People of all older ages often tell me they hope to age in place.
Meaning, they want to be able to remain in their home and community, even as time brings changes to life, health, and abilities.
These days, many older people do end up moving, often reluctantly. And this doesn’t have to be a bad thing; I find that after a period of adjustment, many aging adults enjoy their new homes and communities. But no one likes the thought that they might *have* to move, because it’s become too difficult or risky to remain in one’s preferred home.
Now, as for all things in life and health and aging, it’s impossible to guarantee the outcome we want. But, as in almost all things in life and health and aging, there’s plenty you can do to put the odds in your favor, when it comes to aging in place.
The key is to understand what often interferes with remaining in one’s home. Then you can think about how to anticipate, prevent, or work around many of those challenges to aging in place.
In this post, I’ll describe some of the common reasons that I see older adults struggling to age in place. Then I’ll share 5 specific things you can do, to help an older person better age in place.
Aging is not in of itself a problem. But as they age, most people begin to experience a series of common issues related to health. They are:
Increased physical and cognitive vulnerability
This means that even when our bodies and minds feel pretty good, as we age it becomes easier for us to be tipped into illness, injury, or disability.
Part of this is due to wear-and-tear of aging, part of it might be due to lifestyle factors such as stress, nutrition, exercise, and part of this may be due to slow damage from a chronic condition, such as diabetes or high blood pressure.
What this means for aging in place: You need a plan for accessing extra help and support in case of injury or illness. If your older relative has fallen and can’t get up, how will anyone know? If an illness brings on delirium in someone with mild dementia, how will your family notice and then offer extra support?
Multiple chronic conditions
Age is a strong risk factor for many chronic health conditions, such as heart disease, osteoarthritis, COPD, heart failure, diabetes, atrial fibrillation, and of course, dementia.
As people get older, it’s common for them to have multiple ongoing chronic health conditions. This means more “self-healthcare” to keep up with (e.g. taking medications, monitoring for symptoms and taking action when needed, etc.).
What this means for aging in place: I recommend people really try to organize and plan for proper management of chronic conditions. It’s essential, as this helps prevent health crises and delay long-term complications, which can help an aging person remain safely in their home. Even for a younger senior who doesn’t have cognitive or physical problems, managing multiple chronic conditions can be a challenge. So it’s important to be organized and proactive. For more on how to do this, see this article: How to Age Better by Optimizing Chronic Conditions. It also helps to use a journal and a personal health record.
Chronic physical and cognitive impairments
Although some lucky people manage to live into their 90s with hardly any impairments, most people will eventually develop some chronic problems with their physical abilities, their mental abilities, or both.
What this means for aging in place: We can hope for the best, but we should plan for the likely. This means older adults and their families should consider how life’s daily tasks — and pleasures — might be managed, in the event of physical limitations or memory problems. At a minimum, you should consider a physical living space that can be managed even if someone needs a walker or can’t manage stairs well. It’s also a good idea to consider options if an older person becomes unable to drive. Considering impairments is also very important when it comes to managing self-healthcare for chronic illnesses.
Another challenge to aging in place
The other primary challenge to aging in place that I see is lack of enough nearby social resources.
Social resources include family, friends, and neighbors. They are important for maintaining emotional and cognitive well-being, no matter what level of independence and health we are at.
And they become really critical when we start to struggling with independence, because it’s that social network that ends up stepping in to support us, whether it’s with small things like a little help carrying groceries, or more significant things like a husband helping his wife take her medications every day.
The number one thing I recommend is that older adults and their families educate themselves about the geriatrics approach to managing health and well-being in older adults. That’s because avoiding risky medications, and focusing on healthcare that optimizes function and well-being can go a long way toward maintaining an older adult’s ability to remain safely in his or her home.
And don’t forget that the geriatrics approach is often relevant for people as young as age 60s: falls and medication mishaps can be major health problems for younger seniors.
To learn about better healthcare for aging adults, look for health information that has been written or endorsed by geriatricians. For example, you can find good information at HealthInAging.org, a website managed by the American Geriatrics Society. You can also look for “mini-med school for the public” courses on geriatrics topics.
By educating yourself with geriatrics health information, you’ll be better able to request geriatrics-style care from non-geriatricians, who provide the vast majority of healthcare services to older adults.
