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Perceptions of Living Alone Among
Older Adult Women
Elaine M. Eshbaugh
University of Northern Iowa
This exploratory study examines older women’s perceptions of living alone. Older adult
women (N= 53) living alone were interviewed. Findings show tremendous variability in the
perceptions of this sample. Whereas some women showed significant levels of loneliness
and depression, many did not. Thirteen percent of the participants (n= 7) negatively per-
ceived living alone, 49.1% (n= 26) neutrally perceived living alone, and 37.7% (n= 20)
positively perceived living alone. Participants’ most enjoyed aspects of living alone were
being one’s own boss/being independent (51%) and keeping one’s own schedule (49%).
Common responses for least enjoyable aspects of living alone were lack of companionship
(62%), no one to help with housework (36%), and fear of falling or getting hurt (30%).
Nurses should be aware that although some have perceived older adult women living alone
as a vulnerable population, one cannot make assumptions based on living arrangements.
In recent decades, there has been a significant increase in the number of people who live
alone (Chandler, Williams, Maconachie, Collett, & Dodgeon, 2004). Living arrange-
ments have shifted toward living alone for older adults in particular (Kramarow, 1995).
At the turn of the century, only 12% of widows age 65 and older lived alone, whereas
70% resided alone in 1990 (Kramarow, 1995). Women, compared to men, are more likely
to live alone (Davis, Moritz, Neuhaus, Barclay, & Gee, 1997). It is not surprising, that un-
married women ages 80 and older are more likely to live alone than men of the same age
group (Zimmer, 2005). This difference is present mainly due to the increased life expec-
tancy of women and the tendency for women to marry men older than themselves, as the
death of a spouse is a primary reason people transition into living alone (Bureau of the
Census and National Institute on Aging, 1993; Kinsella, 1995). In addition, a growing
number of older women are experiencing divorce in later life (Nakonezny, Rodgers, &
Journal of Community Health Nursing, 25:125–137, 2008
Copyright © Taylor & Francis Group, LLC
ISSN: 0737-0016 print/1532-7655 online
DOI: 10.1080/07370010802221685
Correspondence should be addressed to Elaine M. Eshbaugh, 241 Latham Hall, University of Northern
Iowa, Cedar Falls, IA 50614–0332. E-mail: Elaine.eshbaugh@uni.edu
Nussbaum, 2003; Stroup & Pollock, 1999), an occurrence that in the past was considered
rare.
Although maintaining a household with a spouse is typical for married older adults,
the living arrangements of unmarried older women (e.g., widowed, divorced) are much
more variable. Historically, older women moved in with adult children after the death of a
spouse (Macunovich, Easterlin, Schaeffer, & Crimmins, 1995). According to some (e.g.,
Costa, 1999) this significant change in the living arrangements of older women has had a
profound effect on the lives of aged women in both North America and Europe. This
change has impacted elder women’s lives in the areas of mental, physical, and financial
health. Although the demographic changes in living arrangements in this population are
substantial, it has been suggested that gerontologists have not adequately addressed the
needs of older adult women who live alone (Jenkins, 2003).
Why has the proportion of older adults, particularly older adult women, living alone
increased so substantially through the 20th century? Kramarow (1995) presents three
possibilities. First, the decline in fertility has decreased the number of available adult
children that older adults may choose with which to reside. Second, older adults in recent
decades have had increased incomes and are able to support their own residences with
less of a financial struggle than in the past. Third, it has been suggested that modern cul-
ture has changed to a more individual (vs. family) focus, and therefore living alone is
more desirable for today’s older adults than for older adults of the past who had a stronger
desire to live with family. In other words, today’s older adult values independence more
than yesterday’s older adult.
ELDERS LIVING ALONE: A VULNERABLE POPULATION?
Some research suggests that elders who live alone may be vulnerable to physical and
mental health problems and therefore deserve special attention from social workers,
community nurses, and other professionals. Typically, older adults who live alone have
an increased risk of infections, falls, dehydration, and injuries (Campion, 1996). Unfor-
tunately, it is not unusual for emergency medical services to find older adults living
alone, particularly older women, helpless or even dead in their homes (Gurley, Lum,
Sande, Lo, & Katz, 1996). This is referred to by Campion (1996) as being “found down”
(p. 1738). Because older adults who live alone may not be able to summon help, this dis-
covery often is a result of a neighbor noticing they have not seen an elder for several days.
