I’ve come to appreciate this after conversations with hundreds of older adults over the past eight years for nearly 200 “Navigating Aging” columns.

Time and again, people have described what it’s like to let go of certainties they once lived with and adjust to new circumstances.

These older adults’ lives are filled with change. They don’t know what the future holds except that the end is nearer than it’s ever been.

And yet, they find ways to adapt. To move forward. To find meaning in their lives. And I find myself resolving to follow this path as I ready myself for retirement.

Patricia Estess, 85, of the Brooklyn borough of New York City spoke eloquently about the unpredictability of later life when I reached out to her as I reported a series of columns on older adults who live alone, sometimes known as “solo agers.”

Estess had taken a course on solo aging. “You realize that other people are in the same boat as you are,” she said when I asked what she had learned. “We’re all dealing with uncertainty.”

Consider the questions that older adults — whether living with others or by themselves — deal with year in and out: Will my bones break? Will my thinking skills and memory endure? Will I be able to make it up the stairs of my home, where I’m trying to age in place?

Will beloved friends and family members remain an ongoing source of support? If not, who will be around to provide help when it’s needed?

Will I have enough money to support a long and healthy life, if that’s in the cards? Will community and government resources be available, if needed?

It takes courage to face these uncertainties and advance into the unknown with a measure of equanimity.

“It’s a question of attitude,” Estess told me. “I have honed an attitude of: ‘I am getting older. Things will happen. I will do what I can to plan in advance. I will be more careful. But I will deal with things as they come up.’”

For many people, becoming old alters their sense of identity. They feel like strangers to themselves. Their bodies and minds aren’t working as they used to. They don’t feel the sense of control they once felt.

That requires a different type of courage — the courage to embrace and accept their older selves.

Marna Clarke, a photographer, spent more than a dozen years documenting her changing body and her life with her partner as they grew older. Along the way, she learned to view aging with new eyes.

“Now, I think there’s a beauty that comes out of people when they accept who they are,” she told me in 2022 when she was 82, just before her 93-year-old husband died.

Arthur Kleinman, a Harvard professor who’s now 83, gained a deeper sense of soulfulness after caring for his beloved wife, who had dementia and eventually died, leaving him grief-stricken.

“We endure, we learn how to endure, how to keep going. We’re marked, we’re injured, we’re wounded. We’re changed, in my case for the better,” he told me when I interviewed him in 2019. He was referring to a newfound sense of vulnerability and empathy he gained as a caregiver.

Herbert Brown, 68, who lives in one of Chicago’s poorest neighborhoods, was philosophical when I met him at his apartment building’s annual barbecue in June.

“I was a very wild person in my youth. I’m surprised I’ve lived this long,” he said. “I never planned on being a senior. I thought I’d die before that happened.”

Truthfully, no one is ever prepared to grow old, including me. (I’m turning 70 in February.)

Chalk it up to denial or the limits of imagination. As May Sarton, a writer who thought deeply about aging, put it so well: Old age is “a foreign country with an unknown language.” I, along with all my similarly aged friends, are surprised we’ve arrived at this destination.

For me, 2025 is a turning point. I’m retiring after four decades as a journalist. Most of that time, I’ve written about our nation’s enormously complex health care system. For the past eight years, I’ve focused on the unprecedented growth of the older population — the most significant demographic trend of our time — and its many implications.

In some ways, I’m ready for the challenges that lie ahead. In many ways, I’m not.

The biggest unknown is what will happen to my vision. I have moderate macular degeneration in both eyes. Last year, I lost central vision in my right eye. How long will my left eye pick up the slack? What will happen when that eye deteriorates?

Like many people, I’m hoping scientific advances outpace the progression of my condition. But I’m not counting on it. Realistically, I have to plan for a future in which I might become partially blind.

It’ll take courage to deal with that.

Then, there’s the matter of my four-story Denver house, where I’ve lived for 33 years. Climbing the stairs has helped keep me in shape. But that won’t be possible if my vision becomes worse.

So my husband and I are taking a leap into the unknown. We’re renovating the house, installing an elevator, and inviting our son, daughter-in-law, and grandson to move in with us. Going intergenerational. Giving up privacy. In exchange, we hope our home will be full of mutual assistance and love.

There are no guarantees this will work. But we’re giving it a shot.

Without all the conversations I’ve had over all these years, I might not have been up for it. But I’ve come to see that “no guarantees” isn’t a reason to dig in my heels and resist change.

Thank you to everyone who has taken time to share your experiences and insights about aging. Thank you for your openness, honesty, and courage. These conversations will become even more important in the years ahead, as baby boomers like me make their way through their 70s, 80s, and beyond. May the conversations continue.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Hall contracted HIV, the virus that can cause AIDS, in 1986. Since then, he’s battled depression, heart disease, diabetes, non-Hodgkin lymphoma, kidney cancer, and prostate cancer. This past year, Hall has been hospitalized five times with dangerous infections and life-threatening internal bleeding.

But that’s only part of what Hall, a gay man, has dealt with. Hall was born into the Tlingit tribe in a small fishing village in Alaska. He was separated from his family at age 9 and sent to a government boarding school. There, he told me, he endured years of bullying and sexual abuse that “killed my spirit.”

Because of the trauma, Hall said, he’s never been able to form an intimate relationship. He contracted HIV from anonymous sex at bath houses he used to visit. He lives alone in Seattle and has been on his own throughout his adult life.

“It’s really difficult to maintain a positive attitude when you’re going through so much,” said Hall, who works with Native American community organizations. “You become mentally exhausted.”

It’s a sentiment shared by many older LGBTQ+ adults — most of whom, like Hall, are trying to manage on their own.

Of the 3 million Americans over age 50 who identify as gay, bisexual, or transgender, about twice as many are single and living alone when compared with their heterosexual counterparts, according to the National Resource Center on LGBTQ+ Aging.

This slice of the older population is expanding rapidly. By 2030, the number of LGBTQ+ seniors is expected to double. Many won’t have partners and most won’t have children or grandchildren to help care for them, AARP research indicates.

They face a daunting array of problems, including higher-than-usual rates of anxiety and depression, chronic stress, disability, and chronic illnesses such as heart disease, according to numerous research studies. High rates of smoking, alcohol use, and drug use — all ways people try to cope with stress — contribute to poor health.

Keep in mind, this generation grew up at a time when every state outlawed same-sex relations and when the American Psychiatric Association identified homosexuality as a psychiatric disorder. Many were rejected by their families and their churches when they came out. Then, they endured the horrifying impact of the AIDS crisis.

“Dozens of people were dying every day,” Hall said. “Your life becomes going to support groups, going to visit friends in the hospital, going to funerals.”

It’s no wonder that LGBTQ+ seniors often withdraw socially and experience isolation more commonly than other older adults. “There was too much grief, too much anger, too much trauma — too many people were dying,” said Vincent Crisostomo, director of aging services for the San Francisco AIDS Foundation. “It was just too much to bear.”

In an AARP survey of 2,200 LGBTQ+ adults 45 or older this year, 48% said they felt isolated from others and 45% reported lacking companionship. Almost 80% reported being concerned about having adequate social support as they grow older.

Embracing aging isn’t easy for anyone, but it can be especially difficult for LGBTQ+ seniors who are long-term HIV survivors like Hall.

Related Links

• Americans With HIV Are Living Longer. Federal Spending Isn’t Keeping Up. Jun 17, 2024
• ‘Stonewall Generation’ Confronts Old Age, Sickness — And Discrimination May 22, 2019
• Staying Out Of The Closet In Old Age Oct 17, 2016

Of 1.2 million people living with HIV in the United States, about half are over age 50. By 2030, that’s estimated to rise to 70%.

Christopher Christensen, 72, of Palm Springs, California, has been HIV-positive since May 1981 and is deeply involved with local organizations serving HIV survivors. “A lot of people living with HIV never thought they’d grow old — or planned for it — because they thought they would die quickly,” Christensen said.

