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Strategies to Help You Stay Independent

Staying IndependentSurveys suggest that about 90 percent of older adults want to live independently for as long as possible. But independence requires a level of physical function that can be difficult to maintain if you have a disability—and a recent U.S. National Institute on Aging (NIA) analysis reveals that 40 percent of Americans over age 65 fall into this category.

Patricia Bloom, MD, associate clinical professor of geriatrics and palliative medicine at Mount Sinai, says that maintaining good physical and cognitive function, disease prevention, and good management of existing medical conditions can help you avoid disability. But she also points out that the term “disability” focuses on an individual’s limitations when many of these can be mitigated by improving the environment. “Functional limitations aren’t the exclusive and inevitable result of physical impairment,” she says. “They also are a product of inadequacies in the architectural and social environment. For example, being unsteady on your feet doesn’t inevitably cause limitations in mobility, but streets that are in poor condition due to cracks, potholes, and broken curbs may put you off venturing outdoors to walk, while lack of good public transportation options may reduce your social engagement opportunities.”

Unfortunately it may not always be possible to solve these environmental problems, but that doesn’t mean you can’t preserve your physical and mental functioning, and your independence. Disability doesn’t have to be inability.

Preserving your physical function There is little doubt that disabilities arising from chronic diseases and/or impaired vision can limit mobility, daily living such as bathing and dressing, and create special needs that make even a simple walk (one of the most popular forms of physical activity chosen by seniors) seem like an impossible goal. Indeed, difficulty walking was the most common functional issue reported in the NIA analysis.

Ideally, older adults should aim to walk for 30 minutes each day. But if you’re intimidated by the thought of navigating your way solo around those cracks, potholes, and broken curbs, what are the alternatives? Dr. Bloom points to mall walking as one solution. “Many malls have walking programs that can be a good option if you need to use a cane or a walker for support, since you’ll be traversing a smooth surface,” she says.

If local streets are your only option, boost your ability to cope with the demands of this environment. Wear proper walking shoes with non-slip soles for better grip. Walk during the day—wear reflective clothing if the weather is murky or foggy—and always face oncoming traffic. “Stay alert for broken paving that could be a tripping hazard,” Dr. Bloom adds. “If you live in a rural area, or are using an unpaved walking trail, watch out for tree roots that could trip you. Also be aware of other pedestrians, cyclists, and dogs that may frequent walking trails.”

Physical functioning also benefits from resistance exercises, so plan in 15-minute sessions two or three times a week. At home you can use simple dumb-bells and/or resistance bands, or invest in a weight machine. “It’s also important for older adults to work on balance and flexibility, since falls and fractures, especially hip fractures, are a major factor in loss of independence,” Dr. Bloom says. “Research has shown that yoga and tai chi, a form of martial arts, reduce the risk of falls.” Check with your local YMCA or senior center for classes.

Maintaining your brainpower Keeping your brain working at maximum efficiency can help you stay independent for longer. Look to your diet to help you achieve this—studies associate a Mediterranean style eating plan with a lower incidence of dementia. The Mediterranean diet includes lots of fruits, vegetables, whole grains and legumes. Get healthy fats from olive oil and fatty fish, and avoid saturated fats found in red meats, full-fat dairy products, and butter. Limit your intake of sugar-sweetened foods and beverages. If you drink alcohol, consume it in moderation—no more than one alcoholic beverage daily.

Staying engaged mentally and socially also is vital, and you can achieve this even if your social environment is working against you. “Many older adults experience social network shrinkage as loved ones and friends pass on,” Dr. Bloom notes. “Loneliness is linked to a raised risk for dementia, so if you are alone because you’ve lost your spouse or friends have relocated, reach out to other sources of social support—for example, your local senior center, place of worship, and library.”

Many older adults are interested in whether “brain-training” exercises maintain cognitive function. “It would be fair to state that the jury is out concerning whether brain-training exercises and videogames are helpful in maintaining cognition,” Dr. Bloom observes. “Research suggests they may be helpful, but more investigation is needed. Some studies have demonstrated that mindfulness practice, a secular form of meditation, can build up the brain in areas related to memory and cognition, and result in reduced cognitive decline.”

Disease prevention Take action to prevent health problems that can hinder your ability to live on your own. Stop smoking if you smoke, lose weight if you’re overweight, and keep your blood pressure under control. A healthful diet and physical activity (as outlined here) can help you manage these health issues, and help reduce the risk of heart and vascular disease—and if you reduce the risk of heart disease, you are also reducing the risk of brain disease.

Good medical treatment If you have a chronic medical condition, it’s vital to take all medications as prescribed. If you experience problematic side effects, discuss possible alternatives with your doctor. Attend all your scheduled medical appointments and routine screenings.

In addition to scheduling a yearly wellness visit with your doctor, have your hearing and vision checked at least once every two years or any time you notice changes in how well these senses are working. If left untreated, vision and hearing impairments can contribute to difficulties with activities of daily living, such as answering the phone or the doorbell, cooking, and taking medications correctly.

Ask for help if you need it Independence may be your goal, but Dr. Bloom says that it is important to acknowledge when you need help. “Try to have an open mind,” she advises. “If you are willing to accept help when you need it, you are more likely to achieve the goal of staying in your own home.”


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