Data suggest that 3.2% of older adult men and women age 65 years and older who live
alone will be found down each year (National Center for Health Statistics, Cohen, & Van
Nostrand, 1995).
Living alone may be related to declining health for older women with severe health
impairments. Among a group of severely impaired elderly women in Baltimore, those
who lived alone had a greater deterioration of functioning when compared to those living
126 Eshbaugh
with others (Sarwari, Freedman, Langenberg, & Magaziner, 1998). Research on the older
adult population in Hong Kong has suggested that elders who live alone, compared to
those who live with others, perceive their health more negatively (Chou & Chi, 2000). El-
ders who live alone are also more likely to enter a nursing home than elders who live with
others (Steinbach, 1992; Wolinsky, Callahan, Fitzgerald, & Johnson, 1992).
There may also be psychological ramifications of living alone for this population. Ac-
cording to Dean, Kolody, Wood, and Matt (1992), living alone may play a role in the de-
velopment of depression. Mui and Burnette (1994) also report higher rates of depressed
mood among elders living alone. Furthermore, a recent study of community-dwelling in-
dividuals ages 75 years and older suggests a strong positive relationship between living
alone and loneliness (Routasalo, Savikko, Tilvis, Strandberg, & Pitkala, 2006), a finding
corroborated by other studies (e.g., Chou & Chi, 2000; Mui & Burnette, 1994). A study
of community-dwelling Chinese elders (60 years and older) suggests that life satisfaction
may be lower for older adults living alone when compared to older adults in other com-
munity living situations (Chou & Chi, 2000).
POSITIVE PERSPECTIVES ON LIVING ALONE
International, national, and local policy has recognized the need to decrease social isola-
tion and loneliness among older adults to improve elders’quality of life (Cattan, White,
Bond, & Learmouth, 2005). Although many of these policies target older adults living
alone, living alone is not equal to being lonely (Yeh & Lo, 2004), and some have sug-
gested that elders who live alone are not a group deserving of high-risk status (Iliffe et al.,
1992). In fact, living alone is a highly valued way of life for older adults who desire to re-
main independent (Yeh & Lo, 2004). It is not surprising that older adults who value pri-
vacy also strongly prefer their own residence (Kim & Rhee, 1997). Although some may
assume that these elders living alone are in need of special intervention services, a body
of research suggests that they may not have greater physical and mental health needs
when compared to older adults in other community living situations.
Some research on the mortality rates of those who live alone has suggested that living
alone does not negatively impact survival (Davis et al., 1997; Davis, Neuhaus, Moritz, &
Segal, 1992). In fact, some research (e.g., Zimmer, 2005) has indicated that older unmar-
ried women living alone are less limited by health factors than older unmarried women
who live with their adult children or others. In addition, a recent study of older adults liv-
ing in New Mexico (both men and women) indicated that elders living alone did not have
higher rates of health problems such as diabetes, hypertension, arthritis, emphysema, and
asthma (Tomaka, Thompson, & Palacios, 2006). When subjective ratings are used to
measure health, older adults living alone rate their health more positively than older
adults living with others (Mui & Burnette, 1994). In sum, older adult women who live
Perceptions of Living Alone 127
alone seem to be no less healthy than other older adult women, and some studies even
find that they are healthier than their counterparts who live with others.
Qualitative research has pointed to the strong meaning of home to older adult women
living alone (Swenson, 1998). The sense of self appears to be connected to the home en-
vironment, and some women feel an attachment to the home that they are committed to
maintaining for as long as possible. Homes give meaning to their lives, and maintaining a
home is key to independence (Letvak, 1995). Women may also prefer the living arrange-
ment of their own home to “keep the generations separate” (Porter, 1998, p. 401) and not
burden adult children. This symbolism and importance of the home environment may be
important for professionals working with older adult women because the home may play
a somewhat intangible role in maintaining and improving women’s physical and mental
health.
