The support needs of terminally ill people living alone at home: a narrative review

Abstract

Context: The number of terminally ill people who live alone at home and without a caregiver is growing and exerting pressure on the stretched resources of home-based palliative care services. Objectives: We aimed to highlight the unmet support needs of terminally ill people who live alone at home and have no primary caregiver and identify specific models of care that have been used to address these gaps. Methods: We conducted a narrative review of empirical research published in peer-reviewed journals in English using a systematic approach, searching databases 2002–2013. This review identified 547 abstracts as being potentially relevant. Of these, 95 were retrieved and assessed, with 37 studies finally reviewed. Results: Majority of the studies highlighted the reduced likelihood of this group to be cared for and die at home and the experiences of more psychosocial distress and more hospital admissions than people with a primary caregiver. Few studies reported on the development of models of care but showed that the challenges faced by this group may be mitigated by interventions tailored to meet their specific needs. Conclusion: This is the first review to highlight the growing challenges facing community palliative care services in supporting the increasing number of people living alone who require care. There is a need for more studies to examine the effectiveness of informal support networks and suitable models of care and to provide directions that will inform service planning for this growing and challenging group.

A sense of security in palliative homecare in a Norwegian municipality; dyadic comparisons of the perceptions of patients and relatives - a quantitative study

“…Thirteen of the 32 patients in the present study lived alone. Despite the fact that the number of participants is low, it is worth mentioning that many patients live alone, even in the palliative phase [12,50,51]. We need to be aware that changes in family structures from extended to nuclear families in western society will lead to more people, especially older ones, living alone.…”

“…A relative is often the key to meeting the patients' preferences as well as achieving political aims [12]. Many relatives take on the responsibility for providing practical and medical care, in addition to social and emotional support, while at the same time facing the threat of losing a loved one [13].…”

The Right Place at the Right Time: Medical Oncology Outpatients' Perceptions of Location of End-of-Life Care

“…6,7 Additionally, many patients do not have informal carers available to provide home care. 8 Helping people achieve their preferred care location might be more indicative of high-quality EOL care. However, patients infrequently die in their preferred location.…”

Older people living alone at home with terminal cancer

“…Although the findings seem particularly pertinent to Australia, they nevertheless are likely to have international application where the support needs of terminally ill people living alone remain an under-examined topic (Rolls et al 2011;Aoun et al 2014b).…”

“…This has raised and continues to raise challenges for the provision and delivery of health and community services at the end of life. The growing population of people living alone and the reduced availability of informal caregivers together mediate the capacity to remain at home at end of life (Aoun et al 2014b). Social support, respite care, assistance to maintain independence and safeguarding from isolation were reported as needs of palliative care clients living alone which could become more of a challenge as people reach the end of their lives, with the associated disability this transition often brings (Aoun et al 2008).…”