Jeff Berry is executive director of the Reunion Project, an alliance of long-term HIV survivors. “Here people are who survived the AIDS epidemic, and all these years later their health issues are getting worse and they’re losing their peers again,” Berry said. “And it’s triggering this post-traumatic stress that’s been underlying for many, many years. Yes, it’s part of getting older. But it’s very, very hard.”

Being on their own, without people who understand how the past is informing current challenges, can magnify those difficulties.

“Not having access to supports and services that are both LGBTQ-friendly and age-friendly is a real hardship for many,” said Christina DaCosta, chief experience officer at SAGE, the nation’s largest and oldest organization for older LGBTQ+ adults.

Diedra Nottingham, a 74-year-old gay woman, lives alone in a one-bedroom apartment in Stonewall House, an LGBTQ+-friendly elder housing complex in New York City. “I just don’t trust people,“ she said. “And I don’t want to get hurt, either, by the way people attack gay people.”

When I first spoke to Nottingham in 2022, she described a post-traumatic-stress-type reaction to so many people dying of covid-19 and the fear of becoming infected. This was a common reaction among older people who are gay, bisexual, or transgender and who bear psychological scars from the AIDS epidemic.

Nottingham was kicked out of her house by her mother at age 14 and spent the next four years on the streets. The only sibling she talks with regularly lives across the country in Seattle. Four partners whom she’d remained close with died in short order in 1999 and 2000, and her last partner passed away in 2003.

When I talked to her in September, Nottingham said she was benefiting from weekly therapy sessions and time spent with a volunteer “friendly visitor” arranged by SAGE. Yet she acknowledged: “I don’t like being by myself all the time the way I am. I’m lonely.”

Donald Bell, a 74-year-old gay Black man who is co-chair of the Illinois Commission on LGBTQ Aging, lives alone in a studio apartment in subsidized LGBTQ+-friendly senior housing in Chicago. He spent 30 years caring for two elderly parents who had serious health issues, while he was also a single father, raising two sons he adopted from a niece.

Bell has very little money, he said, because he left work as a higher-education administrator to care for his parents. “The cost of health care bankrupted us,” he said. (According to SAGE, one-third of older LGBTQ+ adults live at or below 200% of the federal poverty level.) He has hypertension, diabetes, heart disease, and nerve damage in his feet. These days, he walks with a cane.

To his great regret, Bell told me, he’s never had a long-term relationship. But he has several good friends in his building and in the city.

“Of course I experience loneliness,” Bell said when we spoke in June. “But the fact that I am a Black man who has lived to 74, that I have not been destroyed, that I have the sanctity of my own life and my own person is a victory and something for which I am grateful.”

Now he wants to be a model to younger gay men and accept aging rather than feeling stuck in the past. “My past is over,” Bell said, “and I must move on.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Fourteen years later, Jaffe, now 102, still lives alone — just a few blocks away from the frenetic flashing lights and crowds that course through Times Square.

She’s the rarest of seniors: a centenarian who is sharp as a tack, who carries grocery bags in each hand when she walks back from her local market, and who takes city buses to see her physicians or attend a matinee at the Metropolitan Opera.

Jaffe cleans her own house, does her own laundry, manages her own finances, and stays in touch with a far-flung network of family and friends via email, WhatsApp, and Zoom. Her son, Richard Jaffe, 78, lives in San Jose, California. Her daughter, Barbara Vendriger, 75, lives in Tel Aviv.

She’s an extraordinary example of an older adult living by herself and thriving.

I’ve spoken with dozens of seniors this past year for a series of columns on older Americans living alone. Many struggle with health issues. Many are isolated and vulnerable. But a noteworthy slice of this growing group of seniors maintain a high degree of well-being.

What might account for this, particularly among people in the farthest reaches of old age?

Sofiya Milman is director of Human Longevity Studies at the Institute for Aging Research at Albert Einstein College of Medicine. She studies people known as “superagers” —95 and older. “As a group, they have a very positive outlook on life” and are notably resilient, like Jaffe, she told me.

Qualities associated with resilience in older adults include optimism and hopefulness, an ability to adapt to changing circumstances, meaningful relationships, community connections, and physical activity, according to a growing body of research on this topic.

Jaffe has those qualities in spades, along with a “can-do” attitude.

“I never expected to be 102. I’m as surprised as everybody else that I am here,” she said recently over lunch at a Chinese restaurant just steps from her 30-story apartment building.

Jaffe’s perspective on her longevity is unsentimental. She credits her genetic heritage, luck, and her commitment to “keep moving,” in that order. “You don’t work toward it: It happens. Every day, you get up and you’re a day older,” she said.

This matter-of-fact stance is characteristic of Jaffe’s approach to life. Asked to describe herself, she quickly responded “pragmatic.” That means having a clear-eyed view of what she can and can’t do and making adjustments as necessary.

Living alone suits her, she added, because she likes being independent and doing things her way. “If a problem comes up, I work it out,” Jaffe said. 

In this, she’s like other older adults who have come to terms with their “I’m on my own” status and, for the most part, are doing quite well. 

Still, Jaffe is unusual, to say the least. There are only 101,000 centenarians in the U.S., according to the most recent Census Bureau data. Of this small group, 15% live independently or operate independently while living with someone, according to Thomas Perls, the founder and director of the New England Centenarian Study, the largest study of centenarians in the world. (Jaffe is one of 2,500 centenarians participating in the study.)

About 20% of centenarians are, like Jaffe, free of physical or cognitive impairments, Perls said. An additional 15% have no age-related illnesses such as arthritis or heart disease.

Practically, that means Jaffe doesn’t know anybody like her. Nor do her physicians. “My primary care doctor says, ‘You’re the only centenarian who walks in without an assistant or a cane. You’re off the charts,’” Jaffe said, when I asked about her health.

She has only a few medical conditions — reflux, an occasional irregular heartbeat, osteoporosis, a touch of sciatica, a lung nodule that appeared and then disappeared. She monitors those conditions vigilantly, following her doctors’ advice to the letter.

Every day, Jaffe tries to walk 3,000 steps — outside if the weather is good or inside, making laps in her hallway, if the weather is bad. Her diet is simple: bread, cheese, and decaffeinated coffee for breakfast; a sandwich or eggs for lunch; often chicken and a vegetable or restaurant leftovers for dinner. She never smoked, doesn’t drink alcohol, and sleeps an average of eight hours each night.

Even more important, Jaffe remains engaged with other people. She has subscriptions to the Metropolitan Opera, the New York Philharmonic, and a chamber music series. She participates in online events and regularly sees new exhibits at four of New York’s premier museums, where she has memberships. She’s in regular contact with family members and friends.

Jaffe also belongs to a book club at her synagogue on Manhattan’s Upper West Side and serves on the synagogue’s adult education committee. For more than a decade, she’s volunteered several times a week as a docent at the New York Public Library’s main branch on Fifth Avenue.

“Loneliness, it’s not an issue,” she said. “I have enough to do within my capability.”

On a recent Tuesday afternoon, I followed Jaffe as she led visitors from Mexico, England, Pittsburgh, and New Jersey through the library’s “Treasures” exhibit. She was a wealth of information about extraordinary objects such as a Gutenberg Bible from 1455 (one of the first books printed in Europe using movable type), Charles Dickens’ writing desk, and an enormous folio of John James Audubon’s “The Birds of America.” She spoke without notes, articulately.

When I asked about the future, Jaffe said she doesn’t worry about what comes next. She just lives day to day.

That change in perspective is common in later life. “Focusing on the present and experiencing the here and now becomes more important to older adults,” said Laura Carstensen, founding director of Stanford University’s Center on Longevity, who has studied emotional changes that accompany aging for decades. “As does savoring positive things in their lives.”

