Solo Seniors with Social Support Are Less Likely to Need Nursing Home Care

November 15, 2021

UCSF Study Shows ‘Health Shock’ May Upend Living Situation in Older Adults without Assistance

By Suzanne Leigh

Home caregiver helping a black senior man standing up at home stock photo

Research shows that many seniors living alone prefer to recover from acute illness in their own homes, rather than in long-term care facilities. Now a new study by researchers at UC San Francisco has identified one factor that buffers the likelihood of a “health shock” culminating in a nursing home stay of at least 30 days.

Older adults who said they could count on a friend or relative to “help with personal care if needed,” in the event of a hospitalization of at least two days or a new diagnosis of a life-threatening condition, reduced their risk of requiring institutional care over a two-year period from 14.2 percent to 10.9 percent.

In the study, which published in JAMA Internal Medicine on Nov. 15, the UCSF researchers tracked data from 4,772 adults who had been enrolled in the Health and Retirement Study, a nationally representative, longitudinal study that assessed changes in disability, health and wealth as participants transitioned from the workforce to retirement. The UCSF cohort was restricted to those aged 65 and older who lived alone in the community and managed activities of daily living, ranging from basic self-care to finances and home maintenance. They found that 68 percent of these participants experienced a sudden adverse change in their health status.

‘Unnerving’ Number of Seniors Without Assistance

Among the older adults living alone, 38 percent were unable to identify a friend or family member to help them in the event of a serious health issue, a number that lead author Sachin Shah, MD, from the UCSF Division of Hospital Medicine, described as “unnerving.”

“I think they are quite vulnerable. We see it in the hospital all the time,” he said. “We admit people who could be OK at home if they only had a little support.”

Many older adults are able to take care of themselves until they experience a health crisis.


Many older adults are able to take care of themselves until they experience a health crisis, said senior author Kenneth Covinsky, MD, of the UCSF Division of Geriatrics. “They may have been able to walk without help, shower, dress and manage their medications, but after a health shock, they can no longer do so. This question can identify those at risk.”

Possible solutions, according to the researchers, is for more cities to implement programs in which older adults requiring assistance in their home can be matched with salaried caregivers or have a friend or family member receive a salary for their own caregiving. “This would be in keeping with the preferences of most older adults to remain in their homes, and would reduce the tremendous cost of institutional care both to older adults and to insurers,” said Shah.

The researchers found no difference in mortality and self-care ability between those older adults living alone who could identify social support and those who could not.

Co-Authors: Other authors are Margaret C. Fang, MD, from the UCSF Division of Hospital Medicine; S. Rae Wannier, MPH, of the UCSF Department of Epidemiology and Biostatistics; and Michael Steinman, MD, from the UCSF Division of Geriatrics.

Funding: The study was supported by the National Institute on Aging (R03AG060090, P30AG044281, K24AG049057), the National Heart Lung and Blood Institute (K24HL141354) and the UCSF Division of Hospital Medicine.

Competing Interests: Dr. Fang reports grants from NHLB/NIH during the study and grants from PCORI outside the submitted work. The other authors report grants from NIH/NIAS during the study.

The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.