Use this checklist to identify weaknesses threatening your ability to stay in your own home.
Published: November 2020
In this pandemic era, you may be motivated to avoid moving to a retirement facility, where COVID-19 risks can be high. But how can you tell if you're healthy enough to do that? "Sometimes people don't recognize the signs. They often will say everything is okay, when it turns out that bills have been piling up, the home is a mess, and there is no food in the fridge. So the conversation often needs to be corroborated with someone else," says Dr. Suzanne Salamon, medical editor of the Harvard Special Health Report Aging in Place (www.health.harvard.edu/aip).
Consider the following health-related requirements for living independently. Use the blank boxes on the checklist to check off potential weaknesses, then talk to your family members and doctor about solutions. (We've listed a few to get you started.)
Sharp thinking skills
It's normal to forget things from time to time. But if you're having a little trouble thinking — difficulty managing medications, paying bills, choosing clothes for the day, selecting and buying groceries, turning off stoves and faucets, recognizing when food has spoiled or that it's time to clean the house, doing paperwork, making decisions — and you think it's worse than a year or two ago, you should discuss it with your doctor.
Solutions: "I typically do a mini screening for these complaints. If I suspect mild cognitive impairment [MCI], I'll refer the person to a neuro-psychologist. But having MCI doesn't mean you can't live at home. It does mean you'll need coping strategies," Dr. Salamon explains. Strategies include cutting down on the clothes in your closet and the tools in your kitchen to limit choices, using schedules and lists, and getting phones that are easier to use.
Quick-start ideas: Label drawers and cabinets to help you remember what's inside. If you use online banking, set your bills on autopay.
Living independently requires you to lift groceries; cook (put a skillet on the stove or a bowl into a microwave); get out of bed or off a chair or toilet; and perhaps climb stairs. Are you strong enough to do those things? Can you pull open various doors (to the microwave, the clothes dryer, or your car if you're still driving)? Can you carry laundry to the washing machine or take out the garbage?
Solutions: If weakness is affecting your activities, work with a physical therapist or trainer who'll develop a strength-training program tailored to your needs. "It's best not to try strength training on your own: you can injure your muscles and bones if you don't do the exercises properly," Dr. Salamon notes. Once you learn the strength-training routine, continue training at home at least twice per week. If you can't get as strong as you'd like, find out if you can have a caregiver or an aide come into your home or have meals delivered.
Quick-start ideas: Carry smaller loads (but make more trips). Get a tool to make it easier to exit a chair, such as a "couch cane" that provides a handle you can grab as you stand.
Arthritis and inactivity reduce flexibility. But you need flexibility in your hands, wrists, elbows, and shoulders to dress, brush your teeth, bathe, and reach up to a cabinet or out to a door. It takes a flexible neck to look behind you if you drive, and flexible hips, ankles, and knees to walk and get up and down from a chair. Are you finding it harder to do those activities?
Solutions: If you're just starting to experience muscle tightness, start a gentle stretching program at home. Stretch after your daily walk or after you've marched in place for a few minutes to get blood flowing to your muscles and make them more pliable. Find stretching workouts for older adults online, or get the Harvard Special Health Report Stretching (www.health.harvard.edu/str). For very tight muscles, work with a physical therapist or trainer to begin a stretching program.
Quick-start ideas: If you normally reach up to grab drinking glasses or dishes, relocate them to lower cabinets. Use assistive tools when dressing (like long-handled hooks to put on socks).
Simply getting out of bed or standing up from a chair requires good balance; so does walking across a room, showering, stair climbing, and standing as you prepare a meal. Poor balance increases your risk for falls, which could land you in a hospital or cause permanent injury. "One way to detect balance problems is to notice if you're stumbling more or if you're holding on to furniture to walk through your house," Dr. Salamon says.
Solutions: Talk to your doctor if you suspect imbalance; it could be due to aging, or it might be the result of an inner ear problem, low blood pressure, or neurological disease. Treating underlying conditions can help resolve some balance issues. Work with a physical trainer to come up with an individualized program of balance exercises.
Quick-start ideas: Install grab bars in your home, especially in the bathroom (where it's slippery and falls often occur). Remove fall hazards, such as floor clutter and throw rugs.
Are you easily winded? This could be a problem for independent living, especially if you have a large home. It takes endurance (in addition to strength and balance) to climb stairs, walk from one room to another, and do household chores.
Solutions: A lack of endurance could signal an underlying condition that needs to be treated, such as a heart or lung problem. But it also could also be that you're just out of shape. With your doctor's agreement, start getting more aerobic exercise, the kind that gets your heart and lungs pumping. Your ultimate goal will be 150 minutes of aerobic activity per week, but it's okay to start with just a few minutes per day, and it's okay to exercise a little bit throughout the day. In the long term, consider moving to a smaller home, if possible.
Quick-start ideas: If stair climbing is a problem, get some help and move your bedroom to the first floor. If your budget allows, hire outside help to assist with chores.
Social isolation hurts health. "People with a small community of friends and family — or none at all — are much more likely to develop serious illness and have short life expectancies," says Dr. Anthony Komaroff, editor in chief of the Health Letter. Do you have friends and family nearby? Do you know your neighbors? Do you have caregivers coming into your home on a regular basis or other community members you get to talk to regularly?
Solutions: It's tough to enlarge your social circle during a pandemic. If you don't know how to make a video call, it's time to learn. Ask someone for help, or search for how-to videos online. Consider a physically distanced visit with a friend (keep your masks on). And remember that when this pandemic is over, a good way to meet people will be to join a club or religious organization, volunteer, or go to a gym.
Quick-start idea: Join an online social network such as My Boomer Place (www.myboomerplace.com) or Stitch (www.stitch.net), designed to help you connect with people in your age group who share your interests.
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