When Carol Marak was in her 30s, she asked herself whose life she wanted: her brother’s – the life of a successful and well-traveled businessman – or his wife’s – the life of a woman whose career better accommodated raising three children.
The answer was a no-brainer: “My brother was in a position I wanted,” says Marak, now a 64-year-old editor at SeniorCare.com who lives in Waco, Texas. Although she had been married and divorced earlier in life, at that point she had no kids and “made a very conscious decision” to keep it that way, she says.
Plenty of Marak’s peers did the same thing. According to a 2012 study in The Gerontologist, about one-third of 45- to 63-year-olds are single, most of whom never married or are divorced. That’s a whopping 50 percent increase since 1980, the study found. What’s more, about 15 percent of 40- to 44-year-old women had no children in 2012 – up from about 10 percent in 1980, U.S. Census data shows. “My career was No. 1 in my life,” says Marak, who worked in the technology industry for years.
But today, Marak and her single, childless contemporaries are facing a repercussion of their decision that never crossed their minds as 30-somethings: “How in the world will we take care of ourselves?” she asks.
Dr. Maria Torroella Carney, chief of geriatrics and palliative medicine at North Shore-LIJ Health System in New York, is asking the same thing. In research presented this year at The American Geriatric Society’s annual meeting, Carney and her colleagues found that nearly one-quarter of Americans over age 65 are or may become physically or socially isolated and lack someone like a family member to care for them. Carney calls them “elder orphans.”
“The risk of potentially finding yourself without a support system – because the majority of care provided as we get older is provided by family – may be increasing,” she says.
The consequences are profound. According to Carney’s work, older adults who consider themselves lonely are more likely to have trouble completing daily tasks, experience cognitive decline, develop coronary heart disease and even die. Those who are socially isolated are also at risk for medical complications, mental illness, mobility issues and health care access problems.
“You could be at a hospital setting at a time of crisis and could delay your treatment or care, and your wishes may not be respected [if you can’t communicate them],“ says Carney, also an associate professor at Hofstra North Shore-LIJ School of Medicine.
Take "Mr. HB,” a 76-year-old New York man described in Carney’s research as “a prototypical elder orphan." After attempting suicide, he arrived at a hospital with cuts on his wrist, bed sores, dehydration, malnutrition and depression. He lived alone and hadn’t been in contact with any relatives in over a year. His treatment was complicated, the researchers report, in part because he was too delirious to make clear decisions or understand his options. He wound up at a nursing facility with plans to eventually be placed in long-term care.
But growing older without kids or a partner doesn’t mean you’re doomed – just as aging with kids and a partner doesn’t mean all’s clear. "We’re all at risk for becoming isolated and becoming elder orphans,” Carney says. You could outlive your spouse or even your children, find yourself living far from your family or wind up in the caretaker role yourself if a family member gets sick. Keep in mind that 69 percent of Americans will need long-term care, even though only 37 percent think they will, according to SeniorCare.com.
Plus, there’s no way around the natural physical and mental declines that come with age. “Everybody has to prepare to live as independently as possible,” Carney says. Here’s how:
1. Speak up.
Marak wishes she had talked more with her friends and colleagues about her decision not to become a mom early on. That may have given her a jump-start on anticipating various problems and developing solutions to growing older while childless. She advises younger generations to discuss their options openly with friends – married and single, men and women – before making a firm decision.
“We discuss our psychological issues with professionals. We discuss our money strategies with financial experts,” Marak says. “Why not talk openly about family concerns and what it means to have or not have children? So many of us go into it with blinders on."
2. Act early.
How early you start planning for your future health depends partly on your current condition – and your genes, says Bert Rahl, director of mental health services at the Benjamin Rose Institute on Aging. "If your ancestry is that people die early, you have to plan sooner and faster,” he says.
But whether you come from a family of supercentenarians or people who have shorter life spans, it’s never too soon to save for long-term care, whether it’s by investing in a home, putting aside a stash for medical emergencies or “whatever you can do to have a nest egg,” Marak says. “Life is serious, especially when you get old. Don’t get to [a point] when you’re 60 and now you’re having to scramble to catch up.”
Still not motivated? "Everybody wants some control in [their] life,“ Rahl says. "If you don’t plan, what you’re choosing to do is cede that control to somebody else – and the likelihood that they’re going to have your best interests at heart is a losing proposition.”
3. Make new friends and keep the old.
Your social connections can help with practical health care needs, like driving you to the doctor when you’re unable. But they also do something powerful: keep you alive, research suggests. In a 2012 study of over 2,100 adults age 50 and older, researchers found that the loneliest older adults were nearly twice as likely to die within six years than the least lonely – regardless of their health behaviors or social status.
Connections can also help ward off depression, which affects nearly 20 percent of the 65-and-older population, according to the National Alliance on Mental Illness. “One of the things that keeps people from being depressed is to be connected,” Rahl says. “The more social activities you have, the more friends, the more things you can do to keep your body and mind active – that’s the best protection you have against mental illness.”
4. Appoint a proxy.
Who is your most trusted friend or relative? “Identify somebody to help you if you’re in a time of crisis, and revisit that periodically over your life,” Carney suggests. Make sure that person knows your Social Security number, where you keep your insurance card, which medications you take – "the whole list of things somebody needs to know if they’re going to help you,“ advises Dr. Robert Kane, director of the University of Minnesota’s Center on Aging.
