Dealing with decisions of old age

USA Today (Society for the Advancement of Education), August, 1995

Bad health or a financial crisis may require that some decisions be made abruptly, but by familiarizing themselves with their own and/or a spouse's routines and limitations, mature people can become better prepared for making plans related to aging, according to Cynthia Robinson, geriatric specialist and assistant professor of occupational therapy, University of Oklahoma Health Sciences Center.

One of the biggest lifestyle changes, obviously, is retirement. If possible, she suggests, it should not occur until the person feels emotionally and financially ready. It is important that the normal routine of the workday be replaced with new activities. "Routine is healthy and important. Develop new activities or indulge those you haven't had time to before. Routine provides structure, and structure is very important for elders who may have short-term memory problems. For example, always keep your car keys, glasses, medications, etc. in the same place."

A popular trend has been for a couple to retire and promptly move away to sunnier, vacation-type locations such as Florida or Arizona. This, however, is not necessarily healthy for everyone. "Once you have spent years in a community, you usually have a very important support system that includes a close circle of friends and people in the community, such as your physician, banker, grocer, mailman, etc. Moving away requires that you re-establish all those community ties."

Both psychologically and financially, the best option often is to take advantage of that support system in order to remain in one's home for as long as possible. When an individual notices that he or she is having difficulty performing certain self-care tasks, there are many devices and adaptations available that can be used to make the home safer and everyday activities easier. These may include improving lighting, installing handrails and benches in the bathtub, removing slippery scatter rugs, and re-arranging kitchen cabinets.

Driving is a complex task, requiring numerous cognitive, sensory/perceptual, and physical skills. When an older person begins having difficulty behind the wheel, this calls for a comprehensive, multi-disciplinary evaluation which may result in recommendations as simple as new glasses. Giving up driving involves sacrificing a substantial amount of independence, and sometimes an elderly person may be unwilling to admit or may not realize that there is a problem. Compromises are possible. Some people may be willing to limit their nighttime driving or to avoiding periods of heavy traffic. Older people sometimes can fall into an all-or-nothing mentality - believing that giving up driving on the freeway or restricting certain activities is only a step away from being in a nursing home. To help overcome this fear, Robinson recommends taking advantage of geriatric assessment clinics that are springing up across the country. They provide a team of interdisciplinary medical specialists - doctors, physical and occupational therapists, nurses, social workers, and physician assistants - who offer complete physical, cognitive, and psychosocial exams, evaluate the older person's level of function and living situation, and prescribe a variety of medical treatment and lifestyle/home adaptations aimed at preserving independence. Finally coping with the loss of loved ones, including spouses, siblings, children, arid even pets, can be a devastating experience, and one that obviously hits more frequently for the older individual. Anyone of post-retirement age who has experienced a loss should try to remain active and perhaps consider volunteer work or a part-time job that can provide an income supplement while not jeopardizing Social Security benefits. Support groups, in particular, can be helpful in coping with loss. One benefit of the aging of America is that there are an increasing number of services available, although rural and minority elders continue to be underserved. Support groups and senior citizen's and adult day care centers can be valuable sources of friendship, companionship, and assistance.

"What continually amazes me is that all these services are still underutilized," Robinson notes. "Once a person is eligible and has the need to do so, he or she should be aggressively seeking out these services, whether the need is medical, financial, or related to living assistance, transportation, or fun and companionship. For some people. these services literally mean the difference between functioning in an independent living situation or institutionalization."