Unbefriended: The tragic fate of many older adults

The Bottom Line

  • Many older adults are unable to make decisions on their own, and do not have a family member or friend who can be their guardian, representative, or substitute decision-maker. These individuals are sometimes called ‘elder orphans’ or ‘unbefriended elders’.

  • The limited body of research evidence paints a grim picture of unbefriended older adults, particularly in terms of their poor quality of life.

  • There is an alarming lack of data on unbefriended older adults, which raises questions about the unmet care needs of this vulnerable population.

At some point in our life, we may become unable to assert our rights and express our wishes, and to administer our financial affairs. We may become incapacitated. There are various degrees of incapacity: it can be partial or total, temporary or permanent.(1) This incapacity can be due to a mental illness or intellectual disability, the consequences of an accident, a stroke, or a degenerative disease like Alzheimer's. Many incapacitated people can rely on family members or friends who can step in and act as their protector, representative, or substitute decision-maker. These people can thus protect their health and well-being, and manage their affairs.(2)

However, many incapacitated individuals are alone. They do not have the ability to make decisions, they do not have advance directives (it is a legal document that only takes effect if they are unable to communicate) or the ability to carry out their directives, and they do not have a family member or friend who may be their protector, representative or substitute decision-maker.(2; 4) These individuals require a public guardian. A public guardian is a case manager whose job is to make legal and personal decisions on behalf of incapacitated individuals.

Such situations are already common and will be even more so in the future. The 2016 census reveals that one-person households are the most common in Canada (accounting for 28.2% of all Canadian households).(3) Combined with a longer life-expectancy and growing geographical mobility, the chances of aging alone (and becoming incapacitated) are therefore considerable.(3)

But what can we learn from the research on unbefriended older adults?

What the research tells us

A recent systematic review was conducted by Canadian researchers to identify studies published since the 1990s on unbefriended older adults in Canada and the United States.(4) Despite an extensive documentary search, only five studies conducted in the United States have been identified, revealing a very limited body of research evidence on this pressing issue.

Existing research evidence paints a grim picture of unbefriended older adults, particularly in terms of their poor quality of life. Unbefriended older adults are more likely to be single and childless, to have fewer siblings, and to have limited financial resources compared to older adults with a family member or friend who acts as their guardian. Unbefriended older adults often have dementia (or a cognitive impairment affecting their ability to remember, learn new things, focus or make decisions that affect their daily lives) and multiple chronic diseases.

The review also revealed a lack of coordination among governments, which has resulted in variability and inconsistency in the monitoring of unbefriended older adults. In addition, the authors pointed out the alarming lack of population data about unbefriended older adults. This is all the more disturbing as it is a high-risk and vulnerable population, and that public-guardianship systems face serious challenges, including long waiting times, considerable workloads and limited resources.(2) The researchers concluded that future research should monitor unbefriended older adults over time and identify their unmet care needs. In addition, future research should also examine whether guardianship programs and services are used differently based on the demographic characteristics of unbefriended older adults. Such research could inform how to strengthen or reform public-guardianship systems.

Getting your affairs in order

We never know what the future holds. It is therefore important to get your affairs in order:
- Check with the office of the public guardian and trustee in your province or territory to understand how to protect yourself or your loved ones, or consult a lawyer or notary.
- Prepare a power of attorney for personal care (so that the trusted person you designate can make decisions about your health care, housing or other aspects of your life) and a power of attorney for property (so that the trusted person you designate can make decisions about your financial affairs) if you become mentally incapable of making these decisions.(5; 6)
- Communicate your values and wishes for treatment and care - this will help your substitute decision-maker that you designated to make the best health decisions if you become mentally incapable of making these decisions, which can be very complex and emotional (especially at the end of life).(5)

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Author Details


  1. Éducaloi. Incapacity (being unable to care for yourself or your affairs). 2019.
  2. Chamberlain S. Will you be old and 'unbefriended'? The Conversation. 5 July 2018.
  3. Statistics Canada. Families, households and marital status: Key results from the 2016 Census. Government of Canada, 2017.
  4. 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.
  5. Gauvin FP, Abelson J, Lavis JN. Citizen Brief: Improving End-of-life Communication and Decision-making in Ontario. Hamilton, Canada: McMaster Health Forum, 30 November 2013.
  6. Ontario Ministry of the Attorney General. How powers of attorney work. Government of Ontario, 17 March 2017.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.