ORCID Identifier(s)


Graduation Semester and Year




Document Type


Degree Name

Doctor of Philosophy in Social Work


Social Work

First Advisor

Vijayan Pillai


Elder orphan is a term popularized by the media to describe the more than 22% of community-dwelling US adults aging alone with limited social support, social isolation, multiple chronic health issues, and childlessness. Elder orphans who have not initiated advance directives are at risk of becoming unbefriended, having no able or willing family or friends to make medical decisions during acute injury or medical crisis. The purpose of this explanatory sequential mixed-methods study was to understand the determinants of well-being and advance care planning. A cross-sectional analysis of members (n = 368) of an online Facebook group of elder orphans was conducted followed by an interpretative phenomenological analysis of in-depth interviews with (n = 6) volunteer participants. Hierarchical regression revealed income, adverse childhood experiences, discrimination, social network, and multiple health issues were found to be significant predictors of well-being among elder orphans, whereas mid-life events were not significant predictors of well-being among elder orphans. Contradictory to prediction, higher levels of well-being increased the likelihood of having advance directives while perceived risk of incapacitation had no influence on the likelihood of having advance directives. The qualitative follow-up interpretative phenomenological analysis revealed four sub-ordinate themes: (1) the road to elder orphanhood: making meaning of the past; (2) a sudden halt: caregiving experiences and consequences; (3) connecting and trying to connect; and (4) barriers and future concerns. This study represents a unique and valuable examination of an under-studied group of older adults, who are often unidentified by health care professionals.


aging, elder orphan, unbefriended, advance directives


Social and Behavioral Sciences | Social Work


Degree granted by The University of Texas at Arlington

Included in

Social Work Commons