Independence is important to older adults. Eighty-eight percent of individuals over the age of 65 want to stay in their own homes for as long as they can, according to a recent AARP survey, and an estimated 93 percent of Medicare enrollees 65 and older are following through on that intention. However, the fact is that 22 percent of older adults have lost their independence by age 85 and moved to long-term care facilities or community housing with services, according to Medicare.
While it’s true that certain factors outside of a person’s control—such as a medical crisis, lack of family support or other life circumstances—can lead to dependency in older age, the good news is that, with the proper planning, many of us can prolong the time that we are capable of living on our own. Paying attention to physical, emotional, and social factors that can be controlled may help protect your health and well-being as you age so that you can remain self-sufficient for as long as possible.
“Being proactive and planning for your later years while you are still healthy and cognitively intact gives you a better chance of putting off or avoiding altogether many of the causes of decline that lead to disability and dependence,” says neuropsychologist Janet Sherman, PhD, Clinical Director of the Psychology Assessment Center at Massachusetts General Hospital (MGH). “Think about how you envision living when you need more support. Find out what sources of support are out there, and how you can utilize that support.”
Living on your own involves being capable of various basic functions, such as caring for your daily needs; making personal decisions; managing home maintenance, finances, and communication with the larger world; and engaging in meaningful activities and relationships—all of which call for at least a moderate level of physical fitness and mental alertness.
The key to aging in place is to avoid problems like health conditions that can cause functional decline and greater reliance on others, Dr. Sherman says. She suggests these five strategies:
1. Stay physically fit. Problems with mobility and physical frailty are a major reason for loss of independence. The Institute of Medicine at NIH issued a research review on April 14, 2015 in which it concluded that, among other things, “physical activity is strongly linked to healthy aging and remaining independent.” With your doctor’s okay, try to engage in exercise at least 30 minutes a day, five days a week. Workouts that focus on a mixture of strength training, balance and stretching exercises, and aerobic fitness are ideal. Regular exercise boosts physical health and supports the ability to perform everyday activities essential for independence, such as climbing stairs, shopping, and carrying objects. It also improves cognitive functioning to keep you mentally sharp.
“Exercise helps prevent one of the biggest causes of the loss of independence, which is falls,” Dr. Sherman points out. “Regular workouts help older adults maintain balance and flexibility, build strong muscles, and increase bone density, reducing the likelihood of broken bones and fractures and other physical injuries.” (See What You Can Do.)
2. Make your health a priority. A health crisis often leads to loss of independence, so do what you can to protect your health. Avoid destructive practices such as smoking or excessive drinking (more than one drink per day), get at least seven hours of sleep at night, and find ways to relieve stress—such as yoga, meditation, or relaxing in a hot bath. Have regular checkups and follow your doctor’s recommendations to prevent and/or manage medical conditions such as cardiovascular disease, respiratory problems, diabetes, and other ailments that, if untreated, could lead to physical or mental disability. Discuss your medications with your physician, and include over-the-counter drugs and natural remedies on the list. Have your vision and hearing tested: Both are important to cognitive health and physical safety. Seek treatment for anxiety and depression, both of which can increase risk for physical and mental decline.
What You Can Do
Falls and accidents take an enormous toll on older adults, and frequently lead to loss of independence. To lower your risk, be sure to:
- Have your driving assessed.
- Seek a medical assessment for dizziness or other issues that affect balance.
- Get regular vision checks.
- Eliminate fall hazards and make structural changes around your home, such as installing handrails, improving lighting, etc.
- Wear seatbelts when traveling in vehicles.
- Protect your head by wearing a helmet while biking or skating.
- Wear appropriate footwear.
- Know your physical limitations, and avoid activities that might increase your risk of falls.
3. Emphasize healthy eating. Research suggests there’s a strong link between poor nutrition and cognitive decline, frailty (showing signs of weight loss, low grip strength, slow walking speed, low physical activity, and exhaustion), and other physical problems that might interfere with independence. Be sure to eat regular meals, and aim for a nourishing low-calorie diet such as the Mediterranean diet, which includes plenty of vitamin-rich fruits and vegetables, nuts, healthy fats such as olive oil, fish, whole grains, and legumes. Abundant research suggests that people who adhere to a Mediterranean diet are not only physically healthy, but also have better cognitive function, reduced risk of Alzheimer’s disease (AD) and stroke, and lower rates of cognitive decline.
4. Stay engaged. Rewarding activities and supportive social relationships can help counteract feelings of isolation, offer mental stimulation, and provide connections with others that are a prerequisite for good mental health and mental acuity in older age. Research suggests that loneliness can double the risk for AD in older adults. There are many ways to enjoy a fulfilling social life. For example, volunteering to help others can lead to greater life satisfaction; engaging in activities with friends and family, such as enjoying a meal together or attending a concert, provides stimulating social interaction; and learning a new hobby or visiting a museum may be intellectually challenging. Stay in touch with others by telephone or email, as well as through face-to-face encounters.
5. Be realistic and flexible.Remaining independent requires frankly acknowledging what you can and cannot do, and getting help when you need it. For example, if you have experienced a few fender-benders in the past few months, it may be time to consider using public transportation. Instead of struggling to accomplish difficult tasks on your own, find support that allows you to continue to stay in your home comfortably and safely. Independence also requires flexibility: Take a positive approach, and adopt a resilient attitude toward change. Try to see this stage of life as an adventure, and look forward to the next step. A positive attitude is basic to self-sufficiency.
“Remember to consider your quality of life,” Dr. Sherman advises. “You may be reluctant to lose your independence, but if you find that you are becoming ‘house bound’ and can no longer go out and participate in activities, you might find that your life would be improved in a more supportive environment.”