Unbefriended older adults have poorer quality of life

Chamberlain S, Baik S, Estabrooks C. Going it alone: A scoping review of unbefriended older adults Canadian Journal on Aging. 2018;37(1):1-11.

Review question

•    What is known about ‘unbefriended’ older adults?

Background

•      Many older adults can rely on family members or friends who can intervene and act as their guardian, representative or substitute decision-maker if they are deemed incapable of managing their own affairs.

•      However, some older adults are considered unbefriended, meaning that they lack decision-making capacity, they do not have advanced directives (this is a legal document that goes into effect only if they are incapacitated and unable to speak for themselves) or do not have the capacity to execute the directives, and they lack a family member or a friend who can act as their guardian, representative or substitute decision-maker.

•      This systematic review examines what is known about unbefriended older adults in Canada and the United States.

How the review was done

•      A comprehensive literature search was conducted in 12 electronic databases (including PsycINFO, PubMed, CINAHL, and the Cochrane Library) to find articles published in scientific journals about unbefriended older adults. They also run a comprehensive search in the grey literature, as well as conference proceedings.

•      A total of 14,793 English-language articles published between 1991 and 2016 were retrieved for review. Of those, only five articles were included after assessing their eligibility.

•      Funding information was not disclosed for this review.

What the researchers found

•      The limited number of studies examining unbefriended older adults reveals the dearth of research in this field.

•      Findings indicated that between 29 and 42 per cent of older adults in the included studies were unbefriended.

•      Findings also suggest a grim picture of the profile and quality of life of unbefriended older adults. They are more likely to be single, childless, have fewer siblings, and limited financial resources when compared to older adults with a family or friend guardian. Unbefriended older adults often have dementia (or related cognitive impairment affecting their capacity to remember, learn new things, concentrate, or make decisions that affect their everyday life) and multiple chronic conditions.

•      Findings also reveal a lack of state or provincial coordination, which resulted in variability in national reporting and inconsistent regional oversight of unbefriended older adults.

Conclusion

•      Overall, it was found that unbefriended older adults constitute a high-risk population and have poor quality of life. Yet, there is a lack of population-level data about them. Future research should focus on longitudinal assessments and identify the unmet care needs of unbefriended older adults.

•      Future research should also examine whether guardianship programs and services are used differently depending on the demographic characteristics of unbefriended older adults. This research could inform the work of Offices of the Public Guardian, as well as programs, services and policies to provide support to unbefriended older adults.