durations, she said.

“Most patients need to pay out-of-pocket and since cognitive impairment can last for decades, it is unsustainable for most people. Aides that are available via Medicaid are very poorly paid and usually receive limited training in caring for older adults with cognitive impairment,” she added.

Subsidized home care aides plentiful in Europe, Japan, Canada

In contrast, subsidized home care aides are generally available to a significantly larger percentage of their counterparts living in parts of Europe, Japan and Canada, said Portacolone, citing a  2021 review of 13 countries, of which she was the senior author.

The study’s findings illustrate substantial deficiencies in how our health system provides for people with dementia, said senior author Kenneth E. Covinsky, MD, MPH, of the UCSF Division of Geriatrics.

“In an era when Medicare is going to spend millions of dollars for newly approved drugs with very marginal benefits, we need to remember that Medicare and other payers refuse to pay far less money to provide necessary supports for vulnerable people with dementia.”

The researchers advocate for a system in which robust supports are made available by funding from an expanded Medicare and Medicaid. This will become increasingly critical, said Portacolone, “because effective treatments to reverse the course of cognitive impairment are unavailable, childlessness and divorce are common, and older adults are projected to live longer and often alone.” 

About this aging and cognitive decline research news

Author: Suzanne Leigh
Source: UCSF
Contact: Suzanne Leigh – UCSF
Image: The image is credited to Neuroscience News

Original Research: Open access.
“Perceptions of the Role of Living Alone in Providing Services to Patients With Cognitive Impairment” by Elena Portacolone et al. JAMA Network Open

Marital Transition and Risk of Stroke

My transition to unmarried probably vastly increased my chances of a long life. 

My story; I would still be leading a life of quiet desperation.

Why my stroke was the best thing to ever happen to me

I've been living alone now for 10+ years. I can't see getting married, it would severely limit my traveling and social connections. But there are quite a few old college roommates which could work.

Martha Gellhorn on her relationship with Ernest Hemingway

I do very well without marriage
I'd rather sin respectably any day of the week
Ernest thinks, of course, that marriage saves you a lot of trouble and he is all for it,
I think sin is very clean, there are no strings attached to it

The latest here:

Marital Transition and Risk of Stroke

How Living Arrangement and Employment Status Modify Associations

Kaori Honjo,

Hiroyasu Iso,

Ai Ikeda,

Manami Inoue,

Norie Sawada,

Shoichiro Tsugane and

on behalf of the JPHC Study Group

Originally published1 Mar 2016https://doi.org/10.1161/STROKEAHA.115.011926Stroke. 2016;47:991–998

• Other version(s) of this article

Abstract

Background and Purpose—

There have been consistent findings reported that marital transition (ie, change in marital status during a given time period) is associated with risk of cardiovascular disease; however, few studies have been conducted on stroke risk, particularly stroke subtypes. Moreover, no studies have examined the moderating effect of living arrangement and employment status on the association between marital transition and stroke risk.

Methods—

We examined sex-specific associations between marital transition and stroke risk using data from Japan Public Health Center–based Prospective Study. We included 24 162 men and 25 626 women who were married at prebaseline (5 years before baseline). Marital transition was determined by marital status at baseline. Weighted hazard ratios of stroke risk were estimated by Cox proportional regression analysis with inverse probability of weighting using a propensity score.

Results—

An increased risk of stroke, particularly hemorrhagic stroke, was observed among men and women with marital transition (ie, married to unmarried); weighted hazard ratios (95% confidence interval [CI]) for men and women were 1.26 (1.13–1.41) and 1.26 (1.09–1.45), respectively. Participants with marital transition and lived with children had increased stroke risk. Living with parents buffered the increased stroke risk owing to marital transition among men; however, no such effect was identified among women. Elevated stroke risk owing to marital transition was magnified among women if they were unemployed; weighted hazard ratio=2.98 (95% CI, 1.66–5.33).

Conclusions—

Living arrangement and employment status modified the positive associations between marital transition and stroke risk, which differed by sex.