Carstensen’s research group was the first to show that older adults were more resilient emotionally during the covid-19 pandemic than young or middle-aged adults. “Older people are better able to cope with difficulties,” she said. In part, this is because of skills and perspective gained over the course of a lifetime. And, in part, it’s because “when we see our future as shorter, it feels more manageable.”

Jaffe certainly understands the value of facing forward and letting go of the past. Losing her husband, Gerald Jaffe, in 2005 after 63 years of marriage was hard, she admitted, but relinquishing her life and most of her belongings in New Jersey five years later was easy.

“It was enough. We had done what we had wanted to do there. I was 88 at that point and so many people were gone. The world had changed,” she told me. “I didn’t feel a sense of loss.”

“It was so exciting for me, being in New York,” she continued. “Every day you could do something — or nothing. This location couldn’t be better. The building is safe and well maintained, with lots of staff. Everything is here, close by: a market, the pharmacy, restaurants, buses. In a house in New Jersey, I would be isolated. Here, I look out the window and I see people.”

As for the future, who knows what that will hold? “My joke is I’m going to be done in by a bicycle delivery person cutting through the pedestrian crosswalk,” Jaffe said. Until that or something else happens, “I live in a state of surprise. Every day is a new day. I don’t take it for granted at all.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.

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Catorce años después, Jaffe, que ahora tiene 102 años, sigue viviendo sola, a pocas cuadras de las frenéticas luces parpadeantes y las multitudes que recorren Times Square.

No es la típica persona mayor: una centenaria que se mantiene físicamente ágil y mentalmente alerta, que lleva las bolsas de las compras, una en cada mano, cuando vuelve caminando del mercado, y que toma buses urbanos para ir a ver a sus médicos o asistir a una matiné en la Ópera Metropolitana.

Jaffe limpia su casa, lava su ropa, gestiona sus finanzas y se mantiene en contacto con una amplia red de familiares y amigos por correo electrónico, whatsapp y zoom. Su hijo, Richard Jaffe, de 78 años, vive en San José, California. Su hija, Barbara Vendriger, de 75 años, vive en Tel Aviv, Israel.

Es un ejemplo extraordinario de una persona mayor que vive sola y prospera.

El año pasado esta reportera habló con docenas de personas mayores para una serie de columnas sobre estadounidenses mayores que viven solos. Muchos tienen problemas de salud. Muchos están aislados y son vulnerables. Pero una parte notable de este creciente grupo de personas mayores mantiene un alto nivel de bienestar.

¿A qué puede deberse esto, sobre todo entre las personas que se encuentran en los confines de la vejez?

Sofiya Milman es directora de Estudios de Longevidad Humana del Instituto de Investigación sobre el Envejecimiento de la Facultad de Medicina Albert Einstein. Estudia a las personas conocidas como “superagers”, de 95 años o más. “Como grupo, tienen una visión muy positiva de la vida” y me dijo que son muy resilientes, como Jaffe.

Entre las cualidades asociadas a la resiliencia en los mayores se incluyen el optimismo y la esperanza, la capacidad de adaptarse a circunstancias cambiantes, las relaciones personales relevantes, las conexiones con la comunidad y la actividad física, según un creciente número de investigaciones sobre este tema.

Jaffe tiene todas esas cualidades, además de una actitud positiva.

“Nunca esperé cumplir 102 años. Estoy tan sorprendida como cualquiera de estar aquí”, declaró recientemente durante un almuerzo en un restaurante chino a pocos pasos de su edificio de 30 pisos.

La manera en que Jaffe ve su longevidad no tiene nada de sentimental. Lo atribuye a su herencia genética, a la suerte y a su compromiso de “seguir adelante”, en ese orden. “No te esfuerzas para conseguirlo, sucede. Cada día te levantas y eres un día más vieja”, afirmó.

Así es como Jaffe afronta la vida, con total normalidad. Cuando se le pide que se describa a sí misma, responde rápidamente “pragmática”. Eso significa tener una visión clara de lo que puede y no puede hacer, y hacer los ajustes necesarios.

Vivir sola le viene bien, agregó, porque le gusta ser independiente y hacer las cosas a su manera. “Si surge un problema, lo resuelvo”, dijo Jaffe.

En esto se parece a otras personas mayores que han asumido su condición de “soledad” y, la mayoría, lo llevan bastante bien.

Aun así, Jaffe es, cuando menos, inusual. Sólo hay 101,000 centenarios en Estados Unidos, según los datos más recientes de la Oficina del Censo. De este pequeño grupo, el 15% vive de forma independiente o lo hace mientras vive con alguien, según Thomas Perls, fundador y director del New England Centenarian Study, el mayor estudio de centenarios del mundo. (Jaffe es uno de los 2,500 centenarios que participan en el estudio).

Según Perls, un 20% de los centenarios están libres de problemas físicos o cognitivos, como Jaffe. Otro 15% no padece enfermedades relacionadas con la edad, como artritis o cardiopatías.

En la práctica, eso significa que Jaffe no conoce a nadie como ella. Tampoco sus médicos. “Mi médico de cabecera siempre me dice: ‘Eres la única centenaria que entra a la consulta sin asistente ni bastón. Eres una fuera de serie’”, contó Jaffe al hablar de su salud.

Sólo tiene unos pocos problemas: reflujo, latidos irregulares ocasionales, osteoporosis, un poco de ciática y un nódulo pulmonar que apareció y desapareció. Jaffe vigila de cerca estos problemas y sigue al pie de la letra los consejos de sus médicos.

Todos los días, intenta caminar 3.000 pasos, al aire libre si hace buen tiempo o dentro de casa, dando vueltas en el pasillo, si el día está feo. Su dieta es sencilla: pan, queso y café descafeinado para desayunar; un sándwich o huevos para comer; a menudo pollo y verdura o sobras del restaurante para cenar. Nunca ha fumado, no bebe alcohol y duerme una media de ocho horas cada noche.

Y lo que es más importante, Jaffe sigue relacionándose con los demás. Está abonada a la Ópera Metropolitana, la Filarmónica de Nueva York y a un ciclo de música de cámara. Participa en eventos en línea y visita regularmente las nuevas exposiciones de cuatro de los principales museos de Nueva York, de los que es miembro. Y se mantiene en contacto con familiares y amigos.

Jaffe también pertenece a un club de lectura de su sinagoga en el Upper West Side de Manhattan y forma parte del comité de educación de adultos de la sinagoga. Durante más de una década, ha trabajado como voluntaria varias veces a la semana en la Biblioteca Pública de Nueva York, en la Quinta Avenida.

“La soledad no es mi problema”, señaló. “Tengo bastante que hacer dentro de mis posibilidades”.

Un martes por la tarde, Jaffe guiaba a visitantes de México, Inglaterra, Pittsburgh y Nueva Jersey por la exposición “Tesoros” de la biblioteca. Ella les dio mucha información sobre objetos extraordinarios, como una Biblia de Gutenberg de 1455 (uno de los primeros libros impresos en Europa con tipos móviles), el escritorio de Charles Dickens y una enorme publicación de “Las aves de América” de John James Audubon. Habló sin mirar notas, articuladamente.

Cuando le preguntan por el futuro, Jaffe dijo que no se preocupa por lo que vendrá después. Simplemente vive el día a día.

Ese cambio de perspectiva es habitual en la madurez. “Centrarse en el presente y vivir el aquí y el ahora es más importante para los mayores”, afirmó Laura Carstensen, directora y fundadora del Centro de Longevidad de la Universidad de Stanford, que lleva décadas estudiando los cambios emocionales que acompañan al envejecimiento. “Lo mismo que saborear las cosas positivas de sus vidas”.

El grupo de investigación de Carstensen fue el primero en demostrar que los adultos mayores eran más resistentes emocionalmente durante la pandemia de covid-19 que los adultos jóvenes o de mediana edad. “Las personas mayores enfrentan mejor las dificultades”, señaló. En parte, esto se debe a las habilidades y la perspectiva adquiridas a lo largo de la vida. Y también al hecho de que “cuando vemos nuestro futuro más corto, nos parece más manejable”.

