Last winter, as Barbara Howes watched her beloved husband of 56 years wage a losing battle with cancer, she risked her own health to ensure his comfort. Howes, who has diabetes, went without her prescription medications to buy the oil needed to heat their apartment.

"Everything fell apart all at once," recalled Howes, 73, who had moved to Haverhill from Florida when just a teenager after falling for a local boy. She married Ernest Howes when she was 17. "We had never asked anyone for anything, but I learned my lesson the hard way - I can't go without my medications. I ended up in the hospital last year."

Patch the leaky roof or pay the rent? Buy needed medications or send the local utility company a check?

Advocates for the poor fear thousands of area seniors, crushed by the latest economic downturn, will be forced to make gut-wrenching choices this year. Already, social service agencies are being flooded with calls from frail elders who are worried about how they'll make ends meet on Social Security checks and meager savings during the cold winter months.

"We're getting hundreds of phone calls each month from seniors who need help with medical bills, heating bills, shelter, even clothing," said Rosanne DiStefano, executive director of Elder Services of the Merrimack Valley, Inc., a nonprofit agency that strives to help elders remain in their homes. The agency serves seniors in 23 communities, from Dunstable to Amesbury.

"The people we serve are not living off retirement plans," said DiStefano. "These are people who get by on Social Security and scant savings. Until now, they've managed to keep their heads above water, but as the costs of basic necessities continue to escalate, we're seeing unprecedented levels of fear and anxiety."

Such fears are driving many seniors back into the labor force. Today, more than 6 million workers are 65 or older, according to the Bureau of Labor Statistics. And over the next decade, the number of workers age 55 and up is expected to rise at more than five times the rate of the overall workforce, the bureau reported.

"Years ago, folks would retire and six months later they'd go out and get part-time jobs to have something to do," said Susan Cripps, a counselor with SHINE (Serving the Health Information Needs of Elders) who helps seniors navigate the complex world of Medicare. "Now, we're seeing a lot of seniors getting jobs to supplement their income. This seems to be especially true for older women who typically stayed home to raise their children and didn't put much into their retirement plans or didn't have retirement plans at all."

But for elders like Howes with serious health problems, returning to the 9 to 5 grind is not an option. Instead, they're being forced to delay home repairs or rethink their lifestyle. Some seniors are curbing out-of-town travel to save money at the gas pump. Others are finding they must change their eating habits to rein in costs at the supermarket.