Introduction

Marital status is viewed as an important determinant of health.¹ Married people have been consistently reported to be healthier than unmarried people, with more profound effects among men.^2–7 These associations can be attributed to both marital selection (ie, healthier people are more likely to be married) and marital protection (refers to the benefits of marital ties on health).^8–11

Consistent findings have been reported from research investigating marital transition (ie, a change in marital status during a given time period).⁵ Men and women who experience marital transition by death or divorce have prospectively increased risk of associated onset and progression of cardiovascular disease.^12–14 The hypothesized mechanisms underlying the association between marital transition and cardiovascular risk include preexisting health conditions,⁵ change to unhealthy profiles of health behavior,^15–17 poorer psychological state² stemming from the loss of financial stability,^18,19 and reduced social support and social networks^11,20 owing to loss of the spouse. However, few studies have been conducted to address stroke risk,^17,21 particularly stroke subtypes,²² in this population. In addition, no such studies have been conducted in Asia.

Sociocultural differences could be a potential moderator for the health effect of marital transition.⁵ A prospective study of middle-aged men and women in Japan showed that marital dissolution significantly increased the risk of cardiovascular mortality among men, but no such impact was identified among women.⁶ Another prospective study of Japanese elderly adults showed no evidence of increased all-cause mortality risk among widowed men and women; in fact, decreased mortality risk was found among widowed women.⁷ These inconsistent results could be because the social roles of men and women in Japanese society are different, with strong gender role norms (ie, the male breadwinner model). Under such social norms, women are generally more likely to adopt the role of providing emotional support to their spouse. Therefore, widowed women might feel relieved of their duty to care for their spouse emotionally, which might in turn lower their mortality risk.

Marital transition often changes people’s living arrangement and economic situation. Living alone is a well-known health risk factor.^23–26 In addition, a previous study conducted in Japan showed that who people live with was important for increased risk of coronary heart disease incidence and mortality.²⁶ Thus, the magnitude of stroke risk could vary by living arrangement.

In the same way that marital transition affects economic status (ie, through loss of the breadwinner or reduced sources of household income), the impact on employment status must also be considered. However, to our knowledge, no studies have examined the moderating effect of living arrangement and employment status on the association between marital transition and stroke risk.

In this study, we sought to examine the sex-specific associations between marital transition and incidence of total stroke and stroke subtypes, as well as modification of the identified associations, according to living arrangement and employment status, in a large prospective cohort in Japan.

More at link.

As Gen X and Boomers Age, They Confront Living Alone

I've been living alone now for 10 years. I can't see getting married, it would severely limit my traveling and social connections. But there are quite a few old college roommates which could work.

Martha Gellhorn on her relationship with Ernest Hemingway

I do very well without marriage
I'd rather sin respectably any day of the week
Ernest thinks, of course, that marriage saves you a lot of trouble and he is all for it,
I think sin is very clean, there are no strings attached to it

As Gen X and Boomers Age, They Confront Living Alone

Jay Miles has lived his 52 years without marriage or children, which has suited his creative ambitions as a videographer in Connecticut and, he said, his mix of “independence and stubbornness.” But he worries about who will take care of him as he gets older.

Donna Selman, a 55-year-old college professor in Illinois, is mostly grateful to be single, she said, because her mother and aunts never had the financial and emotional autonomy that she enjoys.

Mary Felder, 65, raised her children, now grown, in her row house in Philadelphia. Her home has plenty of space for one person, but upkeep is expensive on the century-old house.

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Felder, Miles and Selman are members of one of the country’s fastest-growing demographic groups: people 50 and older who live alone.

In 1960, just 13% of American households had a single occupant. But that figure has risen steadily, and today it is approaching 30%. For households headed by someone 50 or older, that figure is 36%.

Nearly 26 million Americans 50 or older now live alone, up from 15 million in 2000. Older people have always been more likely than others to live by themselves, and now that age group — baby boomers and Gen Xers — makes up a bigger share of the population than at any time in the nation’s history.

The trend has also been driven by deep changes in attitudes surrounding gender and marriage. People 50-plus today are more likely than earlier generations to be divorced, separated or never married.

Women in this category have had opportunities for professional advancement, homeownership and financial independence that were all but out of reach for previous generations of older women. More than 60% of older adults living by themselves are female.

