The present study identified the patterns of support exchange between the elderly living alone and their children in a metropolitan city in Japan and examined the relationships between the patterns of support exchange and their life satisfaction. The sample was collected from 1,020 the elderly living alone in Osaka city selected with random sampling method. The questionnaires were mailed to the respondents, who were asked to send them back. The response rate was 51.7%(n = 526). We used 371 sample of respondents who have children. The results indicated that:(1)the patterns of support exchange were different by the types of social support, (2)the life satisfaction of the elderly who had an appropriate balance of a support exchange pattern was significantly higher than the life satisfaction of those who had low support exchange or only provided supports to their children. The findings imply that an appropriate balance of support exchange between the elderly living alone and their children was crucial in improving life satisfaction of the elderly living alone.