PURPOSE
Although authors (e.g., Findlay, 2003) have suggested that the increase in older persons
living alone should trigger concern of social isolation, there are older adult women who
live alone and are resilient from social isolation and loneliness (Letvak, 1997). Some
older adult women even see later life aloneness as an opportunity to establish creativity
and new meaning in life. There is great variability in older women’s perceptions of living
alone and the perceived advantages and disadvantages of the living arrangement. How-
ever, little research has acknowledged elder women’s perspectives on living alone (Por-
ter, 1994). In this descriptive study, a strengths approach was taken to examine the sub-
jective perceptions older adult women living alone have of their living arrangements.
Older women were divided into three groups (negative, neutral, and positive) regarding
their perception of living alone. In addition, older women’s responses to questions about
their likes and dislikes about living alone and their levels of loneliness and depression
were explored.
METHOD
Sample
Participants were 53 older adult women (age 65 years and over) who lived alone in the lo-
cal community. Women were recruited through flyers posted at senior centers, physical
therapy clinics, doctors’offices, urgent care clinics, community libraries, bookstores, and
quilting stores. Interested participants were asked to call the researcher to determine their
eligibility and set up an appointment for an interview. Women ranged in age from 65
years to 93 years. All participants identified themselves as White/European-American.
128 Eshbaugh
Forty participants (75%) were widowed, nine participants (17%) were divorced, and 3
(6%) had never married. The remaining participant’s husband was in a nursing home with
end-stage Alzheimer’s disease. Among the 40 widows, the mean number of years since
being widowed was 12.1 (SD = 11.04, min = 0, max = 53). Of the 53 participants, 5 (9%)
indicated that their highest level of education was “less than high school,” 32 (60%) indi-
cated “high school diploma/GED,” and 16 (30%) indicated they had attended at least
some college. All except for three participants (94%) had worked outside the home dur-
ing their life, and five (9%) were currently working part-time (ranging from 5 to 20 hr per
week). Seventy-nine percent (n= 42) of the participants owned their own home. Exclud-
ing the never-married participants, only four (10%) women had lived alone before their
marriage. Only one of the four lived alone for longer than 6 months before marrying. The
remainder moved directly from their parent(s)’home into a residence with their husband.
Although the group overall was in good health, 29 participants (55%) indicated symp-
toms of arthritis and 7 (13%) indicated they had diabetes.
Procedure
Whereas one woman preferred to be interviewed at a local restaurant, the remainder of
interviews were conducted in the participants’ home. Interviews lasted approximately 1
hr and participants were compensated with a $15 gift certificate for their time. Data col-
lection began in July of 2007 and ended in November of 2007. With the exception of
measures of depression and loneliness, the questionnaire used in this study was con-
structed by the researcher.
Perceptions of living alone.
Participants were asked the following open-ended
question: “How do you feel about living alone?” All of the responses were coded as posi-
tive, negative, or neutral by the researcher. A graduate student then coded 100% of the re-
sponses to determine interrater reliability (94%). Although many participants responded
with several advantages and disadvantages of their living arrangement, the first response
given by the participant was decided to be most important for coding purposes.
Most and least enjoyable aspects of living alone.
All participants were asked
to list the three most enjoyable and three least enjoyable aspects of living alone. Most, but
not all participants were able to provide three responses for both items.
Depression.
The 10-item short-form Center for Epidemiological Studies Depres-
sion Scale (CES-D; Radloff, 1977), a self-report measure designed for the general popu-
Perceptions of Living Alone 129
lation, was used to assess depressive symptoms in participants. Respondents indicate
how many times per week they experienced each item, using a scale ranging from rare or
none of the time to most or all of the time. The internal consistency for the 20-item mea-
sure has been shown to be .85 for the general population (Radloff, 1977). Higher scores
indicate more symptoms of depression. It should be stressed that this scale measures de-
pressive symptoms and does not determine a clinical depression diagnosis. However, a
cut-off of greater than or equal to 8 has been used to indicate the presence of clinically
relevant depressive symptoms. This measure has been validated for use with older adults
(Irwin, Artin, & Oxman, 1999). Possible scores range from 0 to 30, and Cronbach’s alpha
in the present study was .80.
Loneliness.
The UCLA Loneliness Scale, a 20-item measure, was used to measure
loneliness (Russell, Peplau, & Cutrona, 1980). The scale assesses general, or global lone-
liness, and is one of the most widely used loneliness measures. The scale uses a 4-point
system (1 = I have never felt this way,to4=I have felt this way often). Possible scores
range from 20 to 80, with higher scores indicating higher levels of loneliness. Perry
(1990) indicated ranges of 20–34 for low levels of loneliness, 35–49 for moderate levels
of loneliness, and 50 and higher for moderately high or high levels of loneliness.
Cronbach’s alpha in the present study was .84.
Other variables
Participants were also asked to provide the following ratings and
indications: their health on a scale of 1–10, their closeness to neighbors on a scale of 1–3,
how many close friends lived within 50 miles of their home, how many hrs a week they
spent volunteering, their fear of living alone and the difficulty of living alone on a scale of
1–10, their daily level of pain on a scale of 1–10, and how many days per week they typi-
cally drive. In addition, participants were asked questions about their family and marital
history.
RESULTS
Perceptions of Living Alone
Thirteen percent of the participants (n= 7) had responses coded as negative, 49.1% (n=
26) had responses coded as neutral, and 37.7% (n= 20) had responses coded as positive.
Examples of negative, neutral, and positive responses are displayed in Table 1. Table 2
displays means of study variables by group (negative, neutral, and positive) and for the
sample as a whole. Because of the small sample size (and the particularly small number
of participants in the negative group), no inferential statistics were performed on this
130 Eshbaugh
data. Although caution should be applied when making conclusions based on group com-
parisons, it may be useful to look at trends in the descriptive data. The positive group was
the youngest group (M= 72.45 years; SD = 7.63), and the negative group was the oldest
(M= 82.71 years; SD = 5.31). In addition, self-rated health appeared to differ between the
three groups; the positive group’s self-rated health mean was 8.20 (SD = 2.04), whereas
the neutral (M= 7.19; SD = 2.17) and negative (M= 6.57; SD = 1.90) groups perceived
their health more negatively. Interestingly, the negative group had lived alone (M= 6.71
years; SD = 3.63) for about half of the length of time of the neutral group (14.39 years; SD
= 15.76) and the positive group (12.60 years; SD = 9.58). The negative group (M= 7.71;
SD = 2.28) also perceived the difficulty of living alone as greater than the neutral (M=
3.88; SD = 2.28) and positive (M= 2.30; SD = 1.45) groups. The negative group (M=
9.71; SD = 2.87) appeared more depressed than the neutral (M= 8.65; SD = 5.84) and
positive (M= 4.35; SD = 4.35) groups.
Perceptions of Living Alone 131
TABLE 1
Examples of Negative, Neutral, and Positive Responses
Negative (n = 7) Neutral (n = 26) Positive (n = 20)
“I don’t like it but there’s nothing I
can do.”
“I don’t mind it.” “I enjoy it. I do what I want. I love being
so blinkin’ independent.”
“I hate it.” “I get along okay.” “I’m perfectly content here.”
“It’s really lonely.” “I’m used to it now.” “I love it.”
“I can’t stand the quiet.” “It’s better than a nursing home.” “I could never live with someone else
ever again.”
“It surely wouldn’t be my choice.” “It’s alright. I can handle it okay.” “I didn’t think I’d like it as much as I do.”
“It’s the hardest adjustment I’ve had
to make in my life.”
“It’s not easy, but being here is my
choice.”
“It certainly has its advantages.”