“There is this huge, kind of explosive social and demographic change happening,” said Markus Schafer, a sociologist at Baylor University who studies older populations.

In interviews, many older adults said they feel positively about their lives.

But while many people in their 50s and 60s thrive living solo, research is unequivocal that people aging alone experience worse physical and mental health outcomes and shorter life spans.

And even with an active social and family life, people in this group are generally more lonely than those who live with others, according to Schafer’s research.

In many ways, the nation’s housing stock has grown out of sync with these shifting demographics. Many solo adults live in homes with at least three bedrooms, census data shows, but find that downsizing is not easy because of a shortage of smaller homes in their towns and neighborhoods.

Compounding the challenge of living solo, a growing share of older adults — about 1 in 6 Americans 55 and older — do not have children, raising questions about how elder care will be managed in the coming decades.

“What will happen to this cohort?” Schafer asked. “Can they continue to find other supports that compensate for living alone?”

Planning for the Future

For many solo adults, the pandemic highlighted the challenges of aging.

Selman, the 55-year-old professor, lived in Terre Haute, Indiana, when COVID-19 hit. Divorced for 17 years, she said she used the enforced isolation to establish new routines to stave off loneliness and depression. She quit drinking and began regularly calling a group of female friends.

This year, she got a new job and moved to Normal, Illinois, in part because she wanted to live in a state that better reflected her progressive politics. She has met new friends at a farmers’ market, she said, and is happier than she was before the pandemic, even though she occasionally wishes she had a romantic partner to take motorcycle rides with her or just to help carry laundry up and down the stairs of her three-bedroom home.

She regularly drives 12 hours round trip to care for her parents near Detroit, an obligation that has persuaded her to put away her retirement fantasy of living near the beach, and move someday closer to her daughter and grandson, who live in Louisville, Kentucky.

“I don’t want my daughter to stress out about me,” she said.

Watching their own parents age seems to have had a profound effect on many members of Gen X, born between 1965 and 1980, who say they doubt that they can lean on the same supports that their parents did: long marriages, pensions, homes that sometimes skyrocketed in value.

When his mother died two years ago, Miles, the videographer, took comfort in moving some of her furniture into his house in New Haven, Connecticut.

“It was a coming home psychologically,” he said, allowing him to feel rooted after decades of cross-country moves and peripatetic career explorations, shifting from the music business to high school teaching to producing films for nonprofits and companies.

“I still feel pretty indestructible, foolishly or not,” he said.

Still, caring for his divorced mother made him think about his own future. She had a government pension, security he lacks. Nor does he have children.

“I can’t call my kid,” he added, “the way I used to go to my mom’s house to change light bulbs.”

His options for maintaining independence are “all terrible,” he said. “I’m totally freaked out by it.”

Several Gen X solo dwellers said they had begun exploring options to live communally as they age, inspired, in part, by living arrangements they had enjoyed in college years and young adulthood.

“I’ve been talking to friends about end-of-life issues and how we might want to get together,” said Patrick McComb, 56, of Riverview, Michigan, a graphic artist. “Being alone till the end would not be the worst thing in the world. But I would prefer to be with people.”

With Space to Spare

Katy Mattingly, 52, an executive secretary, bought a house in Ypsilanti, Michigan, three years ago. It is small but offers plenty of space, with three bedrooms.

The question for her, and many other single homeowners, is whether they can cash in when they get older.

Mattingly said she did not think she would ever be able to pay down the mortgage and build wealth.

“It’s implausible that I’ll ever be able to retire,” she said.

Living solo in homes with three or more bedrooms sounds like a luxury but, experts said, it is a trend driven less by personal choice than by the nation’s limited housing supply. Because of zoning and construction limitations in many cities and towns, there is a nationwide shortage of homes below 1,400 square feet, which has driven up the cost of the smaller units, according to research from Freddie Mac.

Forty years ago, units of less than 1,400 square feet made up about 40% of all new home construction; today, just 7% of new builds are smaller homes, despite the fact that the number of single-person households has surged.

