At age 66, South Carolina physician Paul Rousseau decided to retire after tending for decades to the suffering of people who were seriously ill or dying. It was a difficult and emotionally fraught transition.

“I didn’t know what I was going to do, where I was going to go,” he told me, describing a period of crisis that began in 2017.

Seeking a change of venue, Rousseau moved to the mountains of North Carolina, the start of an extended period of wandering. Soon, a sense of emptiness enveloped him. He had no friends or hobbies — his work as a doctor had been all-consuming. Former colleagues didn’t get in touch, nor did he reach out.

His wife had passed away after a painful illness a decade earlier. Rousseau was estranged from one adult daughter and in only occasional contact with another. His isolation mounted as his three dogs, his most reliable companions, died.

Rousseau was completely alone — without friends, family, or a professional identity — and overcome by a sense of loss.

“I was a somewhat distinguished physician with a 60-page resume,” Rousseau, now 73, wrote in the Journal of the American Geriatrics Society in May. “Now, I’m ‘no one,’ a retired, forgotten old man who dithers away the days.”

In some ways, older men living alone are disadvantaged compared with older women in similar circumstances. Research shows that men tend to have fewer friends than women and be less inclined to make new friends. Often, they’re reluctant to ask for help.

“Men have a harder time being connected and reaching out,” said Robert Waldinger, a psychiatrist who directs the Harvard Study of Adult Development, which has traced the arc of hundreds of men’s lives over a span of more than eight decades. The men in the study who fared the worst, Waldinger said, “didn’t have friendships and things they were interested in — and couldn’t find them.” He recommends that men invest in their “social fitness” in addition to their physical fitness to ensure they have satisfying social interactions.

Slightly more than 1 in every 5 men ages 65 to 74 live alone, according to 2022 Census Bureau data. That rises to nearly 1 in 4 for those 75 or older. Nearly 40% of these men are divorced, 31% are widowed, and 21% never married.

That’s a significant change from 2000, when only 1 in 6 older men lived by themselves. Longer life spans for men and rising divorce rates are contributing to the trend. It’s difficult to find information about this group — which is dwarfed by the number of women who live alone — because it hasn’t been studied in depth. But psychologists and psychiatrists say these older men can be quite vulnerable.

When men are widowed, their health and well-being tend to decline more than women’s.

“Older men have a tendency to ruminate, to get into our heads with worries and fears and to feel more lonely and isolated,” said Jed Diamond, 80, a therapist and the author of “Surviving Male Menopause” and “The Irritable Male Syndrome.”

Add in the decline of civic institutions where men used to congregate — think of the Elks or the Shriners — and older men’s reduced ability to participate in athletic activities, and the result is a lack of stimulation and the loss of a sense of belonging.

Depression can ensue, fueling excessive alcohol use, accidents, or, in the most extreme cases, suicide. Of all age groups in the United States, men over age 75 have the highest suicide rate, by far.

For this column, I spoke at length to several older men who live alone. All but two (who’d been divorced) were widowed. Their experiences don’t represent all men who live alone. But still, they’re revealing.

The first person I called was Art Koff, 88, of Chicago, a longtime marketing executive I’d known for several years. When I reached out in January, I learned that Koff’s wife, Norma, had died the year before, leaving him hobbled by grief. Uninterested in eating and beset by unremitting loneliness, Koff lost 45 pounds.

“I’ve had a long and wonderful life, and I have lots of family and lots of friends who are terrific,” Koff told me. But now, he said, “nothing is of interest to me any longer.”

“I’m not happy living this life,” he said.

Nine days later, I learned that Koff had died. His nephew, Alexander Koff, said he had passed out and was gone within a day. The death certificate cited “end stage protein calorie malnutrition” as the cause.

The transition from being coupled to being single can be profoundly disorienting for older men. Lodovico Balducci, 80, was married to his wife, Claudia, for 52 years before she died in October 2023. Balducci, a renowned physician known as the “patriarch of geriatric oncology,” wrote about his emotional reaction in the Journal of the American Geriatrics Society, likening Claudia’s death to an “amputation.”

“I find myself talking to her all the time, most of the time in my head,” Balducci told me in a phone conversation. When I asked him whom he confides in, he admitted, “Maybe I don’t have any close friends.”

Disoriented and disorganized since Claudia died, he said his “anxiety has exploded.”

We spoke in late February. Two weeks later, Balducci moved from Tampa to New Orleans, to be near his son and daughter-in-law and their two teenagers.