TABLE 2
Differences by Response Type
Negative (n = 7) Neutral (n = 26) Positive (n = 20) Total (N = 53)
Age 82.71 (5.31) 78.50 (8.18) 72.45 (7.63) 76.77 (8.37)
Length of time (yrs.) lived alone 6.71 (3.63) 14.39 (15.76) 12.60 (9.58) 12.71 (12.68)
Number of living children 5.14 (1.46) 2.19 (1.74) 4.20 (1.47) 3.33 (1.97)
Children living within 50 miles 2.85 (.89) 1.04 (1.40) 2.35 (1.87) 1.77 (1.69)
Health (1–10) 6.57 (1.90) 7.19 (2.17) 8.20 (2.04) 7.49 (2.14)
Neighbor closeness (1–3) 2.71 (.49) 2.15 (.88) 2.40 (.68) 2.32 (.78)
Friends w/in 50 miles 1.86 (2.34) 2.27 (3.82) 2.45 (2.16) 2.28 (3.07)
Volunteer hours 1.43 (2.93) 2.92 (4.68) 2.40 (4.59) 2.52 (4.41)
Fear (1–10) 2.14 (2.19) 2.08 (1.85) 2.50 (2.14) 2.25 (1.98)
Difficulty (1–10) 7.71 (2.28) 3.88 (2.76) 2.30 (1.45) 3.79 (2.82)
Pain (1–10) 4.28 (1.98) 3.38 (1.96) 3.35 (2.56) 3.49 (1.69)
Days drive 2.57 (1.51) 4.88 (2.80) 4.20 (2.42) 4.32 (2.60)
Loneliness 29.14 (3.53) 30.12 (8.54) 26.90 (6.31) 28.77 (7.30)
Depression 9.71 (2.87) 8.65 (5.84) 4.35 (2.80) 7.17 (5.02)
Most and Least Enjoyable Aspects of Living Alone
Participants were also asked about the three most and least enjoyable aspects of living
alone. Ten of the 53 participants (19%) were unable to come up with three enjoyable as-
pects, and two participants (4%) said there were no enjoyable aspects. Common re-
sponses were being one’s own boss/being independent (n= 27; 51%), keeping one’s own
schedule (n= 26; 49%/), being able to eat what one wants (n= 22; 42%), having control
of the TV/remote control (n= 20; 38%), having quiet around the home (n= 9; 17%), not
having to cook (n= 7; 13%), not having to take care of anyone (n= 6; 11%), not feeling
obligated to keep the home clean (n= 5; 9%), and having the bed to one’s self (n= 3; 6%).
Nine of the 53 participants (17%) were unable to come up with three aspects of living
alone that they did not find enjoyable, and three participants (6%) responded that there
were no aspects of living along that they did not enjoy. Common responses for least en-
joyable aspects were lack of companionship/no one to share things with/loneliness (n=
33; 62%), no one to help with housework (n=19; 36%), fear of getting hurt/falling (n=
16; 30%), no one to help make decisions (n= 9; 17%), home is too quiet (n= 9; 17%), and
home maintenance (plumbing, electrical, yard work; n = 8; 15%).
Depression and Loneliness
Actual CES-D scores ranged from 1 to 19 (possible range 0 to 40). Overall, 41.5% (n=
22) of participants had a score equal to or greater than 8 on the CES-D short form, indi-
cating depressive symptoms of clinical significance. Within the negative group, 71.4% (n
= 5) of the participants had depressive symptoms of significance. This percentage was
53.8% (n= 14) for the neutral group and 5% (n= 3) for the positive group. Actual loneli-
ness scores ranged from 20 to 45 (possible range 20 to 80). Examination of the entire
sample revealed that no participants reached moderately high levels of loneliness, and
22.6% (n= 12) indicated moderate levels of loneliness. Whereas no women in the nega-
tive group reached moderate levels of loneliness, 38.5% (n= 10) of the women in the neu-
tral group and 10% (n= 4) of the participants in the positive group indicated moderate
levels of loneliness.
DISCUSSION
This data points to the tremendous heterogeneity in older adult women’s perceptions of
living alone. Although participants lived in the same area and identified with the same
ethnic background, women’s perceptions of living alone ranged from extremely negative
to extremely positive. In addition, most women viewed living alone as neither all positive
132 Eshbaugh
nor all negative. Most (64%) were able to identify both positives and negatives to their
living arrangement.
Only seven of the 53 participants perceived living alone negatively. The vast majority
of women in this study (87%) viewed living alone either positively or neutrally. This is
not to imply that this 87% did not see negative aspects of living alone. However, when
asked how they felt about living alone, their first response was not negative. The majority
of the women in this study were living alone for the first time in their lives; most did not
live alone before marriage. The findings imply that although many women must adjust to
living alone for the first time late in life, they are able to successfully adapt to their new
living arrangement. Professionals should be encouraged by this, particularly when one
considers that several women who perceived living alone positively lost their husband to
death when they were 75 years old or older.