Jaffe entiende perfectamente el valor de mirar hacia delante y dejar atrás el pasado. Admitió que perder a su marido, Gerald Jaffe, en 2005 tras 63 años de matrimonio fue duro, pero renunciar a su vida y a la mayoría de sus pertenencias en Nueva Jersey cinco años después, fue fácil.

“Ya era suficiente. Habíamos hecho lo que queríamos hacer allí. Yo tenía 88 años y mucha gente se había ido. El mundo había cambiado”, me dijo. “No tuve sensación de pérdida”.

“Para mí fue muy emocionante estar en Nueva York”, continuó. “Todos los días podías hacer algo… o nada. Esta ubicación no podría ser mejor. El edificio es seguro y está bien cuidado, con mucho personal. Aquí, todo está cerca: un mercado, la farmacia, restaurantes, autobuses. En una casa de Nueva Jersey, estaría aislada. Aquí, miro por la ventana y veo gente”.

En cuanto al futuro, ¿quién sabe lo que deparará? “Mi broma es que acabará conmigo un repartidor en bicicleta andando por la vereda”, dijo Jaffe. Hasta que eso u otra cosa ocurra, “vivo en un estado de sorpresa. Cada día es un día nuevo. No lo doy por sentado en absoluto”.

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Gayle Williams-Brett, 69, plans to tackle a project she’s been putting off for months: organizing all her financial information.

Michael Davis, 71, is going to draft a living will and ask a close friend to be his health care surrogate and executor of his estate.

These seniors have been inspired to take these and other actions by an innovative course for such “solo agers”: Aging Alone Together, offered by Dorot, a social services agency in New York City.

Most of them live alone, without a spouse, a partner, or adult children to help them manage as they grow older.

Until a few years ago, few resources were available for this growing slice of the older population.

Now, there are several Facebook groups for solo agers, as well as in-person groups springing up around the country, conferences and webinars, a national clearinghouse of resources, and an expanding array of books on the topic.

All address these seniors’ need to connect with other people, prevent isolation, and prepare for a future when they might become less robust, encounter more health issues, and need more assistance.

“Older adults who cannot rely on family members need to be very intentional about creating support systems and putting other plans in place,” said Ailene Gerhardt, a patient advocate in Boston who created the Navigating Solo Network three years ago.

In a survey published last year, AARP — which broadens the definition of older Americans to people 50 and older — examined those who live alone and don’t have living children. Ten percent of those 50 or older meet this definition, AARP estimates. An additional 11% have at least one living child but are estranged from them. And 13% have children who they believe can’t or won’t help them manage their finances and health care.

Preparing in isolation for the future can be daunting. “If solo agers don’t feel they have people to talk to as they craft their aging plan, they often will skip the whole process,” said Gerhardt, who endorses a group planning model for these seniors.

That’s the format Dorot has adopted for Aging Alone Together, which is available nationally online free of charge and in person in New York City. More than 1,000 people have participated in the program since it launched in 2021. Dorot is working with partners around the country to expand its reach.

The program consists of six 90-minute, interactive weekly sessions that focus on these seniors’ key concerns: building communities of support, figuring out where to live, completing advance care directives such as living wills, and getting financial and legal affairs in order.

One goal is to help participants identify their priorities and overcome the fear and hesitation that so many older adults feel when peering into their uncertain futures, said Claire Nisen, a Dorot staffer who runs the program. Another is to offer practical tools, advice, and resources that can spur people to action.

Yet another is to foster a sense of community that promotes a “can do” attitude. As Nisen said repeatedly when I took the course in September and October, “Solo aging doesn’t mean aging alone.”

That message resonated deeply with Williams-Brett, who lives with her severely disabled mother, 97, in a two-story brownstone in Brooklyn. Williams-Brett, who is divorced and never had children, expects to be on her own as she grows older. Her mother had a devastating stroke three years ago, and since then Williams-Brett has been her full-time caregiver.

Overwhelmed by everything on her to-do list — declutter the house, make home repairs, straighten out her finances, safeguard her mother’s health — Williams-Brett told me she’d been struggling with shame and fear. “All the time, I feel I’m not doing what I should be well enough,” she said.

Hearing other seniors voice similar concerns during Aging Alone Together sessions, Williams-Brett realized she didn’t judge them as she was judging herself. “I thought, we all have issues we’re dealing with,” she said. “You don’t have anything to feel ashamed of.”

Kromrey, who lives alone in Tampa, Florida, knows he’s fortunate to be healthy, financially stable, and very close with his adult daughter, who will be his health care and legal decision-maker should he become incapacitated. Kromrey, widowed nine years ago, also has three sons — two in South Carolina and one in West Palm Beach, Florida.

While participating in Aging Alone Together, Kromrey realized he had assumed he’d never have a health crisis such as a stroke or heart attack — a common form of denial.

His daughter and her husband planned to travel from North Carolina to join Kromrey over Thanksgiving. During that visit, Kromrey said, he would give her passwords to his computer and online accounts, explain his system for keeping track of bills, and show her where other important files are.

“That way, she’ll just be able to take right over if something unexpected occurs,” he said.

Davis is an artist who never married, doesn’t have siblings and lives alone in Manhattan. In a phone conversation, he said his most pressing concern is “finding something to do that’s worthwhile” now that arthritis has made it difficult for him to paint.

In some ways, Davis is prepared for the future. He has a long-term care insurance policy that will pay for help in the home and a rent-regulated apartment in a building with an elevator. But he recognizes that he’s become too isolated as his artistic activities have waned.

“There are days that go by when I don’t say a word to anyone,” Davis acknowledged. “I have my friends, but they have their own lives, with their children and grandchildren. I’m turning to Dorot for more social contact. And Aging Alone Together has helped me focus on the here and now.”

For more information about Aging Alone Together, email agingalonetogether@dorotusa.org or visit the program’s website.

A national clearinghouse of resources for solo agers and information about solo-ager groups in the United States is available at the Navigating Solo website.

The National Council on Aging has assembled a guide to resources and support for older adults living alone.

Facebook groups for solo agers include Elder Orphans (Aging Alone), Elder Orphans, NYC Solo Agers, and Solo Aging Without Personal Representative. Another online community is the Solo Ager/Aging Together.

Books about planning for solo aging include “Essential Retirement Planning for Solo Agers,” “Solo and Smart,” “Who Will Take Care of Me When I’m Old?” and “The Complete Eldercare Planner.”

Several videos about planning for solo aging can be found on YouTube, including this helpful video from CJE SeniorLife.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.

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Gayle Williams-Brett, también de 69, planea empezar un proyecto que lleva meses posponiendo: organizar toda su información financiera.

Michael Davis, de 71, va a redactar un testamento y va a pedirle a un amigo íntimo que sea su representante para asuntos de salud y albacea de su patrimonio.

Estas personas mayores se han inspirado para emprender estas y otras acciones en un curso innovador para “personas que envejecen solas”: Aging Alone Together, ofrecido por Dorot, una organización de servicios sociales de Nueva York.

La mayoría de ellos viven solos, sin cónyuge, pareja ni hijos adultos que los ayuden a desenvolverse a medida que envejecen.

Hasta hace unos años, había pocos recursos disponibles para este creciente segmento de la población de edad avanzada.

Ahora hay varios grupos de Facebook para personas que envejecen solas, y grupos presenciales que surgen en todo el país, conferencias y seminarios en internet, un centro nacional de intercambio de recursos y una creciente variedad de libros sobre el tema.

Todos estos recursos abordan la necesidad de estos adultos mayores de relacionarse con otras personas, evitar el aislamiento y prepararse para un futuro en el que podrían tener menos energía, más problemas de salud y necesitar más ayuda.

