An Exploration of the Precarities, Outcomes, and Interventions for Older Adults without Care Partners: A Scoping Review

Background and Purpose: Demographic changes in rates of living alone, divorce, migration, and having no living partner, spouse, or children are leaving more older adults without the typical “informal” care providers that are the backbone of caregiving in the U.S. These older adults without care partners face a precarious situation given our lack of a robust care structure outside of family/social network members, reductions in publicly funded care, rising costs of privately funded care, and a care workforce shortage. This issue is also a social justice concern, as there are differences by population that place already marginalized groups at greater risk of not having access to care support. To date, the literature on this population has been semantically muddled, variably focused on one or more aspects of risk for having no available care partner, such as living alone or having no available kin. This scoping review helps address this gap so aging scholars and social workers can better understand and intervene with this growing population of older adults.

Methods: Using the Joanna Briggs Institute guidelines and PRISMA-ScR protocol, we registered and conducted a scoping review of nine databases to synthesize the current peer-reviewed evidence regarding three concepts: this population’s risks and vulnerabilities; adverse consequences; and any interventions that have been developed and tested specifically for this population. Three independent reviewers screened titles/abstracts and full-text articles and extracted data from included articles. The first author conducted descriptive qualitative analysis of the findings related to precarities, outcomes, and interventions. Our comprehensive search strategy resulted in 5100 unique articles, 33 of which met our inclusion criteria.

Findings: Precarities facing older adults without care partners included risk for social isolation, impaired self-care, delays and exclusions from medical treatment, worse medication adherence, and lack of advance directives and planning for end-of-life care. Negative outcomes included increased likelihood of hospital and nursing home admission, loneliness, lower quality of life, higher mortality, and death by suicide. No rigorously studied interventions are currently published that specifically target this population. However, some evidence suggested positive benefits from community-based, intensive services (e.g. intensive case management and interdisciplinary care) and volunteer supports.

Conclusion and Implications: Evidence suggests that lack of a care partner is a risk distinct from living alone, lack of kin, or isolation (factors typically focused on in the literature regarding this population). And yet, very few of the included articles in this review set out to specifically study older adults without care partners. This underscores our lack of understanding of their distinctive risks and outcomes, and the vital research remaining to develop and test interventions. Our results highlighted the beneficial ways social workers are currently engaging with this population through intensive case management and as members of interdisciplinary care teams. In the future scholars should collaborate with social workers, community partners, and older adults, to co-create interventions that effectively address this growing population’s unique needs.