Before you start losing any cognitive capacities, consider designating that person as your durable power of attorney for health care, or the person who makes health care decisions for you when you’re no longer able.
If no one comes to mind, hire an attorney who specializes in elder care law by asking around for recommendations or searching online for highly rated professionals. Unlike your friends, they have a license to defend and are well-versed in elder care issues. Most of the time, Rahl’s found, "they’re trustworthy and will do a good job for you.”
5. Consider moving.
Marak is on a mission: “to create my life where I’m not transportation-dependent,” she says. She’s looking to move to a more walkable city, perhaps a college town where she’s surrounded by young people and can stay engaged with activities like mentoring. She also hopes her future community is filled with other like-minded older adults who can look out for one another. “I want to … set up my life where I’m not living alone and isolated,” she says.
Adjusting your living situation so that you can stay connected to others and get to, say, the grocery store or doctor’s office is the right idea, says Carney, who cares for a group of nuns who live communally and has seen other adults create communities that act like “surrogate families,” she says. “Think: Where do you want to live? What’s most easy? How do you access things? How do you have a support system?”
6. Live well.
Marak is lucky: She’s always loved eating healthy foods and walking – two ways to stay as healthy as possible at all ages. “Some of the foods that we eat are really, really bad for the body,” she says. “That’s one of the major causes of chronic conditions – and not exercising.”
Keeping your brain sharp is also critical if you want to be able to make informed decisions about your health care, Rahl says. He suggests doing activities that challenge you – math problems if numbers trip you up, or crossword puzzles if words aren’t your forte. “The old adage, ‘If you don’t use it, you lose it,’ is 100 percent correct,” he says.
What is cognitive aging?
Much like the wear and tear of an old set of car tires, your brain’s ability to carry the weight of your cognition – memory, decision-making, wisdom, and learning – can begin to dull or change. This change is known as cognitive aging. It’s not necessarily a sign of Alzheimer’s disease or dementia – a decline in mental sharpness happens to all of us – but it can impact daily activities such as financial and health care decisions.
Scientifically sound advice.
Write this down – you might forget. All puns aside, the Institute of Medicine was tasked with addressing the current state of cognitive aging for both health care providers and patients in a report published last month. In “Cognitive Aging: Progress in Understanding and Opportunities for Action,” the authors offer three evidence-based ways you can protect your aging brain. Dr. Dan Blazer, chair of the report and professor emeritus of psychiatry at Duke University Medical Center, and Dr. Valentin Fuster, director of Mount Sinai Heart and physician-in-chief at the Mount Sinai Hospital, share these three steps and more brain health tips.
1. Be physically active.
Taking part in a simple exercise routine each day such as bicycling, walking or even gardening can provide greater blood supply to the brain and help keep you cognitively and physically active, Blazer explains. “The best evidence we see in terms of maintaining and improving cognitive function is exercise,” he says. Exercise fends off many health issues later in life, not just cognitive decline, he adds.
2. Reduce your cardiovascular risk factors.
Cardiovascular risk factors, including high blood pressure, diabetes and smoking can damage tiny vessels in your brain, impacting the way it ages, Fuster says. To reduce risks, quit smoking and maintain a healthy weight and blood pressure. If you have high cholesterol, you should follow your doctor’s instructions and follow up with any necessary blood tests, Fuster says. The key is to change any unhealthy habits.
3. Manage your medications.
Do you take multiple medications? “Older adults are sometimes on more medications than they need to be on,“ Blazer says. ”… Many, if not all of them, can potentially affect your cognitive functioning.” Check with your doctor to see if your medications have any possible cognitive side effects. For example, sleep medications are known to impact cognitive function, Blazer says. “Asking if you really need to be taking this medication in consultation with a health care professional is an important step to taking care of cognitive health,” he says.
4. Maintain a healthy sleep schedule.
If you’re already active, healthy and managing your medications, but are still eager to stay sharp, there are a few more actions you can take. For one, maintaining good sleep habits may help. “When you have irregular sleep habits and you’re napping during the day or not sleeping well at night, you are not as cognitively sharp when you get up in the morning,” Blazer says. “There’s a big difference between a 20-minute nap and a two-hour nap.” Here are 10 ways to get more sleep and maintain sleep hygiene without medication.
5. Stimulate your brain.
Blazer says being intellectually engaged is a valuable way to protect your brain. You can do this by simply reading and tackling puzzles or games that require strategies, such as sudoku, chess or checkers. Download a brain stimulation game to your phone or tablet, and keep it up. If you only dabble in these activities or try for a few months and stop, you won’t reap any benefits. “What we think the evidence shows is keeping intellectually engaged does protect one from cognitive decline and maintains cognitive health,” Blazer says.
6. Be sociable.
People who are more socially connected to others are better off than those who isolate, Blazer says. Try getting out of the house and spending time around others. You can do this by offering to tutor elementary school students, volunteering or being active in your religious group or community. Blazer says there’s little scientific evidence on how social engagement improves brain function, but adds that we shouldn’t underestimate its importance.
There is hope.
Blazer says it’s important to know that cognitive aging and Alzheimer’s disease are two very different issues. In Alzheimer’s disease and dementia, there is a clear loss of brain cells. With cognitive aging, the neurons in the brain tend to be maintained – not lost – and can be re-established, Blazer says. “That’s why we have hope at a more biological level that with the proper stimulation, activities, and conditions, we have an opportunity to maintain and improve cognitive function as people age,” he says.
Anna Medaris Miller STAFF WRITER
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