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.
Why it’s hard to 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. Considering impairments is also very important when it comes to managing self-healthcare for chronic illnesses.
5 ways to help someone age in place
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.
- 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.
Ron Cole MD says
Part of aging in place often requires dealing with vision loss that impacts ability to perform many fine detailed daily activities. In the older age group it is also frequently associated with chronic conditions which reduce function. Programs that provide help in both areas often incorporate the services of occupational therapists who appropriately trained can deliver training and education to develop adaptations to compensate for the losses in function. These programs are often found in non-profit agencies for the blind and visually impaired. University medical centers occasionally have these services.
A source of additional information can be found at public access sites of the American Academy of Ophthalmology website.
Nicole Didyk, MD says
Thanks, Dr. Ron for the good suggestions. The art of geriatrics is to intervene at the right time to maintain function or slow its decline, and getting the right team members on board.
JERRY says
I always look forward to, and learn from, your weekly newsletters. Ironically, they usually strike a nerve of something i am worrying about as my age …84…and my several chronic health conditions continue to increase my worry meter. I have excellent doctors and am very proactive in monitoring my health and communicating with my health care providers. My wife, who will be 76 next week, is also in good health but is starting to experience a slight shift in negative direction. We live 500 miles from our closest children, and my son and family live 2500 miles from us. I have never planned or expected to receive physical help from my son or daughter, not that they wouldnt help if it was absolutely necessary. Fortunately, we can afford to move to some sort of retirement facility, but the thought of doing so feels like giving up. Our 3700 sq ft home has become too much to practically handle but we live 5 miles from excellent health care and are located in a top notch retirement community , so the rigors of moving one last time are not appealing. Plan B might be to move back to our home town where at least most of our relatives are located, but that has its plusses and minuses as well. Neither I nor my wife want to become dependent on any of our children so it is looking more like a move to some retirement facility will be what works best. It is hard to know what to do that will work best for us and we have never discussed any of this with our children for their input. At least your timely article made me realize that i need to become more proactive in planning our next and final journey so thanks for that.
Nicole Didyk, MD says
Thanks for sharing your story, Jerry. You describe the struggle that many older adults are facing: whether to make a move or stay put. As you point out, there are pros and cons with every path. I’m glad you found the article timely and helpful!
Ron Cole says
In my previous vision rehabilitation practice working with older people and their vision loss, collaboration with a knowledgeable occupational therapist was invaluable. Training in low vision rehabilitation in addition to their general OT education was beneficial in both helping vision loss adaptations and improving function in other chronic medical conditions. This often maintained independence, safety and a good quality of life.
Nicole Didyk, MD says
Thanks for sharing that info. Low vision rehab can help to improve quality of life and keep someone at home longer for sure.
I found this site that describes low vision and mentions low vision rehabilitation: https://www.aoa.org/healthy-eyes/caring-for-your-eyes/low-vision-and-vision-rehab?sso=y
Mimi Goacher says
I’m 78 and up to last year mobility and health were manageable. In January my Polio side became weak and unreliable and my stamina almost disappeared. My doctor retired and I don’t know the new one very well. Then I had a haemorrhage and will have hysterectomy surgery soon. I need to have a plan for the future to maintain independence and yet prepare for support. I don’t know where to begin. Here in Ireland when older folk are unable to look after themselves they have to go to a nursing home which is very expensive and unless I’m able to avoid that so will I. wonder do other Irish people enjoy this website. My appreciation and thanks.
Nicole Didyk, MD says
Hello Mimi and thanks so much for commenting! We do have readers from all over the world and it’s great to hear from someone from Ireland.
Networking with other older adults can be a great place to start. I would also suggest checking out social agencies (with no financial interest in the nursing homes) that can give you an idea of local resources, their cost and whether you would be eligible for them.
Keep reading and thanks again for sharing your thoughts.
bmniac says
Thanks. I am an 83 year old man widowed in February reasonably active and fit so far. An MI when I was 59 (unstable angina) but survived by changing lifestyle with no intervention; a suitable vegetarian diet, some supplements and some exercise. From a family prone to all metabolic diseases except arthritis. Thanks for timely and useful article on a critical issue
Nicole Didyk, MD says
Good for you for making those lifestyle changes! You might be interested in Dr. K’s article about Mediterranean diet. Keep up the healthy habits!
Bridgette Pace says
I agree with all that has been said above and I have dealt with it myself having cared for two ageing parents with different degrees of dementia. Living in place is possible with assistance and with the genuine care of an adult child/family member or friend.
Where I have a problem is that some aged cared facilities sedate their residents, without due cause, with psychotropic drugs. My sister had a fall in hospital and was given the drug Olanzapine and was sent to a care facility against her will. She has continued to be given it for the past 18 months in that facility without the oversight of an appropriate elder specialist physician. This makes her groggy and I can see it is detrimental to her health. She is docile, does not cause problems and never has, so many care homes especially here in Australia are a cause for concern not celebration.
Elders are not respected here and there is very little effective assistance available unless you have a pocket full of money and take the matter to court and even then, the system works against you. I have raised the question many times about the use of this drug and i just get pushed aside and have to stand by helplessly watching the detrimental affects of that drug on my sister’s health. Aging is a very scary prospect here without strong family support.