“Los mayores que no pueden depender de sus familiares deben ser muy cuidadosos a la hora de crear sistemas de apoyo y poner en marcha otros planes”, afirmó Ailene Gerhardt, activista en favor de los derechos de los pacientes, en Boston, que creó hace tres años la red Navigating Solo Network.

En una encuesta publicada el año pasado, la AARP —que amplía la definición de estadounidenses mayores a las personas de 50 años o más— analizó a quienes viven solos y no tienen hijos vivos. El 10% de los mayores de 50 años se ajusta a esta definición, según estimaciones de AARP. Otro 11% tiene al menos un hijo o hija con vida, pero está alejado de él o ella. Y el 13% tiene hijos que creen que no pueden o no quieren ayudarlos a gestionar sus finanzas y su salud.

Prepararse solos para el futuro puede ser desalentador. “Si las personas que envejecen solas sienten que no tienen con quién hablar mientras planean esos años, a menudo se saltan todo el proceso”, dijo Gerhardt, que respalda un modelo de planificación en grupo para estas personas mayores.

Ese es el formato que Dorot ha adoptado para Aging Alone Together (Envejecer Solos Juntos), disponible gratuitamente en Internet a escala nacional y en persona en Nueva York. Más de 1.000 personas mayores han participado en el programa desde su lanzamiento en 2021. Dorot colabora con socios de todo el país para ampliar su alcance.

El programa consta de seis sesiones semanales interactivas de 90 minutos de duración que se centran en las principales preocupaciones: crear comunidades de apoyo, decidir dónde vivir, completar las voluntades anticipadas, como los testamentos, y poner en orden los asuntos financieros y legales.

Uno de los objetivos es ayudar a los participantes a identificar sus prioridades y superar el miedo y las dudas que tantos mayores sienten cuando se avecina un futuro incierto, explicó Claire Nissen, que dirige el programa de Dorot. Otro es ofrecer herramientas prácticas, consejos y recursos que puedan impulsar a la gente a actuar.

Además, también se trata de fomentar un sentimiento de comunidad que promueva una actitud de “sí se puede”.

Este mensaje caló hondo en Williams-Brett, que vive con su madre de 97 años, gravemente discapacitada, en una casa de piedra rojiza de dos plantas en Brooklyn. Williams-Brett, que está divorciada y nunca ha tenido hijos, espera estar sola cuando se haga mayor. Su madre sufrió un devastador derrame cerebral hace tres años, y desde entonces Williams-Brett es su cuidadora a tiempo completo.

Abrumada por todo lo que tiene que hacer —arreglar la casa, hacer reparaciones, poner orden en sus finanzas, cuidar la salud de su madre—, Williams-Brett dijo que había estado luchando contra la vergüenza y el miedo. “Todo el tiempo siento que no estoy haciéndolo tan bien como debería”, expresó.

Al escuchar a otros mayores expresar preocupaciones similares durante las sesiones de Aging Alone Together, Williams-Brett se dio cuenta de que no los juzgaba como se juzgaba a sí misma. “Pensé: todos tenemos problemas con los que lidiar”, dijo. “No hay nada de que avergonzarse”.

Kromrey, que vive solo en Tampa, sabe que tiene suerte de estar sano, ser económicamente estable y estar muy unido a su hija adulta, que será quien tome sus decisiones en temas legales y de salud si él queda incapacitado. Kromrey, que enviudó hace nueve años, también tiene tres hijos: dos en Carolina del Sur y uno en West Palm Beach, Florida.

Mientras participaba en Aging Alone Together, Kromrey se dio cuenta de que siempre había asumido que nunca sufriría una crisis de salud como un ictus o un infarto, una manera de negarse a aceptar la realidad.

Su hija y su esposo planeaban viajar desde Carolina del Norte para reunirse con Kromrey el Día de Acción de Gracias. Durante esa visita, contó Kromrey, le daría las contraseñas de su ordenador y de sus cuentas en Internet, le explicaría su sistema para pagar las facturas y le enseñaría dónde están otros archivos importantes.

“De ese modo, ella podrá hacerse cargo de todo si surge algún imprevisto”, explicó.

Davis es un artista que nunca se casó, no tiene hermanos y vive solo en Manhattan. En una conversación telefónica, dijo que su preocupación más acuciante es “encontrar algo que hacer que merezca la pena” ahora que la artritis le ha dificultado pintar.

En cierto modo, Davis está preparado para el futuro. Tiene una póliza de seguro de cuidados a largo plazo que pagará la ayuda a domicilio y un apartamento de alquiler regulado en un edificio con elevador. Pero reconoce que se ha aislado demasiado a medida que disminuían sus actividades artísticas.

“Hay días en que no hablo con nadie”, reconoció Davis. “Tengo mis amigos, pero ellos tienen sus propias vidas, con sus hijos y nietos. Recurro a Dorot para tener más contacto social. Y Aging Alone Together me ha ayudado a centrarme en el aquí y ahora”.

Para más información sobre Aging Alone Together, se puede enviar un correo electrónico a agingalonetogether@dorotusa.org o visitar el sitio web del programa.

El sitio web Navigating Solo ofrece un centro nacional de recursos y grupos de apoyo para adultos mayores que viven solos.

El Consejo Nacional sobre el Envejecimiento ha elaborado una guía de recursos y apoyo para personas mayores que viven solas.

Los grupos de Facebook para personas que viven solas son: Elder Orphans, NYC Solo Agers y Solo Aging Without Personal Representative. Otra comunidad en línea es Solo Ager/Aging Together.

Entre los libros sobre planificación del envejecimiento en solitario están “Essential Retirement Planning for Solo Agers”, “Solo and Smart”, “Who Will Take Care of Me When I’m Old?” y “The Complete Eldercare Planner”.

En YouTube se pueden encontrar varios videos sobre la planificación del envejecimiento en solitario, incluido este útil vídeo de CJE SeniorLife.

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“What’s going on with your breathing?” asked Peter Gliatto, director of Mount Sinai’s Visiting Doctors Program.

“I don’t know,” she answered, so softly it was hard to hear. “Going from here to the bathroom or the door, I get really winded. I don’t know when it’s going to be my last breath.”

Dickens, a lung cancer survivor, lives in central Harlem, barely getting by. She has serious lung disease and high blood pressure and suffers regular fainting spells. In the past year, she’s fallen several times and dropped to 85 pounds, a dangerously low weight.

And she lives alone, without any help — a highly perilous situation.

Across the country, about 2 million adults 65 and older are completely or mostly homebound, while an additional 5.5 million seniors can get out only with significant difficulty or assistance. This is almost surely an undercount, since the data is from more than a dozen years ago.

It’s a population whose numbers far exceed those living in nursing homes — about 1.2 million — and yet it receives much less attention from policymakers, legislators, and academics who study aging.

Consider some eye-opening statistics about completely homebound seniors from a study published in 2020 in JAMA Internal Medicine: Nearly 40% have five or more chronic medical conditions, such as heart or lung disease. Almost 30% are believed to have “probable dementia.” Seventy-seven percent have difficulty with at least one daily task such as bathing or dressing.

Almost 40% live by themselves.

That “on my own” status magnifies these individuals’ already considerable vulnerability, something that became acutely obvious during the covid-19 outbreak, when the number of sick and disabled seniors confined to their homes doubled.

“People who are homebound, like other individuals who are seriously ill, rely on other people for so much,” said Katherine Ornstein, director of the Center for Equity in Aging at the Johns Hopkins School of Nursing. “If they don’t have someone there with them, they’re at risk of not having food, not having access to health care, not living in a safe environment.”

Research has shown that older homebound adults are less likely to receive regular primary care than other seniors. They’re also more likely to end up in the hospital with medical crises that might have been prevented if someone had been checking on them.

To better understand the experiences of these seniors, I accompanied Gliatto on some home visits in New York City. Mount Sinai’s Visiting Doctors Program, established in 1995, is one of the oldest in the nation. Only 12% of older U.S. adults who rarely or never leave home have access to this kind of home-based primary care.

