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Elder orphans, who are they?

Hiding in the community are a group of older Australians who are friendless, have no family and are most at risk during the COVID-19 pandemic. 

Experts are using the term ‘elder orphans’ to describe these people and they are increasingly worried about the consequences of extreme isolation in this cohort.  

Dr Jed Montayre, a gerontologist from Western Sydney University ‘s School of Nursing and Midwifery, believes that the current social distancing measures are likely to keep this cohort safe. But if they do catch the virus, their lack of a social network leaves them extremely vulnerable. 

Montayre spoke with Aged Care Insite about elder orphans and the current state of aged care in Australia. 

ACI: What is the definition of an elder orphan? 

JM: Elder orphans is a term that was coined in early 2016 in a paper from the US to describe this status of older people living alone and not having any nearby or close networks. And when I say networks, that means immediate family, or someone related by blood.

So, starting off that concept there’s a growing number of people in the US or in some other countries that are very healthy just like anyone else, but they’re living on their own, and it’s fine because some people like that chose to have that kind of lifestyle. But what was noticed is when these people go to the GPs or in the hospitals or wherever, it became problematic because they don’t have anyone with them. 

For example, if there will be consent issues wherein that particular person might be delirious or confused or whatever, there’s no one to contact because they’re on their own. So, basically, that term came in in the research and in the academic literature describing people who are kin-less, live on their own and actually don’t have that immediate, geographically-close family support.

I’ve been working with a GP back in the US on some of the papers and she was the first person to coin the term ‘elder orphan’. In that article, it [was described as] hiding in plain sight because they are healthy, no issues, nothing. But by the time that, for example, they are scheduled for surgery and you dig more and ask them who’s going to take you home after the surgery, that’s when all of these problems surface. 

We’ve all felt some form of isolation during the pandemic, but I’m assuming that’s exacerbated for these elder orphans who maybe get their social interaction from popping to the shops or they might have regular haunts that they go to and they get some of their interaction that way. 

Absolutely. I think what happens is with older orphans or for those who are living alone or on their own, they tend to spend more time with friends, neighbours or going into the shops or wherever, but because of the lockdown and isolation, it’s just gathered that feeling of isolation and being on their own.  

I would say mentally healthy people have been experiencing depression, anxiety or some mental strain during the pandemic. Again, that must be doubled for someone who is an elder orphan. 

There have been studies, particularly on the link of living alone, social isolation and loneliness and essentially symptoms of depression. 

I think that really has an impact on mental health and wellbeing. Post-COVID, we’ll be dealing with the age care crisis, the financial and economic implications, but a huge part of this burden will go into people’s mental health. 

Is there a ballpark figure of how many people in Australia would fit into that elder orphan category? 

Well, there are probably some numbers and stats of people living alone but it is not considered as that category of elder orphans. There isn’t any data that will tell us that that’s happening in Australia. But what I know, based on my conversations with nurses in ED, is oftentimes they’ve got patients who just come in and just surface in the healthcare system because they had a fall or they had some accident or whatever. And then by the time they go back and are discharged, they don’t have anyone with them. So, although this data is collected upon admission because nurses and doctors normally ask people, who’s with you or what is your social status, what I can say is there are no clear figures, but actually it is felt in the community.

In the US, there is one study so far that I know, because I reviewed the paper before it got published, that the percentage of elder orphans in the US is almost 3 per cent. However, when it comes to those who are projected to be at risk it’s almost a quarter of the oldest people in the United States. So, 22 per cent or 23 per cent are at risk of becoming elder orphans in the next year. 

So, I think, in looking at Australia’s ageing landscape, I think that would mirror similarly to the US for prevalence and risk projections. 

This is obviously being brought to light because of the current crisis in aged care due to the pandemic. What are your wider thoughts on the aged care crisis? What have we been doing right? What have we been doing wrong? 

We were dealing with a totally preventable crisis in aged care, I should say that. It’s something that is not new to us. There’s a lot of people in the media and writing things about what’s happening in aged care, but for me as an aged care expert, it didn’t surprise me at all.  

COVID-19 just became the perfect timing for all of this to unfold. For a very long time, with pressures and shortages and everything, the aged care sector was able to contain and still deliver care to people despite all of these challenges. But actually, what should have been done long time ago is to actually address these challenges every time we learn something about it. 

The aged care minister was at the Senate inquiry the other day and he kept repeating that there was just no way to keep COVID out of aged care. There was no way to stop what we’ve seen happening while there was COVID in the community. Do you agree with that? 

No, I don’t agree with that. We have to acknowledge that COVID is here. I suppose at the moment we co-exist because there’s no effective vaccine for COVID. But if you look at countries like Japan, for example, Japan is super ageing. There’s lots of people. The number of centenarians in Japan is growing at an exponential rate, but they have really low death rates in older people. And why is that? And why can’t Australia not do that, you see? It’s not like we cannot prevent it in aged care. It’s a problem that has been systemic, and it all goes back to funding.  

It is preventable. It is unnecessary for older people to die because of COVID. It’s just that we didn’t prepare quite early enough. 

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2 comments

  1. This is particularly common in the culturally and linguistically diverse communities.

    Service providers providing services to CALD clients regularly come across elderly migrants who have lived in Australia for most of their lives, but on the moving of their children interstate or overseas, have little to no family, and in the case of the women, very little English language, and few friends that are in a position to help.

    It would be of interest to know just what the numbers are for the various diversities, for there most be similarities in disability (Ann Marie Smith comes to mind), the indigenous community, the LGBTI community, as well as the CALD communities.

    • It is absolutely a valid point with CALD communities, and with Australia, being so diverse, we see a lot of this happening in the community. It is also interesting to see what were the protective factors for these group of people that despite having a condition or disability, they were able live and cope alone. Targeted community services are really important to explore around this topic. From our previous study in New Zealand, a lot of older people living alone depends on informal support networks such as the bus drivers, the bank tellers in the community.

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