Old, Alone and ‘Found Down’

A study published in the New England Journal of Medicine last week documents a growing problem for which the medical community has “no treatment plans”: an alarmingly high death rate in patients who were “found down"--unable to get up or even reach a telephone. Some patients had been on the floor for several days, and many of the deaths, said the study’s authors, were due to dehydration, hypothermia or infection.

An increasingly familiar sight in emergency rooms is the stuporous, dehydrated patient brought in by ambulance; “found at home” often is the only information immediately available. Most turn out to be people who lived alone.

Although our individualist culture is a primary cause, much can be done. In the short-term, doctors and the public need to be educated about small electronic devices that enable solitary elderly people to contact relatives, social workers or paramedics in an emergency. Early communication is crucial: Mortality in the study was 67% for those estimated to have been helpless for more than 72 hours but only 12% for those helpless for less than one hour.

The best way of protecting the elderly from the dangers of isolation is obvious: offering them more opportunities to live in communities that provide safety as well as independence. Today, many solitary senior citizens find themselves with only two stark options: living alone in an unsupervised setting or living with others in an expensive nursing home.


Fortunately, the marketplace has begun crafting a third option. Driven by the aging of America’s population (one in 25 Americans was 65 or older in 1900, one in eight is today, and one in six will be in 2020), corporations have begun investing in “assisted-living facilities” that offer supervision as well as group activities. But while these facilities are often marketed slickly--one calls itself a “cruise ship without water"--their quality is uneven.

Such facilities will never be able to compare with naturally evolving elderly communities like the lively Shalom Retirement Hotel that Lithuanian refugees from the Holocaust built three decades ago in Hollywood. But at the very least they should combine supervision with opportunity, enabling senior citizens, as the Roman poet Horace put it many centuries ago, to “pass an old age lacking neither honor nor the lyre.”