Gliatto and his staff — seven part-time doctors, three nurse practitioners, two nurses, two social workers, and three administrative staffers — serve about 1,000 patients in Manhattan each year.

These patients have complicated needs and require high levels of assistance. In recent years, Gliatto has had to cut staff as Mount Sinai has reduced its financial contribution to the program. It doesn’t turn a profit, because reimbursement for services is low and expenses are high.

First, Gliatto stopped in to see Sandra Pettway, 79, who never married or had children and has lived by herself in a two-bedroom Harlem apartment for 30 years.

Pettway has severe spinal problems and back pain, as well as Type 2 diabetes and depression. She has difficulty moving around and rarely leaves her apartment. “Since the pandemic, it’s been awfully lonely,” she told me.

When I asked who checks in on her, Pettway mentioned her next-door neighbor. There’s no one else she sees regularly.

Pettway told the doctor she was increasingly apprehensive about an upcoming spinal surgery. He reassured her that Medicare would cover in-home nursing care, aides, and physical therapy services.

“Someone will be with you, at least for six weeks,” he said. Left unsaid: Afterward, she would be on her own. (The surgery in April went well, Gliatto reported later.)

The doctor listened carefully as Pettway talked about her memory lapses.

“I can remember when I was a year old, but I can’t remember 10 minutes ago,” she said. He told her that he thought she was managing well but that he would arrange testing if there was further evidence of cognitive decline. For now, he said, he’s not particularly worried about her ability to manage on her own.

Several blocks away, Gliatto visited Dickens, who has lived in her one-bedroom Harlem apartment for 31 years. Dickens told me she hasn’t seen other people regularly since her sister, who used to help her out, had a stroke. Most of the neighbors she knew well have died. Her only other close relative is a niece in the Bronx whom she sees about once a month.

Dickens worked with special-education students for decades in New York City’s public schools. Now she lives on a small pension and Social Security — too much to qualify for Medicaid. (Medicaid, the program for low-income people, will pay for aides in the home. Medicare, which covers people over age 65, does not.) Like Pettway, she has only a small fixed income, so she can’t afford in-home help.

Every Friday, God’s Love We Deliver, an organization that prepares medically tailored meals for sick people, delivers a week’s worth of frozen breakfasts and dinners that Dickens reheats in the microwave. She almost never goes out. When she has energy, she tries to do a bit of cleaning.

Without the ongoing attention from Gliatto, Dickens doesn’t know what she’d do. “Having to get up and go out, you know, putting on your clothes, it’s a task,” she said. “And I have the fear of falling.”

The next day, Gliatto visited Marianne Gluck Morrison, 73, a former survey researcher for New York City’s personnel department, in her cluttered Greenwich Village apartment. Morrison, who doesn’t have any siblings or children, was widowed in 2010 and has lived alone since.

Morrison said she’d been feeling dizzy over the past few weeks, and Gliatto gave her a basic neurological exam, asking her to follow his fingers with her eyes and touch her fingers to her nose.

“I think your problem is with your ear, not your brain,” he told her, describing symptoms of vertigo.

Because she had severe wounds on her feet related to Type 2 diabetes, Morrison had been getting home health care for several weeks through Medicare. But those services — help from aides, nurses, and physical therapists — were due to expire in two weeks.

“I don’t know what I’ll do then, probably just spend a lot of time in bed,” Morrison told me. Among her other medical conditions: congestive heart failure, osteoarthritis, an irregular heartbeat, chronic kidney disease, and depression.

Morrison hasn’t left her apartment since November 2023, when she returned home after a hospitalization and several months at a rehabilitation center. Climbing the three steps that lead up into her apartment building is simply too hard.

“It’s hard to be by myself so much of the time. It’s lonely,” she told me. “I would love to have people see me in the house. But at this point, because of the clutter, I can’t do it.”

When I asked Morrison who she feels she can count on, she listed Gliatto and a mental health therapist from Henry Street Settlement, a social services organization. She has one close friend she speaks with on the phone most nights.

“The problem is I’ve lost eight to nine friends in the last 15 years,” she said, sighing heavily. “They’ve died or moved away.”

Bruce Leff, director of the Center for Transformative Geriatric Research at the Johns Hopkins School of Medicine, is a leading advocate of home-based medical care. “It’s kind of amazing how people find ways to get by,” he said when I asked him about homebound older adults who live alone. “There’s a significant degree of frailty and vulnerability, but there is also substantial resilience.”

With the rapid expansion of the aging population in the years ahead, Leff is convinced that more kinds of care will move into the home, everything from rehab services to palliative care to hospital-level services.

“It will simply be impossible to build enough hospitals and health facilities to meet the demand from an aging population,” he said.

But that will be challenging for homebound older adults who are on their own. Without on-site family caregivers, there may be no one around to help manage this home-based care.

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Should McMahon find Hammen in a bad way, she plans to contact his sister-in-law, who lives in a suburb of Des Moines. That’s his closest relative. Hammen never married or had children, and his younger brother died in 2022.

Although Hammen lives alone, a web of relationships binds him to his city and his community — neighbors, friends, former co-workers, fellow volunteers with an advocacy group for seniors, and fellow members of a group of solo agers. McMahon is an emergency contact, as is a former co-worker. When Hammen was hit by a car in February 2019, another neighbor did his laundry. A friend came over to keep him company. Other people went on walks with Hammen as he got back on his feet.

Those connections are certainly sustaining. Yet Hammen has no idea who might care for him should he become unable to care for himself.

“I’ll cross that bridge when I come to it,” he told me.

These are fundamental questions for older adults who live alone: Who will be there for them, for matters large and small? Who will help them navigate the ever more complex health care system and advocate on their behalf? Who will take out the garbage if it becomes too difficult to carry? Who will shovel the snow if a winter storm blows through?

American society rests on an assumption that families take care of their own. But 15 million Americans 50 and older didn’t have any close family — spouses, partners, or children — in 2015, the latest year for which reliable estimates are available. Most lived alone. By 2060, that number is expected to swell to 21 million.

Beyond that, millions of seniors living on their own aren’t geographically close to adult children or other family members. Or they have difficult, strained relationships that keep them from asking for support.

These older adults must seek assistance from other quarters when they need it. Often they turn to neighbors, friends, church members, or community groups — or paid help, if they can afford it.

And often, they simply go without, leaving them vulnerable to isolation, depression, and deteriorating health.

When seniors living alone have no close family, can nonfamily helpers be an adequate substitute? This hasn’t been well studied.

“We’re just beginning to do a better job of understanding that people have a multiplicity of connections outside their families that are essential to their well-being,” said Sarah Patterson, a demographer and sociologist at the Institute for Social Research at the University of Michigan.

The takeaway from a noteworthy study published by researchers at Emory University, Johns Hopkins University, and the Icahn School of Medicine at Mount Sinai was this: Many seniors adapt to living solo by weaving together local social networks of friends, neighbors, nieces and nephews, and siblings (if they’re available) to support their independence.

Still, finding reliable local connections isn’t always easy. And nonfamily helpers may not be willing or able to provide consistent, intense hands-on care if that becomes necessary.

When AARP surveyed people it calls “solo agers” in 2022, only 25% said they could count on someone to help them cook, clean, get groceries, or perform other household tasks if needed. Just 38% said they knew someone who could help manage ongoing care needs. (AARP defined solo agers as people 50 and older who aren’t married, don’t have living children, and live alone.)

Linda Camp, 73, a former administrator with the city of St. Paul, Minnesota, who never married or had children, has written several reports for the Citizens League in St. Paul about growing old alone. Yet she was still surprised by how much help she required this summer when she had cataract surgery on both eyes.

A former co-worker accompanied Camp to the surgery center twice and waited there until the procedures were finished. A relatively new friend took her to a follow-up appointment. An 81-year-old downstairs neighbor agreed to come up if Camp needed something. Other friends and neighbors also chipped in.