Which women appear to be likely to perceive living alone negatively? Although the
sample size was too small to perform inferential statistics, future researchers may want to
explore some of the trends seen in this sample. For instance, women who negatively per-
ceived living alone appeared to be older; however they also had lived alone for a shorter
period of time. It would be useful to determine whether these trends are evident in larger
data sets. Participants who negatively perceived living alone were also likely to be in
poorer self-reported health than other participants. Only longitudinal datasets with larger
samples could determine whether a person’s perception of living alone changes as their
health, age, and time living alone change.
What do older adult women enjoy about living alone? Although many mention the
value of independence, many participants also mention what could be considered small
pleasures: having control of the remote and TV, being able to eat when one wants, having
the bed to one’s self, and not having to cook. In fact, several women confided that widow-
hood brought the revelation that after 40 years of cooking, they really didn’t like to cook
at all! Of course, other women may miss having loved ones for which to cook. What do
older adult women dislike about living alone? More than half of the participants cited
having no one to share day-to-day experiences with, or lack of companionship. Although
most were not significantly lonely overall, this implies that they do sometimes experi-
ence aspects of loneliness. Women also mentioned having no one to help with housework
and home maintenance as well as fear of falling as disadvantages of living alone. Perhaps
these responses reflect the participants’ fear of having to leave their home because they
cannot keep up with home tasks or are unable to maintain physical safety. Previous re-
search (e.g., Letvak, 1997; Swenson, 1998) has suggested the importance and value of
maintaining one’s home environment for similar women.
About 40% of the participants showed clinically significant symptoms of depression.
However, this should be interpreted with caution because the measure used (CES-D)
does not diagnose depression. Although a significant majority reported clinically signifi-
cant depressive symptoms, the range of scores (1 to 19) was large. In fact, 17% of the
sample scoreda1onthemeasure. In summary, some older adult women have significant
Perceptions of Living Alone 133
depressive symptoms, but many do not. This heterogeneity emphasizes the importance of
assessing depression rather than making assumptions based on an older adult woman’s
living situation. Although participants showed varying levels of loneliness, none of the
participants indicated levels of significant loneliness reaching more than moderate. This
finding is encouraging, as this group of women seems to have maintained satisfying so-
cial networks despite living alone. Although this may not be true for all older adult
women living alone, this sample suggests that for women elders, living alone does not
necessarily equate to loneliness.
Although this exploratory study has yielded interesting and useful findings, conclu-
sions must be limited for several reasons. The small, homogeneous, convenience sample
included 53 European-American older adult women living alone. Obviously, this study
may lack generalizability. On a scale of 1 to 10, women’s responses regarding their
self-perceived health ranged from 3 to 10. However, the mean (7.49) indicated that this
was a sample in good health. This is not surprising, because women in poorer health
might be unlikely to initiate involvement in the study. Older adult women living alone
who perceive their health as very poor are certainly a population deserving of more atten-
tion. Women in our sample also averaged 2.5 hrs per week of community service work
(mostly through church). This indicates that perhaps women who wished to be involved
in the study were more active and community-minded than other women living alone.
Older adult women who live alone and are quite isolated from the community may have
not been included in our sample. In addition, this study was cross-sectional rather than
longitudinal. Data yielded a snapshot of older adult women living alone, whereas a longi-
tudinal study might tell a story that it is not possible to uncover with this methodology. It
is impossible to determine how perceptions of living alone may change across time with
cross-sectional data collection. It would be reasonable to assume that feelings about liv-
ing arrangements are dynamic rather than static, but this study cannot address this as-
sumption. For instance, some longitudinal research using small samples (e.g, Morrissey,
1998) suggests that women who live alone tend to see a change in the nature of interac-
tion (from independent to dependent) as time progresses.