This has made it more difficult for older Americans to downsize, as a large, aging house can often command less than what a single adult needs to establish a new, smaller home and pay for their living and health care expenses in retirement.

People in this group often face the reality that “it’s more expensive to get a smaller condo than the single family you’re selling — and that presumes the condo exists, which may not be the case,” said Jennifer Molinsky, director of the Housing an Aging Society Program at Harvard University.

And when they hold onto family-size houses well into retirement, there are fewer spacious homes placed on the market for young families, who in turn squeeze into smaller units or withstand long commutes in a search for affordable housing.

“Both ends of the age distribution are getting squeezed,” said Jenny Schuetz, an expert on housing and urban economics at the Brookings Institution.

The constraints are especially severe for many older Black Americans, for whom the legacy of redlining and segregation has meant that homeownership has not generated as much wealth. The percentage of people living alone in large houses is highest in many low-income, historically Black neighborhoods. In those areas, many homes are owned by single, older women.

One of them is Felder of Strawberry Mansion, a neighborhood in Philadelphia. She and her ex-husband bought their two-story brick row house in the mid-1990s for a song after it was damaged in a fire.

While raising three children, Felder worked a series of jobs, including retail, hotel housekeeping and airport security. She retired in 2008 and has lived by herself for more than a decade, although her sisters, children and grandchildren live nearby.

Maintaining her home is a challenge. In rainstorms, she sometimes had to use every piece of fabric in the house to sop up water pouring down a kitchen wall. And she worries about her safety.

At times, she dreams about relocating to small-town South Carolina, where she was born and raised.

She imagines a small home there, perhaps even a trailer.

But the median value of a home in her neighborhood was $59,000, according to recent census data. Felder thinks she could sell her house and net about $40,000.

“That’s not enough” to retire down south, she said, sighing, sitting in her living room filled with plants.

Felder is a fixture in her neighborhood, keeping watch over it, and has received help from Habitat for Humanity to repair her roof.

But in September, living alone became harder.

While she was cleaning the trash out of a nearby alley with neighbors, a masked gunman looked her in the eyes and shot her twice in the legs.

Felder had no clue who shot her, and there has been no arrest. She recovered at her daughter’s home across town, where the ground floor has a bedroom and bathroom, unlike in her own house.

By late November, she was feeling much better — physically, if not mentally, she said. But she had not stayed overnight in her own home. She is still a little afraid.

“But I’m working on it,” she said. “I really love my house.”

© 2022 The New York Times Company

Loss of Purpose -- A Danger of Aging Alone

I will take that risk rather than being tied to one person. I found out that I'm extremely extroverted when needed and my social life has blossomed since my divorce. Your doctor should have protocols to get you 100% recovered so you can easily go back to your previous life.  Don't settle for the low expectations of recovery that your stroke medical 'professionals' will try to foist off on you. DEMAND 100%!!! Running instead of barely walking with a cane. No spasticity. No fatigue. No cognitive decline.

Loss of Purpose -- A Danger of Aging Alone

How Living Alone May Undermine the Sense of Belonging We All Need

By Paula Spencer Scott, Senior Health Writer

"People who need people are the luckiest people in the world," goes the old song. But the lyrics are wrong: It's people who have people in their lives who are luckiest. All of us need people, research shows.
Loneliness takes a toll on mental health and physical health, in part by undermining this core aspect of being human: one's very sense of life having meaning and purpose. Luckily, this "reason for being" can be rekindled through something simple but invaluable -- interactions with others.
"Meaning is inseparable from belonging. When you have one, you have the other," says social psychologist Tyler Stillman of Southern Utah University. His studies have shown that when people are excluded or when they experience loneliness, they feel life has less meaning. On the other hand, he says, "When life is filled with positive and enduring relationships, life is filled with meaning."
Perceiving meaning, mission, and purpose tends to bring more happiness, more hope, positive outlook, and a generally better sense of well-being, other research shows. This dynamic package in turn attracts still more fulfilling interactions. "People who feel their life has purpose are people with whom others want to forge social bonds," Stillman says.

