Flying Solo and Thriving

Living alone brings special challenges, but the support of friends and family and a regular routine can help you stay healthy and connected

Edith Rish has lived a full and busy life. With her late husband, Harold, she ran a family florist business in West Columbia, S.C., for many years. After her husband’s death in 1986, she continued to work at Rish Florist, finally retiring last year and leaving the business operations to her son.

Now 76, Rish lives alone. Since 1994 she also has managed her diabetes on her own, although her children, who live nearby, keep in close touch. "I have four children who tell me exactly what I have to do," she laughs. "They check on me often enough so I know that I can’t get by with anything."

Managing diabetes is "not that bad," says Rish. "I do pretty well most of the time. I make sure that I have breakfast first thing in the morning, and I go to an exercise program for seniors four times a week. But there are times that I do find it difficult. I haven’t learned how to cook for one."

Rish may be alone, but she is not unusual. In the 1950s, when Rish and her husband launched their business, just 9 percent of American households consisted of people living alone. According to the most recent figures from the U.S. Census Bureau, the proportion of one-person households increased from 17 percent of the population in 1970 to 26 percent — some 
75 million people — in 2005.

Valerie Summerset, a registered nurse and certified diabetes educator who for 10 years has led the diabetes program 
at Lexington Medical Center in West Columbia, worries about her elderly diabetic patients, especially those who live alone. Edith Rish — whose diabetes Summerset discovered during a routine blood test at a local mall — is one of them.

"We advise patients to be creatures of habit — to try to do very similar things every day, and be very regimented about it."

"We have to monitor them more often," says Summerset, who works both with groups and with patients one on one. "My fear is that they will let their blood sugar go too low. Food can be a real challenge because people living alone often don’t want to cook for themselves. They might eat a candy bar for dinner, or go to fast-food places or pop something in the microwave. But many convenience food items are very poor nutritionally."

In addition to leading educational sessions about diabetes, Summerset runs a support group for seniors with type 2 diabetes, and she encourages participants to bring a friend or family member along. She advises all her patients to get out of the house and get involved in the community.

"I get them into the leisure center or their church, or I get them to volunteer here at the center — anything to get them away from sitting in front of the TV set," she says. "Talking to other people with diabetes and retirees who have similar issues really helps. They get to know each other; they have birthday parties and other fun events. Depression goes along with diabetes, and all seniors face tough life events. Being in a group keeps them part of the living."

Finding support

Rish, who participates in Summerset’s support group, agrees. "Hearing the people in the group really helps," Rish says. "It makes you understand that other people have the same problems you have. Going to the meetings gives you reinforcement when you’re feeling overwhelmed. And we all feel that way sometimes."

Rish’s routine of exercise, trying to eat right, and getting support from her diabetes educator and her support group is working. "Things are really looking pretty good," she says. "My A1C is staying pretty much between 6.5 and 7.0, and has been that way a good, long while."

Enlisting a health care team to help monitor your condition is critical for people managing diabetes on their own. "My biggest concern for diabetes patients living alone is for hypoglycemic events where their blood sugar goes too low," says Dr. William M. Gregg, a physician in Nashville, Tenn., who works with a large population of elderly patients and people with diabetes. He suggests that the best way to prevent hypoglycemia is regular blood glucose monitoring. But the challenge for anyone with diabetes — including seniors — is that the care routine can be complex. "They’re trying to time things, or using insulin, or counting carbs. They have to take into account a lot of different factors," he says.

A proactive physician can help minimize the risk by being very clear with patients about what they need and how to follow instructions. "For example, there are pre-filled syringes with larger writing on them, and pillboxes with days of the week. There are lots of things that can be visual or auditory that can help people do things at the right time," Gregg says.

"Depression goes along with diabetes, and all seniors face tough life events. Being in a group keeps them part of the living."

Keeping in touch with your health care provider is important too. "Our patients communicate their blood sugars to us all the time," he says. "They’ll call and say, ‘Here are my sugars,’ and we can make adjustments over the phone. If I make a change in their medicine I will call them in a couple of days. A phone call or a messaging system can go a long way for patients who are at high risk."

Gregg encourages his patients who live alone to get to know their neighbors, to bring a friend or family member to appointments so more than one person knows the instructions, to enlist the help of a care team including a diabetes educator and/or a social worker, and to consider investing in an emergency call button. "They are lifesavers," Gregg says. Most important, "We advise patients to be creatures of habit — to try to do very similar things every day, and be very regimented about it."

Sticking with a routine

That works for Harold G. "Hal" Tufty, 87, a former Foreign Service officer and engineering consultant. After postings in France, India and Africa, Tufty now lives on his own in the rambling Washington, D.C., house where he and his wife, Barbara, who died in 2008, raised their children. Tufty controls his diabetes with insulin injections, and he says
he has his routine down.

"First thing in the morning I check my blood sugar with the little gadget, because I have been told to do that," he says. "I do what the doc tells me. I’m an engineer: If there’s a rule, follow the rule. Then I take 25 units of insulin. I go ahead and whip out my trusty syringe and load it up and zap away. You poke and it’s a skinny needle. Nothing much to it. I do it before I get dressed and before I go downstairs. It’s all part of the waking-up routine."

Tufty gets his medical care through the Veterans Administration. "They’re nice folks, and the price is right," he says. His next-door neighbors keep an eye on him, and his three children — two sons on the West Coast and a daughter in New York State — keep in close touch via e-mail, phone and even Facebook, an online social network.

"When I can’t run this place anymore, I will move in with one of the kids," says Tufty. "But for now I am enjoying sitting on my front porch and watching the world go by."