IMPLICATIONS
How would this information be used by community nurses? Nurses should be aware that
although some have perceived older adult women living alone as a vulnerable population,
these women vary tremendously and one cannot make assumptions based on living ar-
rangements. Whereas some older adult women living alone may be in need of services
that provide social connection, many are not. Some women may be at-risk for depression,
but others are very satisfied with their lives and living situations. The only way to distin-
guish these women is to thoroughly assess them as individuals. Furthermore, similar fea-
tures of living alone may be perceived differently by different women. For instance,
134 Eshbaugh
many women mentioned that their house was “quiet.” However, some indicated this was
a positive and others indicated this was a negative. Participants also mentioned a change
in eating and cooking habits when transitioning to living alone. Yet, several women saw
being able to eat when they wanted and to only cook when they felt like it as a perk of liv-
ing alone. Others missed sitting down to a meal with a loved one. When a woman indi-
cates to community nurses that her home is quiet or that she doesn’t cook anymore, the
nurses should take the time to determine whether the woman views that as an advantage
or disadvantage of her living arrangement. This understanding will help to ensure clients’
voices are heard when suggesting programs and interventions.
Nurses should also be aware of the enjoyment that older adult women may obtain from
living alone, even if it requires an adjustment late in life. This enjoyment may make older
adult women more resistant to suggestions of a change in living arrangement, whether
that suggestion is to move in with family or to a facility (e.g, assisted living, nursing
home). A change in living situation may require giving up control of the remote and the
flexibility to eat when one wants, both of which were appreciated by the participants in
the study. Also, when providing information about resources, nurses should be aware
than many women’s dislikes about living alone pertain to not having help with house-
work and home maintenance. Perhaps providing suggestions about obtaining assistance
in these areas, particularly at a low-cost, would help women to increase their enjoyment
of living alone. Many women also indicated a fear of falling in the home. Nurses can pro-
vide information about services that alert loved ones and emergency services to a prob-
lem with the elder. Perhaps by helping women obtain resources to minimize these dis-
likes, nurses can assist elder women, particularly those who perceive living alone
positively, in remaining in their homes. As a nurse, one should recognize that even older
adult women who have never lived alone before can successfully adapt to their new living
arrangement and learn to appreciate the small pleasures of living alone.
REFERENCES
Bureau of the Census and National Institute on Aging. (1993). Profiles of America’s Elderly: Living Ar-
rangements of the Elderly. No. 4. Washington, DC: US Department of Commerce and US Department of
Health and Human Services.
Campion, E. W. (1996). Home alone, and in danger. The New England Journal of Medicine, 334, 1738–1739.
Cattan, M., White, M., Bond, J., & Learmouth, A. (2005). Preventing social isolation and loneliness
among older people: A systematic review of health promotion interventions. Ageing & Society, 25,
41–67.
Chandler, J., Williams, M., Maconachie, M., Collett, T., & Dodgeon, B. (2004). Living alone: Its place in
household formation and change. Sociological Research Online, 9(3).
Chou, K. L., & Chi, I. (2000). Comparison between elderly Chinese living alone and those living with others.
Journal of Gerontological Social Work, 33, 51–66.
Costa, D. L. (1999). A house of her own: Old age assistance and the living arrangements of older nonmarried
women. Journal of Public Economics, 72, 39–59.
Perceptions of Living Alone 135
Davis, M. A., Moritz, D. J., Neuhaus, J. M., Barclay, J. D., & Gee, L. (1997). Living arrangements, changes
in living arrangements, and survival among community dwelling older adults. American Journal of Pub-
lic Health, 87, 371–377.
Davis, M. A., Neuhaus, J. M., Moritz., D. J. & Segal, M. R. (1992). Living arrangements and survival among
middle-aged and older adults in the NHANES I Epidemiologic Follow-Up Study. American Journal of
Public Health, 82, 401–406.
Dean, A., Kolody, B., Wood, P., & Matt, G. E. (1992). The influence of living alone on depression in elderly
persons. Journal of Aging and Health, 4, 3–18.
Findlay, R. A. (2003). Interventions to reduce social isolation amongst older people: Where is the evidence?
Ageing & Society, 23, 647–658.
Gurley, R. J., Lum, N., Sande, M., Lo, B., & Katz, M. H. (2001). Persons found in their homes helpless or
dead. New England Journal of Medicine, 334, 1710–1716.
Iliffe, S., Tai, S. S., Haines, A., Gallivan, S., Goldenberg, A. B., & Morgan, P. (1992). Are elderly people liv-
ing alone an at risk group? British Medical Journal, 305, 1001–1005.
Irwin, M., Artin, H, A., & Oxman, M. N. (1999). Screening for depression in the older adult. Archives of In-
ternal Medicine, 159, 1701–1704.