“I am planning to help as much as possible with my grandchildren,” he said. “Life has to go on.”

Verne Ostrander, a carpenter in the small town of Willits, California, about 140 miles north of San Francisco, was reflective when I spoke with him, also in late February. His second wife, Cindy Morninglight, died four years ago after a long battle with cancer.

“Here I am, almost 80 years old — alone,” Ostrander said. “Who would have guessed?”

When Ostrander isn’t painting watercolors, composing music, or playing guitar, “I fall into this lonely state, and I cry quite a bit,” he told me. “I don’t ignore those feelings. I let myself feel them. It’s like therapy.”

Ostrander has lived in Willits for nearly 50 years and belongs to a men’s group and a couples’ group that’s been meeting for 20 years. He’s in remarkably good health and in close touch with his three adult children, who live within easy driving distance.

“The hard part of living alone is missing Cindy,” he told me. “The good part is the freedom to do whatever I want. My goal is to live another 20 to 30 years and become a better artist and get to know my kids when they get older.”

The Rev. Johnny Walker, 76, lives in a low-income apartment building in a financially challenged neighborhood on Chicago’s West Side. Twice divorced, he’s been on his own for five years. He, too, has close family connections. At least one of his several children and grandchildren checks in on him every day.

Walker says he had a life-changing religious conversion in 1993. Since then, he has depended on his faith and his church for a sense of meaning and community.

“It’s not hard being alone,” Walker said when I asked whether he was lonely. “I accept Christ in my life, and he said that he would never leave us or forsake us. When I wake up in the morning, that’s a new blessing. I just thank God that he has brought me this far.”

Waldinger recommended that men “make an effort every day to be in touch with people. Find what you love — golf, gardening, birdwatching, pickleball, working on a political campaign — and pursue it,” he said. “Put yourself in a situation where you’re going to see the same people over and over again. Because that’s the most natural way conversations get struck up and friendships start to develop.”

Rousseau, the retired South Carolina doctor, said he doesn’t think about the future much. After feeling lost for several years, he moved across the country to Jackson, Wyoming, in the summer of 2023. He embraced solitude, choosing a remarkably isolated spot to live — a 150-square-foot cabin with no running water and no bathroom, surrounded by 25,000 undeveloped acres of public and privately owned land.

“Yes, I’m still lonely, but the nature and the beauty here totally changed me and focused me on what’s really important,” he told me, describing a feeling of redemption in his solitude.

Rousseau realizes that the death of his parents and a very close friend in his childhood left him with a sense of loss that he kept at bay for most of his life. Now, he said, rather than denying his vulnerability, he’s trying to live with it. “There’s only so long you can put off dealing with all the things you’re trying to escape from.”

It’s not the life he envisioned, but it’s one that fits him, Rousseau said. He stays busy with volunteer activities — cleaning tanks and running tours at Jackson’s fish hatchery, serving as a part-time park ranger, and maintaining trails in nearby national forests. Those activities put him in touch with other people, mostly strangers, only intermittently.

What will happen to him when this way of living is no longer possible?

“I wish I had an answer, but I don’t,” Rousseau said. “I don’t see my daughters taking care of me. As far as someone else, I don’t think there’s anyone else who’s going to help me.”

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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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KFF Health News Peggy Girshman reporting fellow Jackie Fortiér joined a boat tour to spotlight a review of microbes in the Anacostia River, a step toward making the river healthier and swimmable. The story was featured on WAMU’s “Health Hub” on Feb. 26.

On a bright October day, high schoolers from Francis L. Cardozo Education Campus piled into a boat on the Anacostia River in Washington, D.C. Most had never been on the water before.

Their guide, Trey Sherard of the Anacostia Riverkeeper, started the tour with a well-rehearsed safety talk. The nonprofit advocates for the protection of the river.

A boy with tousled black hair casually dipped his fingers in the water.

“Don’t touch it!” Sherard yelled.

Why was Sherard being so stern? Was it dangerously cold? Were there biting fish?

Because of the sewage.

“We get less sewage than we used to. Sewage is a code word for what?” Sherard asked the teenagers.

“Poop!” one student piped up.

“Human poop,” Sherard said. “Notice I didn’t say we get none. I said we get what? Less.”

Tours like this are designed to get young people interested in the river’s ecology, but it’s a fine line to tread — interacting with the water can make people sick. Because of the health risks, swimming hasn’t been legal in the Anacostia for more than half a century. The polluted water can cause gastrointestinal and respiratory illnesses, as well as eye, nose, and skin infections.