Call it the great connected circle of life.
Social interactions aren't the only way people derive meaning and purpose in life, obviously. But they're critical meaning-makers in these ways:

• They provide a critical sense of forward momentum, of planning ahead and having mutual activities to look forward to that underpin purpose.
• They help you feel control over your life. When you feel like others don't desire your company, you may develop a sense of futility.
• They fuel self-worth. Without social feedback and affirmation, we tend to think of ourselves in less favorable ways.

All these elements can fight against a pervasively downbeat, what's-the-point outlook.

Lost Connections, Lost Purpose

Here's where people come in. We all tend to need three kinds of companionship, according to research by University of Chicago psychologist John Cacioppo: intimate connectedness (having someone in your life who confirms who you are), relational connectedness (face-to-face, mutually rewarding contacts), and collective connectedness (feeling part of a group).
Running counter to this need, unfortunately, is the growing number of older adults who live alone as a result of smaller, scattered families; fewer intergenerational households; and shifting cultural preferences (more people choose to be on their own). When the previous century began, only 12 percent of widows age 65 or older lived alone, for example. By 1990, the vast majority did (70 percent). According to the 2005 census, 57 percent of those over age 85 lived alone -- and they constitute a demographic expected to double by 2020.
Not everyone who lives alone feels lonely, it's important to note. The widower next door who's fit and keeps busy within a circle of interests is very different from his frail, isolated counterpart across the street. Conversely, the great-aunt living in a busy home may feel terribly lonely if no one pays her any mind. In general, though, there's a strong correlation between living alone and feeling lonesome, research shows.
In a 2008 study of older women living alone, by Elaine M. Eshbaugh of the University of Northern Iowa, lack of companionship rated as the least enjoyable aspect of their situation, as reported by almost two-thirds of those interviewed.
"My hunch is that it's easier for younger people to find new social connections than older folks," Southern Utah University's Stillman says. "That poses an additional challenge to the elderly."

Ways to Help Foster Purpose

How can you help someone feel less lonely and better connected to the threads of life that knit meaning? Consider these ideas:
Don't merely give help; give companionship. Arranging for meal delivery, laundry services, bill paying, and lawnmowing for a frail older adult can be helpful yet still fall short of giving what he or she needs. Help isn't always about doing; it's also about being.
Ask the lonely person for help. We all like to be needed and to give. One long-distance caregiver wanted to check on her mom, who lived alone, without seeming intrusive. She asked a local friend to seek knitting lessons from the mother. Another friend asked the mother if she'd save her newspapers so she could collect them once week for their crossword puzzles -- along with a visit. These efforts created a double win: reassurance for the daughter and sociability for the mother.
Involve isolated others in your traditions. A friend always invited her next-door neighbor, a widow in her 70s, to her young children's birthday parties. "My intention was to replicate the multigenerational family birthdays I'd grown up with, because our own [relatives] lived many states away," she says. "But I think that Mimi was the one who really thrived. She loved being an 'honorary grandparent' to my kids and being woven into our lives."
Create ongoing engagement. Best are regular activities: inviting someone to join a book club or card club, making a commitment to bring the person to religious services, going grocery shopping together once a week (or doing the marketing for the person and staying afterward to make tea and visit).
Offer to help with a legacy project. Helping someone assess and celebrate his or her life has a purpose both now and after life ends. You might help record an oral history, organize memorabilia or a collection, or create a special photo album.
Ask if the person might be open to talk therapy. When someone's sense of self-worth has been dinged by loneliness, learning to break the cycle of negative thinking can be even more effective than increased company, according to a 2011 meta-analysis of interventions to reduce loneliness done by University of Chicago researchers. Cognitive-behavioral therapy, a type of talk therapy, was found to work especially well.
Optimize living situations. As people age into sickness or frailty, they need more ongoing supports than might be feasible in their own homes. That's when many families look into combining households with an older member or helping the person relocate to a communal living situation. It's not enough to help with the activities of daily living; the person probably also needs help with feeling connected and contributing.
A bonus to all these kinds of helping: You get added social connection -- and a deepened sense of purpose -- in your own life at the same time.

Living alone could be good for your weight

So far it is not good for me.

Living alone could be good for your weight