Jenkins, C. L. (2003). Introduction: Widows and divorcees in later life. Journal of Women & Aging, 15, 1–6.
Kim, C., & Rhee, K. (1997). Variations in preferred living arrangements among Korean elderly parents. Jour-
nal of Cross-Cultural Gerontology, 12, 189–202.
Kinsella, K. (1995). Aging and the family: Present and future demographic issues. In R. Blieszner & V. H.
Bedford (eds.), Handbook of aging and the family (pp. 32–94). Westport CT: Greenwood Press.
Kramarow, E. A. (1995). The elderly who live alone in the United States: Historical perspectives on house-
hold change. Demography, 32, 335–353.
Letvak, S. (1997). Relational experiences of elderly women living alone in rural communities: A
phenomenological inquiry. Journal of the New York State Nurses Association, 28, 20–25.
Macunovich, D. J., Easterlin, R. A., Schaeffer, C. M., & Crimmins, E. M. (1995). Echoes of the Baby Boom
and bust: Recent and prospective changes in the living alone among elderly widows in the United States.
Demography, 32, 17–28.
Morrissey, S. (1998). Resources and characteristics of elderly women who live alone. Health Care for
Women International, 19, 411–421.
Mui, A. C., & Burnette, J. D. (1994). A comparative profile of frail elderly persons living alone and those liv-
ing with others. Journal of Gerontological Social Work, 21, 5–26.
Nakonezny, P. A., Rodgers, J. L., & Nussbaum, J. F. (2003). The effect of later life parental divorce on
adult-child/older-parent solidarity: A test of the buffering hypothesis. Journal of Applied Psychology, 33,
1153–1179.
National Center for Health Statistics, Cohen, R. A., & Van Nostrand, J. F. (1995). Trends in the health of
older Americans: United States, 1994. Washington, DC: Government Printing Office.
Perry, G. (1990). Loneliness and coping among tertiary level adult cancer patients in the home. Cancer
Nursing, 13, 293–302.
Porter, E. J. (1998). Older widows’intention to keep the generations separate. Health Care for Women Inter-
national, 19, 395–410.
Porter, E. J. (1994). “Reducing my risks”: A phenomenon of older widows’lived experience. Advances in
Nursing Science, 17, 54–65.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general popula-
tion. Applied Psychological Measurement, 1, 385–401.
Routasalo, P. E., Savikko, N., Tilvis, R. S., Strandberg, T. E., & Pitkala, K. H. (2006). Social contacts and their
relationship to loneliness among aged people—A population-based study. Gerontology, 52, 181–187.
Russell, D., Peplau, L. A., & Cutrona, M. (1980). The revised UCLA Loneliness Scale: Concurrent and
discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472–480.
Sarwari, A. R., Freedman, L., Langenberg, P., & Magaziner, J. (1998). Prospective study on the relation be-
tween living arrangement and change in functional health status of elderly women. American Journal of
Epidemiology, 147, 370–378.
136 Eshbaugh
Steinbach, U. (1992). Social networks, institutionalization, and mortality among elderly people in the United
States. Journal of Gerontology: Social Sciences, 47, S183–S190.
Stroup, A. L., & Pollock, G. E. (1999). Economic well-being among white elderly divorced. Journal of Di-
vorce & Remarriage, 31, 53–69.
Swenson, M. M. (1998). The meaning of home to five elderly women. Health Care for Women International,
19, 381–393.
Tomaka, J., Thompson, S., & Palacios, R. (2006). The relation of social isolation, loneliness, and social sup-
port to disease outcomes among the elderly. Journal of Aging and Health, 18, 359–384.
Wolinsky, F. D., Callahan, C. M., Fitzgerald, J. F., & Johnson, R. J. (1992). The risk of nursing home place-
ment and subsequent death among older adults. Journal of Gerontology: Social Science, 47, S173–S182.
Yeh, S. J., & Lo, S. K. (2004). Living alone, social support, and feeling lonely among the elderly. Social Be-
havior and Personality, 32, 129–138.
Zimmer, Z. (2005). Health and living arrangement transitions among China’s oldest-old. Research on Aging,
27, 526–555.
Perceptions of Living Alone 137
