UCSF Researcher Challenges Myth of Elderly Independence

By Juliana Bunim

Forty percent of San Franciscans over the age of 75 live alone and nearly one third of them live in poverty. "Luke," age 76, is one of them, living in an single-room-occupancy (SRO) hotel in the Tenderloin and desperately wanting a one-bedroom apartment of his own.

Elena Portacolone, a PhD candidate in Medical Sociology in the UCSF School of Nursing, has dedicated hours to interviewing Luke among other elderly residents, as part of her ethnographic fieldwork to learn more about this often neglected – but growing – segment of society.

For her dissertation project, titled “Precariousness among older adults living alone in San Francisco: An ethnography,” Portacolone delivered food as Meals on Wheels volunteer and spent time with 47 San Franciscans over age 75 living alone with different ethno-racial backgrounds, speaking different languages, and representing diverse sexual orientations.

Portacolone discovered that there are many reasons the San Francisco elderly live alone – some by choice, others by accident, and some by necessity because of rules such as those of low rent apartments with conditions that they live alone. But for many of them, living alone is not a sign of greater independence, but of having limited options.

This is what she calls the “myth of independence.” Many older Americans consider living alone and remaining independent in their retirement years as a triumph. But the reality is often isolation, depression and unmet needs.  “The reluctance to ask for help often goes hand in hand with the pursuit of independent living,” said Portacolone. “Not depending on others and being free to make their own decisions often comes at a great expense.”

Portacolone is part of UCSF’s doctoral program in sociology, which is housed in the Department of Social and Behavioral Sciences (SBS), one of four departments of instruction and research in the School of Nursing. The substantive focus of the program is in the sociology of health, illness, biomedicine and health care systems. Portacolone credits the program with expanding her research into new territory. “Sharon Kaufman, a professor of medical anthropology in the Institute for Health & Aging was always pushing me to go beyond my boundaries and not focus on just independence and what’s beneath,” she said.

Aging in America

As the first round of baby boomers hit 65 years old this year, an unprecedented number of Americans will be confronted with concerns about health, financial security and other issues in the next ten years. According to AARP, between Jan. 1 and Dec. 31, 2011, more than 7,000 people will turn 65 years old every single day. And as many of them will strive to remain independent and not rely on or be a burden to others, for some it will result in a compromised quality of life and care.

Portacolone was first interested in studying alternatives to nursing homes. But as she started her research she realized seniors were living alone and not sharing their problems with anyone. “They are living with credit card debt, depression and isolation,” she said. “So I started moving my focus to the bigger phenomena of living alone in older age.”

Her subject Luke lives in a single room occupancy hotel in the Tenderloin, where space is so compressed there is barely room for a single bed. When Portacolone interviews him, she sits in the only chair as Luke perches on the bed, his polished black shoes hovering in the air. The rest of the room is filled by a fan blowing hot air, a TV surmounted by a DVD player, a small table, books on the floor, DVDs and CDs amassed over the ironing board, bags with clothes on the floor, the tower of a small fridge topped by a microwave topped by an electric grill, and an old rice cooker sitting on the floor beside.

“Something that really struck me when I was interviewing all these people was the idea of the ground falling out from beneath your feet,” said Portacolone. “Resources that were available in the past are not available any longer, and services these people thought they were easy to find are not affordable.

Portacolone’s subjects live in a precarious state where “a lot of friends have died or are institutionalized and family members don’t know the struggles of living alone because the informants don’t want to be a burden to the families,” she said. 

Luke, more than anything, wants to move into a one-bedroom apartment and his physician and social worker put together an application for him to access public housing, but it was rejected. He relies on his social worker to help him navigate the system.

"At the end of the day, when I come home, and I open my door, I want to be able to come to my living room. And then go into my kitchen, and start to prepare dinner for myself. And after dinner is ready, I want to be able to bring it to a dining table and sit down and have a wonderful dinner," Luke said describing the life he wants beyond his single room.

“Even though Luke would qualify for public services because of his low income, there are only five one-bedroom apartments in section 8 housing in San Francisco and the public housing authority closed the list for vouchers eight years ago,” said Portacolone.  “A very good social worker makes a very big difference but it’s hard because social workers are overloaded with clients and the system is hard to navigate for them too. It’s challenging for everyone.” 

Portacolone hopes her research will inspire more people to study the elderly and devote resources to this often neglected group. "It's time to talk about this," she said. "People need to understand the challenges these seniors struggle with every day and they need to be recognized."

Photos by Susan Merrell