Nicole Didyk, MD says
Thanks for sharing your experience and it sounds like you’ve come across ageism in your healthcare journey. This is unfortunately a very real issue in many hospitals and clinics. I made a video about it which you can watch here: https://youtu.be/ylVIAVRebbI
You’re right to wonder about olanzepine, as this family of medications can be risky for older adults with dementia. D. K has a good article about that: https://betterhealthwhileaging.net/medications-to-treat-difficult-alzheimers-behaviors/
Barbara says
Some thought provoking issues. Much is written about “aging parent” issues, being read by that aging person. I am 80 yrs old next month,not married, caring for my 77 yr sister with Parkinson’s and dementia. for the past 3 yrs. Neither of us have children. I moved from a 2 story townhouse after retirement 10 yrs ago to an independent condo community – thought it would be my last move. Now circumstances are different, potentially. While I am currently managing I have to consider what happens. if something happens to me. The past 2 yrs have been bumpy learning to access needed information and services, with some success over time. Am now considering moving to a CCRC type place (has a long term care component) for my sister when needed. The thought of moving again at this age is daunting. And costs are high. But so is home care. Guess I am lucky to have equity to use from the condo if needed.
Nicole Didyk, MD says
Your situation is one that I see in my practice fairly regularly. You and your sister are a “dyad” and any drastic change in your health would affect both of you. Best of luck with your move!
Matt says
Good morning,
This was actually quite thought provoking. Why doesn’t someone make a cell phone that is a “65 and older” (or whatever age we desire to put out there)? I feel like it would be extremely easy to appeal to a generation that is described as “stubborn” with treatment. There could be large font and simple navigation, and apps that are tailored to the patient’s era! In addition, Behavioral Therapy/Neuro related therapy could also be readily available -but less daunting. What do you think? There is already a market for children through I pads.
Nicole Didyk, MD says
Great point! I’m sure there are dome phones out there that are supposed to be for older adults but I haven’t reviewed them in detail.
Many older adults use an “Alexa” device to manage phone calls, set pill reminders, control household gadgets and so on, and they seem to be pretty easy to use.
There is a good newsletter called “Tech Enhanced Life” that has a good forum for older adults to share tech devices that are a good fit. Dr. K interviewed the founder, Dr. Richard Caro on the podcast. You can listen here: https://betterhealthwhileaging.net/podcast/bhwa/longevity-explorers-richard-caro/
bmniac says
Such phones which include an emergency button have been in the market for many years now.
Patricia Harris says
Good morning,
Useful information, thank you.
My experience so far in aging.
I’m coming up to eighty five fairly soon so much of your article is relevant.
Health: I had a stent fitted in 2017 ; diabetes identified in 2018; a disk decompression ten months ago.
Plus some reflux issues.
However, I live in a detached house in a village on thedge of a medium sized city in the south east of England.my home is beside a cricket pitch, and beautiful parkland five minutes away. My current situation is that my daughter stays intermittently (ex intensive care nurse). My two sons live in USA and new Zealand.
I have a weekly cleaner and gardener. I still drive in the town and shop. Do the washing and ironing. Aids: community alarm,(24 hrs), stairlift,( only used for carrying heavy items.
Im not very social but have a few good friends. Luckily I’m pretty good with technology. Im happy in my own company plus cat.
A positive attitude is essential to aging. Of course I regret the loss of a waist, ability to dance and walk much but I love swimming, politics, economics theatres, ballet, books. Above all a good laugh.
I feel very fortunate..Thank you. Patricia
Nicole Didyk, MD says
Patricia, thank you so much for sharing your experience! You describe a very full life with some sensible safeguards and modifications.
We know that staying engaged in life, physically active, and having a network of friends (even just a few good ones) can help an older adult to stay healthy and independent.
Keep it up and I'[m glad you found the article informative!
James M Emmons (Jim) says
Patricia, Thank you!! Your reply was well written, flowed well,….and most of all, is very pertinent! I relate to your list of health issues, having had sinus surgery in 2017 (has resulted in significant nose bleeds and numerous trips to the ER), double hernia surgery in 2018, and a stroke in early 2021. As soon as the ambulance delivered me to St. Luke’s of KC ER, the people started scanning me to determine stroke location. If you look, you will find… I am impressed with St. Luke’s. They also discovered a cranial aneurysm in my head and two lower aneurysms. They inserted a stint to try to reduce the cranial aneurysm. It was not successful, and we are scheduled for a second try later this year.
We may have missed our chance to relocate near our son and his family two years ago. We have a small acreage and my wife has many flowers and plants, while I garden and play over-50 and over-70 softball….among other things. My wife is really the one with the issues. She can still drive, but will now only drive to the neighbors within a block. I take her to appointments, do the shopping, etc. Your stairlift seems very appropriate, but she won’t agree to one. So I do the heavies. I have also put myself on call as best as I can. She falls and I get a scream or a cell phone call.
We are still considering relocating. This gets really complicated! We have discussed this some, but have not come to a conclusion as to where.
Thanks!
Nicole Didyk, MD says
Thanks so much for sharing your experience and for your kind words!
You articulate well the tradeoffs that older adults deal with when they consider a move. I advise making a move before there’s a crisis if at all possible. Stay well.
Marie Reilly says
For my spouse and I the perfect place turned out to be a non-profit Continuing Care Retirement Community.We have built in dining,although;athletic and cultural activities and open,interesting ,and friendly neighbors.Emergency aiisitance and medical care are always available.We are aging in place well.The best advice I can give is to enter young enough to participate in and enjoy it all.
Nicole Didyk, MD says
I’m so glad that you found a place that’s a good fit!
I do agree that it’s better to make a move on one’s own terms and when one is able to fully engage with the community and make new friends. Unfortunately, it often takes a crisis for people to make a change, which can be more difficult and complicated.
Thanks for sharing your experience and advice.