The river is the cleanest it’s been in years, according to environmental experts, but they still advise you not to take a dip in the Anacostia — not yet, at least.

About 40 million people in the U.S. live in a community with a combined sewer system, where wastewater and stormwater flow through the same pipes. When pipe capacities are reached after heavy rains, the overflow sends raw wastewater into the rivers instead of to a treatment plant.

Federal regulations, including sections of the Clean Water Act, require municipalities such as Washington to reduce at least 85% of this pollution or face steep fines.

To achieve compliance, Washington launched a $2.6 billion infrastructure project in 2011. DC Water’s Clean Rivers Project will eventually build multiple miles-long underground storage basins to capture stormwater and wastewater and pump it to treatment plants once heavy rains have subsided.

The Anacostia tunnel is the first of these storage basins to be completed. It can collect 190 million gallons of bacteria-laden wastewater for later treatment, said Moussa Wone, vice president of the Clean Rivers Project.

Climate change is causing more intense rainstorms in Washington, so even after construction is complete in 2030, Wone said, untreated stormwater will be discharged into the river, though much less frequently.

“On the Anacostia, we’re going to be reducing the frequency of overflows from 82 to two in an average year,” Wone said.

But while the Anacostia sewershed covers 176 square miles, he noted, only 17% is in Washington.

“The other 83% is outside the district,” Wone said. “We can do our part, but everybody else has to do their part also.”

Upstream in Maryland’s Montgomery and Prince George’s counties, miles of sewer lines are in the process of being upgraded to divert raw sewage to a treatment plant instead of the river.

The data shows that poop is a problem for river health — but knowing what kind of poop it is matters. Scientists monitor E. coli to indicate the presence of feces in river water, but since the bacteria live in the guts of most warm-blooded animals, the source is difficult to determine.

“Is it human feces? Or is it deer? Is it gulls’? Is it dogs’?” said Amy Sapkota, a professor of environmental and occupational health at the University of Maryland.

Bacterial levels can fluctuate across the river even without rainstorms. An Anacostia Riverkeeper report found that in 2023 just three of nine sites sampled along the Washington portion of the watershed had consistently low E. coli levels throughout the summer season.

Sapkota is heading a new bacterial monitoring program measuring the amount of E. coli that different animal species deposit along the river.

The team uses microbial source tracking to analyze samples of river water taken from different locations each month by volunteers. The molecular approach enables scientists to target specific gene sequences associated with fecal bacteria and determine whether the bacteria come from humans or wildlife. Microbial source tracking also measures fecal pollution levels by source.

“We can quantify the levels of different bacterial targets that may be coming from a human fecal source or an animal fecal source,” Sapkota said.

Her team expects to have preliminary results this year.

The health risk to humans from river water will never be zero, Sapkota said, but based on her team’s research, smart city planning and retooled infrastructure could lessen the level of harmful bacteria in the water.

“Let’s say that we’re finding that actually there’s a lot of deer fecal signatures in our results,” Sapkota said. “Maybe this points to the fact that we need more green buffers along the river that can help prevent fecal contaminants from wildlife from entering the river during stormwater events.”

Washington is hoping to recoup some of the cost of building green spaces and other river cleanup. In January, the office of D.C. Attorney General Brian Schwalb filed a lawsuit seeking unspecified damages from the federal government over decades of alleged pollution of the Anacostia River.

Brenda Lee Richardson, coordinator of the Anacostia Parks & Community Collaborative, said the efforts to cut down on trash and sewage are paying off. She sees a river on the mend, with more plant and animal life sprouting up.

“The ecosystem seems a lot greener,” she said. “There’s stuff in the river now that wasn’t there before.”

But any changes to the waterfront need to be done with residents of both sides of the river in mind, she said.

“We want there to be some sense of equity as it relates to who has access,” she said. “When I look at who is recreating, it’s not people who look like me.”

Richardson has lived for 40 years in Ward 8 — a predominantly Black area on the east side of the river whose residents are generally less affluent than those on the west side. She and her neighbors don’t consider the Anacostia a place to get out and play, she said.

As the water quality slowly improves, Richardson said, she hopes the Anacostia’s reputation is also rehabilitated. Even if it’s not safe to swim in, Richardson enjoys boating trips like the one with the Anacostia Riverkeeper.

“To see all those creatures along the way and the greenery. It was comforting,” she said. “So rather than take a pill to settle my nerves, I can just go down the river.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

This article first appeared on KFF Health News and is republished here under a Creative Commons license.