With no relatives and no friends, replace the person watching you with a neighbor who can enter the home, a place on the community visit list, and an emergency contact in the phone

When there is no relative and no friend, what has to be covered is this: if something happens, someone finds you, and on ordinary days you take medicine and eat on time. Medicine and meals are on you. Write them as a list, and set an alarm. Do not rely on memory. Someone finding you rests on a neighbor being left a spare key, on asking the residents' committee whether you can be put on the visit-and-care list, and on the phone having an emergency contact set, and not being switched off.

Cost

No money. The hard part is opening your mouth first, and saying to a neighbor and to the residents' committee (居委会), "I live alone, and something has just happened at home."

Benefit

44573 outpatients, each with a risk or a history of atherothrombosis (plaque in the vessels, the kind of trouble that a clot can block). Doctors in many countries registered them into the international project REACH and followed them. They were enrolled from December (12) 2003 to December (12) 2004, and followed for 4 years. Of them, 8594 (19%) lived alone. Over those 4 years, death from all causes together was 14.1% for people living alone and 11.1% for people living with others. Cardiovascular death was 8.6% against 6.8%. Both log-rank P<0.01, so the difference is unlikely to be chance. The gap was not the same at every age (interaction P=0.03). From 45 to 65, death for living alone against living with others was 7.7% against 5.7%. After other circumstances were leveled, the HR was 1.24 (95% CI 1.01–1.51), that is, about 24% higher. From 66 to 80 it was 13.2% against 12.3%, HR 1.12 (1.01–1.26), about 10% higher. Over 80 it was 24.6% against 28.4%, HR 0.92 (0.79–1.06), and no rise was seen. A 2022 opinion of the Ministry of Civil Affairs (民政) and the other departments with it says visit-and-care services are to be carried out. The people covered are elders who live alone, elders in an empty nest, elders left behind, elders who have lost the ability to care for themselves, elders with a severe disability, and elders in a special family-planning household. The service is "regular visits into the home, telephone or video, and remote monitoring." The township (or subdistrict) does the survey, and the villagers' committee or the residents' committee assists. They keep basic information and "willingness to receive visit-and-care services," and bring the person into grassroots grid management (a named person watches each patch). By the end of 2025, "make sure the monthly visit rate for elders in special difficulty reaches 100%," and "for elders in special difficulty who have lost the ability to care for themselves, visit-and-care is no less than once a month." The document also encourages the household to set up a smart call system, a smart electricity meter and water meter, health-monitoring products, and an elder-care monitoring device, so that "once monitoring is abnormal, a warning can be given in time, and a prompt is sent to the emergency contact at the same moment." If service staff find an urgent problem, they "shall help call the emergency number right away."

Notes

How to do the practical parts. First, give a spare key, or the temporary code for the door lock, to a neighbor or to the property manager, and tell them "I am alone these days." No friendship is required. Someone only needs to know you are in the room. Second, go to the community residents' committee, say you live alone, and ask whether you can be put on the visit-and-care list. Among elders, living alone, an empty nest, and having lost a child are service targets the official text names. Also ask whether the locality has a smart caller or a smart water meter that is installed free of charge. Third, set an emergency contact and a medical emergency card on the phone, and do not silence it or switch it off these days. The grade is B for a pair of reasons. The link between living alone and mortality comes from studies that looked back through population records. They cannot remove the reverse reading that people who were already in worse health, and in worse circumstances, are more likely to live alone. The original paper itself says this result still awaits confirmation. The visit-and-care document covers elders only. Under 60 there is no matching special system. What can be counted on is a line in another document. It requires grid workers and social workers to "find in time the psychological-crisis risks of a family blow, job loss, dropping out of school, and the like" (see item 11 of this section: if you need someone to talk with you, call 12356). Why "someone in the room" is worth something: see section 13, item 1 (pressing on the chest). Of cardiac arrests that happen outside a hospital, 79.2% happen at home. When someone nearby does compressions, 16.1% leave the hospital alive. When nobody does, only 3.9% do. Nobody in the room means you fall in the lower band. Further things are already at hand. The funeral itself means trips to the funeral home, the community health service, the public security bureau, and the housing provident fund (公积金), several windows (see section 25). Set those trips up as a fixed schedule of going out once a day, and the outings for these days are already there. The hotline can be called again and again. It is not limited to a single call (see item 11 of this section: if you need someone to talk with you, call 12356). "Living alone" is also a long-run risk factor. The mortality ratio for living alone is 1.32, about 30% higher; see section 22, item 9 (treat meeting people on a regular schedule as a health expense). This item only covers these days in front of you. The long-run account is counted separately.

Sources · 2

1. Udell JA, et al. (2012). Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. Archives of Internal Medicine. doi.org/10.1001/archinternmed.2012.2782
2. 民政部等十部门 (2022). 关于开展特殊困难老年人探访关爱服务的指导意见（民发〔2022〕73 号）. gov.cn/zhengce/zhengceku/2022-10/13/content_5…