Going it Alone: A Scoping Review of Unbefriended Older Adults

Abstract

Older adults who have reduced decision-making capacity and no family or friends to compensate for these deficiencies are known as unbefriended and require a public guardian. The purpose of this study was to review the peer-reviewed and grey literature to determine the scope of available research on unbefriended older adults in Canada and the United States. We found limited research examining unbefriended older adults. No Canadian studies or reports were located. Unbefriended older adults were childless or had fewer children, were more cognitively impaired, and were older than older adults who were not unbefriended. These findings demonstrate a stark scarcity of studies on unbefriended older adults. Research is urgently needed using standardized data collection of guardianship status in order to enable studies of the prevalence of public guardianship in Canada.

Elder Orphans’ Experiences of Advance Planning and Informal Support Network

“…The American Geriatric Society recognizes the importance of identifying those who are at risk of being "unbefriended," part of this recognition they quoted the term "adult orphans" (Farrell et al, 2017). Unbefriended older adults lack the cognitive ability to make decisions for themselves and do not have contactable family or friends to represent important decisions to be made (Chamberlain et al, 2018). Moreover, majority of these population lack the advance directives or legal surrogates who will execute decisions for them (Kim & Song, 2018).…”

Developing Age‐friendly Cities: Policy Opportunities and Challenges

“…Winsor Schmidt, a pioneer in guardianship research, detailed concerns over the non-existent national reporting of guardianship, limiting the ability to identify and assess the quality of care and quality of life of those under public care (Bell, Schmidt, & Miller, 1981;Schmidt, 1984;1990;Schmidt, et al, 1988). In the nearly forty years since his initial research, guardianship research in the United States has increased; however, critical gaps remain in knowledge with respect to prevalence, demographic characteristics, decision-making, and quality of care (Chamberlain, Baik, & Estabrooks, 2018;Kim & Song, 2018;Montayre, Montayre, & Thaggard, 2018).…”

“…As alluded to above, the number of individuals under public guardianship in the United States is unknown, due to non-existent federal surveillance and variable monitoring of state guardianship programs (Chamberlain et al, 2018;Teaster et al, 2010). However, the number of individuals requiring public guardianship is increasing, due to increasing numbers of older adults generally, coupled with the rising prevalence of age-related dementia and geographically dispersed family and friends (Carney, Fujiwara, Emmert, Liberman, & Paris, 2016).…”

“…Public guardians who were interviewed described their perception that there had been a shift in the demographic profile of those under public guardianship, previously composed of older women who had outlived family and now reflect an increasingly complex population with mental illness and histories of marginalization . Multiple chronic conditions, dementia, and depression are common in persons under public guardianship (Chamberlain et al, 2018;Kim & Song, 2018). examined the characteristics and unmet needs of nursing home residents under public guardianship and found that these residents are frequently marginalized, often having been previously homeless, and many have histories of drug and/or substance abuse and complex psychiatric conditions.…”

Ethical Challenges in Caring for Unrepresented Adults: A Qualitative Study of Key Stakeholders

“…8,9 The number of unrepresented adults is expected to increase with the aging population and rise in single, childless adults. [10][11][12][13] In addition to legal and practical barriers, unrepresented adults are also at risk of care that is not consistent with their values and transgresses standard ethical practice. 1,12,14,15 Available decision makers, such as physicians, may consult an ethics committee or use the best interest standard, but this does not ensure that decisions uphold the patient's values.…”