Camp was fortunate — she has a sizable network of former co-workers, neighbors, and friends. “What I tell people when I talk about solos is all kinds of connections have value,” she said.

Michelle Wallace, 75, a former technology project manager, lives alone in a single-family home in Broomfield, Colorado. She has worked hard to assemble a local network of support. Wallace has been divorced for nearly three decades and doesn’t have children. Though she has two sisters and a brother, they live far away.

Wallace describes herself as happily unpartnered. “Coupling isn’t for me,” she told me when we first talked. “I need my space and my privacy too much.”

Instead, she’s cultivated relationships with several people she met through local groups for solo agers. Many have become her close friends. Two of them, both in their 70s, are “like sisters,” Wallace said. Another, who lives just a few blocks away, has agreed to become a “we’ll help each other out when needed” partner.

“In our 70s, solo agers are looking for support systems. And the scariest thing is not having friends close by,” Wallace told me. “It’s the local network that’s really important.”

Gardner Stern, 96, who lives alone on the 24th floor of the Carl Sandburg Village condominium complex just north of downtown Chicago, has been far less deliberate. He never planned for his care needs in older age. He just figured things would work out.

They have, but not as Stern predicted.

The person who helps him the most is his third wife, Jobie Stern, 75. The couple went through an acrimonious divorce in 1985, but now she goes to all his doctor appointments, takes him grocery shopping, drives him to physical therapy twice a week and stops in every afternoon to chat for about an hour.

She’s also Gardner’s neighbor — she lives 10 floors above him in the same building.

Why does she do it? “I guess because I moved into the building and he’s very old and he’s a really good guy and we have a child together,” she told me. “I get happiness knowing he’s doing as well as possible.”

Over many years, she said, she and Gardner have put their differences aside.

“Never would I have expected this of Jobie,” Gardner told me. “I guess time heals all wounds.”

Gardner’s other main local connections are Joy Loverde, 72, an author of elder-care books, and her 79-year-old husband, who live on the 28th floor. Gardner calls Loverde his “tell it like it is” friend — the one who helped him decide it was time to stop driving, the one who persuaded him to have a walk-in shower with a bench installed in his bathroom, the one who plays Scrabble with him every week and offers practical advice whenever he has a problem.

“I think I would be in an assisted living facility without her,” Gardner said.

There’s also family: four children, all based in Los Angeles, eight grandchildren, mostly in L.A., and nine great-grandchildren. Gardner sees most of this extended clan about once a year and speaks to them often, but he can’t depend on them for his day-to-day needs.

For that, Loverde and Jobie are an elevator ride away. “I’ve got these wonderful people who are monitoring my existence, and a big-screen TV, and a freezer full of good frozen dinners,” Gardner said. “It’s all that I need.”

As I explore the lives of older adults living alone in the next several months, I’m eager to hear from people who are in this situation. If you’d like to share your stories, please send them to khn.navigatingaging@gmail.com.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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It seemed clear they had some type of cognitive impairment. Yet they were living alone.

Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing?

When she reviewed the research literature more than a decade ago, there was little there. “I realized this is a largely invisible population,” she said.

Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States.

About half have trouble with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, according to their research. But only 1 in 3 received help with at least one such activity.

Compared with other older adults who live by themselves, people living alone with cognitive impairment are older, more likely to be women, and disproportionately Black or Latino, with lower levels of education, wealth, and homeownership. Yet only 21% qualify for publicly funded programs such as Medicaid that pay for aides to provide services in the home.

In a health care system that assumes older adults have family caregivers to help them, “we realized this population is destined to fall through the cracks,” Portacolone said.

Imagine what this means. As memory and thinking problems accelerate, these seniors can lose track of bills, have their electricity shut off, or be threatened with eviction. They might stop shopping (it’s too overwhelming) or cooking (it’s too hard to follow recipes). Or they might be unable to communicate clearly or navigate automated phone systems.

A variety of other problems can ensue, including social isolation, malnutrition, self-neglect, and susceptibility to scams. Without someone to watch over them, older adults on their own may experience worsening health without anyone noticing or struggle with dementia without ever being diagnosed.

Should vulnerable seniors live this way?

For years, Portacolone and her collaborators nationwide have followed nearly 100 older adults with cognitive impairment who live alone. She listed some concerns people told researchers they worried most about: “Who do I trust? When is the next time I’m going to forget? If I think I need more help, where do I find it? How do I hide my forgetfulness?”

Jane Lowers, an assistant professor at the Emory University School of Medicine, has been studying “kinless” adults in the early stages of dementia — those without a live-in partner or children nearby. Their top priority, she told me, is “remaining independent for as long as possible.”

Seeking to learn more about these seniors’ experiences, I contacted the National Council of Dementia Minds. The organization last year started a biweekly online group for people living alone with dementia. Its staffers arranged a Zoom conversation with five people, all with early-to-moderate dementia.

One was Kathleen Healy, 60, who has significant memory problems and lives alone in Fresno, California.

“One of the biggest challenges is that people don’t really see what’s going on with you,” she said. “Let’s say my house is a mess or I’m sick or I’m losing track of my bills. If I can get myself together, I can walk out the door and nobody knows what’s going on.”

An administrator with the city of Fresno for 28 years, Healy said she had to retire in 2019 “because my brain stopped working.” With her pension, she’s able to cover her expenses, but she doesn’t have significant savings or assets.

Healy said she can’t rely on family members who have troubles of their own. (Her 83-year-old mother has dementia and lives with Healy’s sister.) The person who checks on her most frequently is an ex-boyfriend.

“I don’t really have anybody,” she said, choking up.

David West, 62, is a divorced former social worker with Lewy body dementia, which can impair thinking and concentration and cause hallucinations. He lives alone in an apartment in downtown Fort Worth, Texas.

“I will not survive this in the end — I know that — but I’m going to meet this with resilience,” he said when I spoke with him by phone in June.

Since his diagnosis nearly three years ago, West has filled his life with exercise and joined three dementia support groups. He spends up to 20 hours a week volunteering, at a restaurant, a food bank, a museum, and Dementia Friendly Fort Worth.

Still, West knows that his illness will progress and that this period of relative independence is limited. What will he do then? Although he has three adult children, he said, he can’t expect them to take him in and become dementia caregivers — an extraordinarily stressful, time-intensive, financially draining commitment.

“I don’t know how it’s going to work out,” he said.

Denise Baker, 80, a former CIA analyst, lives in a 100-year-old house in Asheville, North Carolina, with her dog, Yolo. She has cognitive problems related to a stroke 28 years ago, Alzheimer’s disease, and serious vision impairment that prevents her from driving. Her adult daughters live in Massachusetts and Colorado.

“I’m a very independent person, and I find that I want to do everything I possibly can for myself,” Baker told me, months before Asheville was ravaged by severe flooding. “It makes me feel better about myself.”

She was lucky in the aftermath of Hurricane Helene: Baker lives on a hill in West Asheville that was untouched by floodwaters. In the week immediately after the storm, she filled water jugs every day at an old well near her house and brought them back in a wheelbarrow.  Though her power was out, she had plenty of food and neighbors looked in on her. 

“I’m absolutely fine,” she told me on the phone in early October after a member of Dementia Friendly Western North Carolina drove to Baker’s house to check in on her, upon my request. Baker is on the steering committee of that organization.

Baker once found it hard to ask for assistance, but these days she relies routinely on friends and hired help. A few examples: Elaine takes her grocery shopping every Monday. Roberta comes once a month to help with her mail and finances. Jack mows her lawn. Helen offers care management advice. Tom, a cab driver she connected with through Buncombe County’s transportation program for seniors, is her go-to guy for errands.

Her daughter Karen in Boston has the authority to make legal and health care decisions when Baker can no longer do so. When that day comes — and Baker knows it will — she expects her long-term care insurance policy to pay for home aides or memory care. Until then, “I plan to do as much as I can in the state I’m in,” she said.

