Many elderly persons living alone have chronic health problems that challenge their independence. Of those living alone, 50% are hyperten¬sive, 54% have vision or hearing problems, and 59% have arthritis. In addition, those who have limited social support are more vulnerable to a rapid decline in health and well-being.
Nutrition
Good nutrition is a special concern for persons living alone, and phy¬sicians should regularly check patients’ nutritional status. Meals have enormous social importance, and persons living alone may not experi¬ence the pleasure that they previously associated with eating. Persons who live alone often do not cook and eat meals regularly and may not be willing to prepare food in interesting or attractive ways.
Access to Health Care
People with low incomes are less likely to visit a physician than are those with higher incomes. Elderly persons with only Medicare cover¬age use physician services and are hospitalized less often than are those with supplementary private insurance. This suggests that low-income older persons face a financial barrier to obtaining health care.
Nor does the Medicaid program ensure access to medical care. Eligi¬bility criteria are determined by state governments, and about % of poor elderly persons do not qualify for Medicaid benefits (see Chs. 110 and 114). Poor elderly persons without Medicaid spend 25% of their income on medical expenses. When medical expenses are deducted from income, the poverty rate of white elderly persons living alone rises from 19% to 27% (see Poverty, above). Similar health care burdens ap¬ply to other racial groups.
Illness and Recuperation
After a hospital stay, 40% of those who live alone care for them¬selves, compared with about 25% of those who are married. About 25% of those living alone report having no one to help them for a few weeks, and 13% indicate having no one to help them for even a few days. At all age and income levels, those alone are more often institutionalized, es¬pecially after a serious illness. Without a social network or community support, they are at the greatest risk for permanent institutionalization and loss of independence if their health declines. Access to social and home care services may be vital to their recuperation.
A physician can order home care services even for those who have not been previously hospitalized (see Ch. 25). Medicare generally cov¬ers home care services if skilled nursing services are required intermit¬tently and consistently with the nature and severity of the illness.

Emergency Response Devices
Personal emergency response devices are appropriate for many el¬derly persons who live alone, especially those who are homebound. The devices are activated by pushing a button on a transmitter that is worn as a pendant or by pressing any one of a number of transmitters placed strategically in the home. Permanently mounted transmitter de¬vices are recommended at the front door and in the bathroom (about 6 in. from the floor). Some devices have special features such as large, soft activation pads for persons with impaired vision or severe arthritis. Portable devices should be light, wireless, and waterproof.
A regional response center monitors any activation of the devices and calls for local medical and emergency services. Devices that hook into existing telephone lines allow two-way communication if acti¬vated. Two-way communication allows for better assessment of the sit¬uation, and the most appropriate emergency help (eg, police, fire, or ambulance) can be ordered. Furthermore, two-way communication de¬vices enable the monitoring personnel to reassure the elderly person that help is on the way.
Advance Directives
Many elderly patients do not discuss their wishes for resuscitation and heroic live-saving measures with their families or physicians. Be¬cause persons living alone usually value their personal autonomy, phy¬sicians should initiate discussions about medical treatment and advance directives. A copy of a living will or a durable power of attorney for health care should be in a patient’s permanent record and should be readily accessible if emergency care is needed.

Many elderly persons living alone have chronic health problems that challenge their independence. Of those living alone, 50% are hypertensive, 54% have vision or hearing problems, and 59% have arthritis. In addition, those who have limited social support are more vulnerable to a rapid decline in health and well-being.
Nutrition
Good nutrition is a special concern for persons living alone, and physicians should regularly check patients’ nutritional status. Meals have enormous social importance, and persons living alone may not experience the pleasure that they previously associated with eating. Persons who live alone often do not cook and eat meals regularly and may not be willing to prepare food in interesting or attractive ways.
Access to Health Care
People with low incomes are less likely to visit a physician than are those with higher incomes. Elderly persons with only Medicare coverage use physician services and are hospitalized less often than are those with supplementary private insurance. This suggests that low-income older persons face a financial barrier to obtaining health care.
Nor does the Medicaid program ensure access to medical care. Eligibility criteria are determined by state governments, and about % of poor elderly persons do not qualify for Medicaid benefits (see Chs. 110 and 114). Poor elderly persons without Medicaid spend 25% of their income on medical expenses. When medical expenses are deducted from income, the poverty rate of white elderly persons living alone rises from 19% to 27% (see Poverty, above). Similar health care burdens apply to other racial groups.
Illness and Recuperation
After a hospital stay, 40% of those who live alone care for themselves, compared with about 25% of those who are married. About 25% of those living alone report having no one to help them for a few weeks, and 13% indicate having no one to help them for even a few days. At all age and income levels, those alone are more often institutionalized, especially after a serious illness. Without a social network or community support, they are at the greatest risk for permanent institutionalization and loss of independence if their health declines. Access to social and home care services may be vital to their recuperation.
A physician can order home care services even for those who have not been previously hospitalized (see Ch. 25). Medicare generally covers home care services if skilled nursing services are required intermittently and consistently with the nature and severity of the illness.

Emergency Response Devices
Personal emergency response devices are appropriate for many elderly persons who live alone, especially those who are homebound. The devices are activated by pushing a button on a transmitter that is worn as a pendant or by pressing any one of a number of transmitters placed strategically in the home. Permanently mounted transmitter devices are recommended at the front door and in the bathroom (about 6 in. from the floor). Some devices have special features such as large, soft activation pads for persons with impaired vision or severe arthritis. Portable devices should be light, wireless, and waterproof.
A regional response center monitors any activation of the devices and calls for local medical and emergency services. Devices that hook into existing telephone lines allow two-way communication if activated. Two-way communication allows for better assessment of the situation, and the most appropriate emergency help (eg, police, fire, or ambulance) can be ordered. Furthermore, two-way communication devices enable the monitoring personnel to reassure the elderly person that help is on the way.
Advance Directives
Many elderly patients do not discuss their wishes for resuscitation and heroic live-saving measures with their families or physicians. Because persons living alone usually value their personal autonomy, physicians should initiate discussions about medical treatment and advance directives. A copy of a living will or a durable power of attorney for health care should be in a patient’s permanent record and should be readily accessible if emergency care is needed.