Along with learning about geriatrics, here are an additional four ideas to help someone age in place successfully:
- Choose an aging-in-place location thoughtfully. This may or may not be the place where an older adult has been living. For aging in place, it’s good to have very easy access to the things that everyone needs to maintain body and soul: social activities, outdoor air, exercise, good food, and favorite activities. Senior living communities usually make it easy for people to interact with neighbors, but a lively mixed-age neighborhood in a city or the suburbs can also work well. Wherever you are, keep in mind that it’s good to have family and longtime friends in proximity. Alternatively, be proactive about cultivating new social connections, through involvement in your community or even by volunteering to help other older adults in need.
- Be organized and proactive about healthcare. Whether or not you seek out geriatrics health information, I highly recommend older adults & families try to be proactive about addressing health concerns. It’s important to know that many “aging” problems, such as limited mobility or social isolation, track back to underlying health problems. Work with a primary care team to develop a good plan for managing chronic illnesses. Ask the medical team for help if you notice your older relative struggling with life tasks; many problems affecting aging adults require medical intervention along with practical “daily life” problem-solving. For example, unintentional weight loss should prompt a medical evaluation, along with consideration of Meals-on-Wheels and other approaches to offering nutritional support. I cover more easily missed geriatric health issues here: 7 Commonly Neglected Problems to Address for Healthier Aging.
- Get help sooner rather than later. Admittedly, this can be tricky. Many of us have difficulty accepting help no matter what our age or condition, and it can be especially hard for aging adults as well as for family caregivers to accept help. Furthermore, finding affordable help can be challenging. Fortunately, senior centers and caregiver support centers often offer ideas and referrals. Geriatric care managers can help you navigate a variety of challenging situations, including the aging adult or family caregiver who is resisting help. And today you can even use the Internet to more easily screen and hire in-home help.
- Consider technology solutions. Although personal emergency response systems (PERS) have been around for a while, a new generation of tech tools is making it easier and cheaper for aging adults to get help when they need it, or manage their life tasks. I can’t yet recommend any specific tools, as they are evolving quickly. But here are some ways in which they can help:
- Fall detection. Newer PERS devices with accelerometers can detect a fall and call for help, even if an older person doesn’t push a button. Many smartwatches now include fall detection, as well.
- Daily life sensors. A new generation of home sensors can keep track of an older adult’s activity patterns, and can send a signal to family if there’s a significant change from the usual. This can help notify a care circle if an older adult is falling ill.
- Easy access to the Internet and digital social tools. Online activity can’t and shouldn’t substitute for in-person contact. But newer technologies can help older adults stay in touch with family and friends who may not live close by, and can be a safe way to socialize during periods of high COVID cases. Although many older adults use conventional computers and tablets, those who are less comfortable with technology may benefit from a slew of new apps and services that simplify tablet use, social media, and online connecting.
- Tech-enhanced healthcare management. This is a big category of tools that is quickly getting bigger. On one hand, there are consumer-oriented tools such as medication reminders and personal health organizers. On the other hand, healthcare providers are creating better care partnerships with patients, by using patient portals, telemedicine, or in-home monitoring. Depending on your needs, some technologies can be really useful when it comes to better — and hopefully easier — management of health issues. For instance, I’ve recently been encouraging my patients to use home blood pressure (BP) cuffs that wirelessly transmit the BP data to the cloud, where the information can easily be shared with doctors or one’s care circle.
Now, I’ll admit that it often doesn’t feel easy to implement the suggestions above. The number of options and choices, when it comes to senior housing (or technology tools, for that matter), can be overwhelming. Financial constraints can be challenging. Plus healthcare — and aging care — is currently in transition, as our society struggles to figure out just how to make it feasible to provide the right care at a sustainable cost.
Last but not least, addressing aging in place does often mean you have to talk about an older person’s abilities and needs, as they stand now and as they are likely to change in the future. This is often a tough topic of conversation for families.
Still, in my experience, investing time and energy in the planning process (whether for healthcare or for housing needs, which really are intertwined when you think about it) does often pay off down the line.
So if you want to help someone age in place, hope for the best and plan for the quite possible.
What have you tried, and what have you found helpful, when it comes to aging in place? I’d love to hear from you in the comments below.
