Palliative care issues for people living alone

The proportion of people living alone in Australia is projected to be between 2.8 million and 3.7 million by 2026. [1] Additionally, by 2021, up to 24% of people living alone will be older Australians (aged 75 years and over), and of these about three-quarters will be women. [2]

By the year 2031 it has also been estimated that in Australia there will be between 28% and 48% of people requiring palliative care will be living alone. [3]

The changing nature of living alone

With generations of family less likely to live together, and more living interstate or overseas, the likelihood of informal care provided by family diminishes. More recent social trends such as declining fertility, delays in having a family, increased divorce rates and increasing life expectancy, has also contributed to the decrease in the availability of younger carers. For many older people, informal care support is provided by an elderly spouse.

As the population increases and ages, so do the number of those living with chronic illness. This may mean being alone at home with less capacity in terms of function, mobility and access to social activities. In the past, elderly widows were those more commonly found living alone, but we now increasingly see adults in their middle years also living alone. Although the majority of younger people still live in family households, the number of people aged 20-29 years living alone has almost doubled in the past 30 years. [4]

Common issues for people living alone

Living alone is associated with lower levels of social and economic participation, a higher prevalence of mental health disorders and of being aged 65 and over. [4] Fewer social supports are likely to exist as people get older, especially if they are living alone. [3] Isolation and loneliness can be co-existing problems and will differ according to gender or to cultural background. Some older people may withdraw from social contacts through their own choice. Either way there are less support mechanisms for these people when they are ill or dying.

End-of-life issues

Many people if asked, say they would like to die at home. The question of place of care and place of death is often posed when people are well and not always raised again as an illness progresses. Some people may change their mind as their circumstances change. [5] Being cared for and dying at home cannot always be realised, especially where there are implications for end-of-life care such as access to 24 hour care. [6] Not everyone wants to die at home with some preferring a more supportive environment, especially if dying at home could mean dying alone. However, choosing not to die at home is not always related to being alone. [7] The ability to participate in decision making is paramount, and a home death should not be inappropriately encouraged nor should it be necessarily seen as a marker of a quality death. [8]

Living alone (with no informal carers) is also associated with a decreased likelihood of a home death regardless of any choices that have been previously made. [7,9,10] Living alone significantly predicts admissions to hospital for symptom control and an increased likelihood of death at an institution. [11]

With increasing life expectancy many people are outliving spouses, friends and other family members. Those without a caregiver need considerably more practical assistance and liaison regarding care, with additional time spent per visit providing support tasks. [11] Relationships with friends and family become significant in place of death, with those living alone reliant on such outside support, which can take many forms (eg, providing emotional comfort, financial assistance or practical help). Some people will move in with family, or others will have relatives helping at home by staying with them overnight as needed.

Others living alone will not have family or close friends, managing sometimes with the help of neighbours or local community resources such as community health services, local councils and the church, or sometimes with no help at all. Some individuals have a strong need to maintain their independence and will often have the resilience to manage by themselves for long periods of time. [9] Some will refuse all offers of help however there are often safety implications in these choices for the health professionals who interact with them.

  1. Australian Bureau of Statistics (ABS). Future living arrangements, Year Book Australia, 2006 [Internet]. 2006 [cited 2014 Aug 12]; ABS cat. no. 1301.0.
  2. Australian Bureau of Statistics (ABS). Household and family projections, Australia 1996 to 2021 [Internet]. 2006 [cited 2014 Aug 12]; ABS cat. no. 3236.0.
  3. O’Connor M. A qualitative exploration of the experiences of people living alone and receiving community-based palliative care. J Palliat Med. 2014 Feb;17(2):200-3.
  4. Clark D. Australian Social Policy 2002 - 2003. The lone person household demographic: Trends and implications [Internet]. Canberra: Commonwealth of Australia; 2004 [Updated 2014 Nov 7; cited 2018 Dec 11]
  5. Aoun SM, Skett K. A longitudinal study of end-of-life preferences of terminally-ill people who live alone. Health Soc Care Community. 2013 Sep;21(5):530-5. Epub 2013 Mar 27.
  6. Houttekier DA, Cohen J, Bilsen J, Deboosere P, Verduyckt P, Deliens L. Determinants of the place of death in the Brussels metropolitan region. J Pain Symptom Manage. 2009 Jun;37(6):996-1005. Epub 2009 Apr 5.
  7. Cohen J, Bilsen J, Hooft P, Deboosere P, van der Wal G, Deliens L. Dying at home or in an institution Using death certificates to explore the factors associated with place of death. Health Policy. 2006 Oct;78(2-3):319-29. Epub 2005 Dec 15.
  8. Australian and New Zealand Society of Palliative Medicine (ANZSPM). Caring for people at the end of life: Submission to the National Health and Hospitals Reform Commission. Braidwood, NSW: ANZSPM; 2009.
  9. Aoun S, Kristjanson LJ, Oldham L, Currow D. A qualitative investigation of the palliative care needs of terminally ill people who live alone. Collegian. 2008;15(1):3-9.
  10. Brink P, Frise Smith T. Determinants of home death in palliative home care: using the interRAI palliative care to assess end-of-life care. Am J Hosp Palliat Care. 2008 Aug-Sep;25(4):263-70. Epub 2008 Jun 11.
  11. Aoun S, Kristjanson L, Currow D, Skett K, Oldham L, Yates P. Terminally-ill people living alone without a caregiver: an Australian national scoping study of palliative care needs. Palliat Med. 2007 Jan;21(1):29-34.

Last updated 20 August 2021