Much can be done to better assist older adults with dementia who are on their own, said Elizabeth Gould, co-director of the National Alzheimer’s and Dementia Resource Center at RTI International, a nonprofit research institute. “If health care providers would just ask ‘Who do you live with?’” she said, “that could open the door to identifying who might need more help.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“I didn’t know what I was going to do, where I was going to go,” he told me, describing a period of crisis that began in 2017.

Seeking a change of venue, Rousseau moved to the mountains of North Carolina, the start of an extended period of wandering. Soon, a sense of emptiness enveloped him. He had no friends or hobbies — his work as a doctor had been all-consuming. Former colleagues didn’t get in touch, nor did he reach out.

His wife had passed away after a painful illness a decade earlier. Rousseau was estranged from one adult daughter and in only occasional contact with another. His isolation mounted as his three dogs, his most reliable companions, died.

Rousseau was completely alone — without friends, family, or a professional identity — and overcome by a sense of loss.

“I was a somewhat distinguished physician with a 60-page resume,” Rousseau, now 73, wrote in the Journal of the American Geriatrics Society in May. “Now, I’m ‘no one,’ a retired, forgotten old man who dithers away the days.”

In some ways, older men living alone are disadvantaged compared with older women in similar circumstances. Research shows that men tend to have fewer friends than women and be less inclined to make new friends. Often, they’re reluctant to ask for help.

“Men have a harder time being connected and reaching out,” said Robert Waldinger, a psychiatrist who directs the Harvard Study of Adult Development, which has traced the arc of hundreds of men’s lives over a span of more than eight decades. The men in the study who fared the worst, Waldinger said, “didn’t have friendships and things they were interested in — and couldn’t find them.” He recommends that men invest in their “social fitness” in addition to their physical fitness to ensure they have satisfying social interactions.

Slightly more than 1 in every 5 men ages 65 to 74 live alone, according to 2022 Census Bureau data. That rises to nearly 1 in 4 for those 75 or older. Nearly 40% of these men are divorced, 31% are widowed, and 21% never married.

That’s a significant change from 2000, when only 1 in 6 older men lived by themselves. Longer life spans for men and rising divorce rates are contributing to the trend. It’s difficult to find information about this group — which is dwarfed by the number of women who live alone — because it hasn’t been studied in depth. But psychologists and psychiatrists say these older men can be quite vulnerable.

When men are widowed, their health and well-being tend to decline more than women’s.

“Older men have a tendency to ruminate, to get into our heads with worries and fears and to feel more lonely and isolated,” said Jed Diamond, 80, a therapist and the author of “Surviving Male Menopause” and “The Irritable Male Syndrome.”

Add in the decline of civic institutions where men used to congregate — think of the Elks or the Shriners — and older men’s reduced ability to participate in athletic activities, and the result is a lack of stimulation and the loss of a sense of belonging.

Depression can ensue, fueling excessive alcohol use, accidents, or, in the most extreme cases, suicide. Of all age groups in the United States, men over age 75 have the highest suicide rate, by far.

For this column, I spoke at length to several older men who live alone. All but two (who’d been divorced) were widowed. Their experiences don’t represent all men who live alone. But still, they’re revealing.

The first person I called was Art Koff, 88, of Chicago, a longtime marketing executive I’d known for several years. When I reached out in January, I learned that Koff’s wife, Norma, had died the year before, leaving him hobbled by grief. Uninterested in eating and beset by unremitting loneliness, Koff lost 45 pounds.

“I’ve had a long and wonderful life, and I have lots of family and lots of friends who are terrific,” Koff told me. But now, he said, “nothing is of interest to me any longer.”

“I’m not happy living this life,” he said.

Nine days later, I learned that Koff had died. His nephew, Alexander Koff, said he had passed out and was gone within a day. The death certificate cited “end stage protein calorie malnutrition” as the cause.

The transition from being coupled to being single can be profoundly disorienting for older men. Lodovico Balducci, 80, was married to his wife, Claudia, for 52 years before she died in October 2023. Balducci, a renowned physician known as the “patriarch of geriatric oncology,” wrote about his emotional reaction in the Journal of the American Geriatrics Society, likening Claudia’s death to an “amputation.”

“I find myself talking to her all the time, most of the time in my head,” Balducci told me in a phone conversation. When I asked him whom he confides in, he admitted, “Maybe I don’t have any close friends.”

Disoriented and disorganized since Claudia died, he said his “anxiety has exploded.”

We spoke in late February. Two weeks later, Balducci moved from Tampa to New Orleans, to be near his son and daughter-in-law and their two teenagers.

“I am planning to help as much as possible with my grandchildren,” he said. “Life has to go on.”

Verne Ostrander, a carpenter in the small town of Willits, California, about 140 miles north of San Francisco, was reflective when I spoke with him, also in late February. His second wife, Cindy Morninglight, died four years ago after a long battle with cancer.

“Here I am, almost 80 years old — alone,” Ostrander said. “Who would have guessed?”

When Ostrander isn’t painting watercolors, composing music, or playing guitar, “I fall into this lonely state, and I cry quite a bit,” he told me. “I don’t ignore those feelings. I let myself feel them. It’s like therapy.”

Ostrander has lived in Willits for nearly 50 years and belongs to a men’s group and a couples’ group that’s been meeting for 20 years. He’s in remarkably good health and in close touch with his three adult children, who live within easy driving distance.

“The hard part of living alone is missing Cindy,” he told me. “The good part is the freedom to do whatever I want. My goal is to live another 20 to 30 years and become a better artist and get to know my kids when they get older.”

The Rev. Johnny Walker, 76, lives in a low-income apartment building in a financially challenged neighborhood on Chicago’s West Side. Twice divorced, he’s been on his own for five years. He, too, has close family connections. At least one of his several children and grandchildren checks in on him every day.

Walker says he had a life-changing religious conversion in 1993. Since then, he has depended on his faith and his church for a sense of meaning and community.

“It’s not hard being alone,” Walker said when I asked whether he was lonely. “I accept Christ in my life, and he said that he would never leave us or forsake us. When I wake up in the morning, that’s a new blessing. I just thank God that he has brought me this far.”

Waldinger recommended that men “make an effort every day to be in touch with people. Find what you love — golf, gardening, birdwatching, pickleball, working on a political campaign — and pursue it,” he said. “Put yourself in a situation where you’re going to see the same people over and over again. Because that’s the most natural way conversations get struck up and friendships start to develop.”

Rousseau, the retired South Carolina doctor, said he doesn’t think about the future much. After feeling lost for several years, he moved across the country to Jackson, Wyoming, in the summer of 2023. He embraced solitude, choosing a remarkably isolated spot to live — a 150-square-foot cabin with no running water and no bathroom, surrounded by 25,000 undeveloped acres of public and privately owned land.

“Yes, I’m still lonely, but the nature and the beauty here totally changed me and focused me on what’s really important,” he told me, describing a feeling of redemption in his solitude.

Rousseau realizes that the death of his parents and a very close friend in his childhood left him with a sense of loss that he kept at bay for most of his life. Now, he said, rather than denying his vulnerability, he’s trying to live with it. “There’s only so long you can put off dealing with all the things you’re trying to escape from.”

It’s not the life he envisioned, but it’s one that fits him, Rousseau said. He stays busy with volunteer activities — cleaning tanks and running tours at Jackson’s fish hatchery, serving as a part-time park ranger, and maintaining trails in nearby national forests. Those activities put him in touch with other people, mostly strangers, only intermittently.

What will happen to him when this way of living is no longer possible?

“I wish I had an answer, but I don’t,” Rousseau said. “I don’t see my daughters taking care of me. As far as someone else, I don’t think there’s anyone else who’s going to help me.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit kffhealthnews.org/columnists to submit your requests or tips.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).