Think ahead to stay safe at home
Ninth of a series
Most people say they want to live at home as they get older — yet few have a clue about the complexities involved or how to make it work.
If you've lived in your home for 50 years, you just assume things will keep going along as usual, right? Wrong! While you're healthy, it's unbelievably hard to imagine how life changes when you become impaired. If your aim is to stay at home as long as possible, you'd be wise to think it through carefully ahead of time. There are seven major barriers to address: Isolation and loneliness: The first thing that changes is our involvement in the world at large. While we're healthy, we pay no attention to how often we talk to people at the bank, across the fence, in the grocery store. Now unable to drive or get out easily, we become virtual prisoners within our homes. There's no surer way to become profoundly depressed, and I've seen thousands of older people do just that, including my own parents. Loneliness creeps in so gradually, we don't notice. Even lifelong loners can't handle the day-to-day, month-to-month isolation of home care. If you're going to stay at home as you age, make a plan that includes people.
Physical activity: Research shows that exercise improves the health of virtually everyone at any age, even those past 90 who suffer from chronic illness. The goal of every older adult should be to avoid sarcopenia (sar-ko-PEEN-ya), severe withering of muscle and strength resulting from inactivity over long periods (classic couch-potato things like watching TV all day). As you do less, you're unable to do more, and so you function at a declining level, which leads to further decline. Use it or lose it. How do you "use it"? By getting up and moving! Especially when you're homebound. Developing a plan to exercise is a critical component of staying at home as you get older.
Nutrition: Malnutrition is a major cause of decline among older people living at home, not because they're poor but because they tend to stop eating healthfully; it's too much trouble, they're depressed, they don't feel good. Many eat just tea and cookies all day, or candy, or potato chips. Worse, the combination of not eating nutritiously and not drinking enough water can lead to memory loss, a temporary condition (if it's caught) that mimics Alzheimer's. Our bodies and brains need proper fuel to keep us strong and sharp as we age, so include good nutrition in your home-care plans.
Oversight: Throughout our lives, friends and family are important, but especially in old age. In fact, 70 to 80 percent of all eldercare is provided by people we know — to get groceries, pay bills, do our taxes or go to the bank. But having people we trust to oversee what's happening is most important as we become frail and hire help to come in and care for us. I firmly believe no one should have in-home help without a close friend or family member available to monitor. If you have no one like this to call on, I recommend hiring a geriatric-care manager (see last Monday's column) to serve in this capacity.
Safety: Falls are the leading cause of fatal and nonfatal injuries for people older than 65 in the United States, and most occur at home. So, fall-proof your home. Use bright lights on stairs, halls and in the kitchen and bathroom. Remove clutter where you walk. Avoid slipping and tripping by eliminating throw rugs, repairing loose or torn carpet and using nonskid floor wax. Bathrooms are the most dangerous rooms in our homes because they're slippery, so install non-skid surfaces and grab-bars in the tub/shower and by the toilet. But the most important source of fall prevention: Strengthen your muscles through exercise so you can catch yourself if you trip.
Live in the right house: Many of us live in homes that are unsuited for even a minor impairment. We expect to die at home yet sabotage ourselves by choosing the wrong house. What's the right one? It's a place that will adapt to your needs as you change, allowing you to "age in place" by offering maximum flexibility with a minimum of remodeling and intervention. Typically this means a bathroom (toilet and a shower or tub), a bedroom and the laundry on the main floor (not the basement), and minimal steps in and out of the house.
Know when to move: All good things must end, and sometimes getting care at home stops being a good thing. Creating a new home elsewhere, such as an assisted-living facility, is not a failure but a recognition that there are limits. Two critical factors to watch for: when your care requires more help than you can afford or becomes too difficult for your spouse or adult children to provide. This is especially true when someone has dementia. This decision belongs to each family and person, but it's important to think about ahead of time.
Next Monday: How to find and hire high-quality home care.
Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families
and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder.