If you have no relatives and no friends, replace “the person who keeps watch on you” with three things: a neighbor who can get into your home, the community's visit list, and an emergency contact in your phone

If you are thinking about suicide right now, call or text 988. If you are in immediate danger, call 911.

Cost

Free. The hard part is speaking up first and telling the neighbor and the residents' committee (居委会): “I live alone, and something has just happened at home.”

What you get

44,573 outpatients, all with atherothrombosis risk or a history of it (the kind of condition where plaque builds up in blood vessels and clots can block them). They were registered by doctors from many countries into an international program called REACH and followed, enrolling from December 2003 to December 2004 and followed for 4 years. Of them, 8,594 (19%) lived alone. Over 4 years, deaths from all causes added together were 14.1% in those living alone and 11.1% in those living with others. Cardiovascular death was 8.6% versus 6.8%. Both log-rank P<0.01, so the difference is unlikely to be chance. The gap differed by age group (interaction P=0.03). At ages 45 to 65, deaths for living alone versus living with others were 7.7% versus 5.7%. After adjusting for other conditions HR was 1.24 (95% CI 1.01–1.51), about 24% higher. At 66 to 80 it was 13.2% versus 12.3%, HR 1.12 (1.01–1.26), about 10% higher. At over 80 it was 24.6% versus 28.4%, HR 0.92 (0.79–1.06), with no increase seen. A 2022 opinion from ten departments including the Ministry of Civil Affairs (民政部) provides that visit and care services are to be carried out. The targets are older adults who live alone, are empty-nesters, are left behind, have lost the ability to care for themselves, have severe disabilities, or are from families with special circumstances under family planning (计划生育特殊家庭). The service methods are “regular home visits, phone or video contact, and remote monitoring.” Townships (subdistricts) survey and check, with village (residents') committees assisting, to learn basic information and “willingness to receive visit and care services,” and bring them into grassroots grid management, that is, assigning areas to particular people to keep watch. By the end of 2025, “ensure a monthly visit rate of 100% for older adults in special difficulty,” and “for older adults in special difficulty who have lost the ability to care for themselves, visit and care for them at least once a month.” The document also encourages families to install smart call systems, smart electricity and water meters, health monitoring products and elderly-care monitoring devices, so that “once an abnormality is detected, a warning can be given promptly and a message sent at the same time to an emergency contact.” When service staff find an urgent problem, they “should immediately help call an emergency number.”

Notes

What to do about the three things. One, give a spare key or a temporary door-lock code to a neighbor or the property management, and say to them, “I'll be on my own these few days.” You don't need to be close, only for someone to know you are in the house. Two, go to the community residents' committee, say you live alone, and ask whether you can be put on the visit and care list. Older adults who live alone, are empty-nesters or have lost their only child are explicitly named as targets of the official service; while you are there, ask whether your area offers free installation of devices such as smart call buttons and smart water meters. Three, set up an emergency contact and a medical emergency card on your phone, and for these few days don't silence it or switch it off. There are two reasons for giving it a B. First, the link between living alone and mortality comes from studies that look back through population data, which cannot rule out the reverse explanation that “people who are already in poor health or poor circumstances are more likely to live alone,” and the original itself says the result needs confirming. Second, the visit and care document covers only older adults. There is no matching dedicated system for people under 60. What you can count on is one provision in the document, which requires grid workers and social workers to “promptly detect psychological crisis risks such as family upheaval, unemployment and dropping out of school” (see §29.11, call 12356 when you want someone to talk with). Why “someone in the house” is worth so much, see §13.1 (chest compressions). Of cardiac arrests outside hospitals, 79.2% happen at home. Where someone beside the person does compressions, 16.1% leave the hospital alive, and where no one does, only 3.9%. If no one is in the house, you fall into the lower group. Two more handy things. Handling a funeral itself means going to several windows: the funeral home, the community health service institution, the police and the provident fund (see §25). Make that a fixed schedule of going out once a day, and these days' outings are ready-made. The hotline can be called repeatedly; it is not a one-time call (see §29.11, call 12356 when you want someone to talk with). “Living alone” is itself a long-term risk factor. The odds ratio of death for living alone is 1.32, about 30% higher; see §22.9 (treat seeing people regularly as health spending). But this item covers only the next few days; the long-term account is counted separately.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Udell JA, et al. (2012). Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. Archives of Internal Medicine. https://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）. https://www.gov.cn/zhengce/zhengceku/2022-10/13/content_5718017.htm

Translated from the Chinese original. Original book, section 29, tip 6. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer