Aging in place presents unique challenges

As a large contingent of Americans retire and enter their senior years, many will choose to face the challenges of their golden years by “aging in place” — staying in their homes instead of moving into a retirement or assisted-living facility. 

Aging in place, however, presents unique challenges to Americans’ health, independence, psychological state and social lives.

A recent Harvard University study, for example, pointed out that Americans have deep concerns about the affordability of staying in their homes and are unsure of how to modify their homes for safe and comfortable senior living. They also wonder about how they can help their elders live at home and how well their communities are equipped to help them navigate this unchartered terrain.

There’s a lot to consider, to be sure, and it can be overwhelming.

The UB Reporter recently asked some UB faculty members who are experts on aging for their advice, suggestions and analysis on how to successfully age at home.

“No one gets up in the morning and says, ‘I can’t wait to move to assisted living,’” notes Debra Street, professor and chair of the Department of Sociology, who specializes in health and income security, long-term care and families, aging and the life course.

Street says most of her research shows that while some people do choose to move — usually after a precipitating event like an illness or injury means that remaining in a private household is too risky — “most of us, most of the time, just want to remain in our own homes as we age.”

Independence and control over what you do and when “are important practical components of living life with dignity,” says Davina Porock, associate dean for research and scholarship in the School of Nursing and director of the school’s Institute for Person-Centered Care. “Living in one’s own home is symbolic of that dignity and sense of control and, indeed, identity as an adult.”

Deborah Waldrop, professor and associate dean for faculty development in the School of Social Work, says the desire to age in place “is often borne out of images of ‘home’ and all the emotional and psychological responses they invoke in us as human beings who develop strong attachments.”

But, Waldrop, whose research interests include aging, end of life care and health care, notes the idea of remaining at home throughout later life is being challenged by the growing numbers of older adults who are living longer and with multiple chronic conditions that erode independence. Moreover, the increasing need for caregiving and declining number of available caregivers, as well as the rising tide of Alzheimer’s disease, also pose barriers to independent living, she says.

Yogesh Bakhai, associate professor of clinical psychiatry in the School of Medicine and Biomedical Sciences and a specialist in geriatric psychiatry, says that from his perspective, “it is nearly always better for an elderly patient to remain at home as long as they possibly can.”

Moving elderly patients to a new environment often confuses and upsets them, he points out. “Rooms are not where they were at home, their things are not where they were at home, visitors may be limited,” he says. “There may be few activities. Anxiety, stress and loneliness arise. All these things have adverse effects on their physical health and their mental well-being.”

Street says there are critical questions that should be asked when deciding where older persons should live. Among them:

• Is there someone else present in the household? If not, can a person live safely by themselves? There are some people for whom increasing frailty and a propensity for falls makes living independently and alone very risky. The appeal of assisted living is that staff is available to assist around the clock. 
• Can the individual take care of the activities of daily living unaided? Can they bathe themselves, dress, use the toilet, feed themselves, transfer between bed, a chair and any other place they need to get to move around a house safely? Can they do the laundry, get groceries, prepare meals? Are they socially isolated? If there are mobility problems, they run the risk of social isolation if they live at home alone.
• Are there physical hazards, like stairs or poorly designed bathrooms, that could pose risks and barriers to elderly homeowners?

But affordability may well be the key issue, Street notes. “The affordability of assisted living or the ability to purchase services required to maintain independence in the home probably trumps many other things,” she says.

The elderly who do not need extensive or labor-intensive care often can remain home for a long time with easy modifications of the environment, Bakhai says. These include installing ramps, handrails and bright lighting if there are vision issues, making sure rugs are secure, adding user-friendly tools like clocks that speak the time, day and date, and easy-to-use kitchen equipment. And of course in-home health care aides — and even therapy dogs — can provide assistance to older adults.

Street and Bakhai cite numerous community services that are available to help elders maintain independence and live interesting, safe and healthy lives in their own homes. Among them are Meals on Wheels, door-to-door transportation services, senior centers where elders living independently can drop by for a meal or companionship, housekeeping and chore services, and grocery deliveries. Some are funded or subsidized through federal, state or local taxes; others may be offered by volunteers and community service agencies.

Laura Lien, assistant professor in the Department of Rehabilitation Science, School of Public Health and Health Professions, points out that successful aging in place relies on many factors.

“For one, the environment must accommodate functional and psychosocial changes that often occur with age, including appropriate accessibility and usability,” Lien says, noting this applies not only to the home itself, but to the surrounding neighborhood as well.

“We often hear about the benefits of a walkable neighborhood — one where residents can access needed services and socialization opportunities,” she says. “Walkability is especially important for mobile older adults — or those who are mobile with assistance — in maintaining physical and psychosocial health.”

And for those unable to navigate the environment independently, “it is important that the appropriate supports be in place — whether it’s caregiving, gerontechnologies or other in-home services like home-health aides, Meals on Wheels, mobile health applications, housekeeping — that provide the assistance necessary to ensure overall health,” she says.

This includes support from family and friends, who can help coordinate care and other services that are necessary to help the older adult age in place, she says.

Lien points out there are some unique opportunities available in the Buffalo area to help older adults age in place. Co-location of care, as will be offered in the new Town Square for Aging on the Weinberg Campus in Getzville, is essentially a “one-stop shop” for older adults who would like to live at home but would benefit from coordinated care services in one location.

The Canopy of Neighbors, a nonprofit organization serving older adults residing in the city of Buffalo, is a volunteer-based program that coordinates needed services and/or provides services for everyday needs.

Similarly, there are ride programs, meal programs, home modification/adaptation services and housing services available through Erie County Senior Services and other nonprofit organizations, she adds.

Moreover, UB researchers are working on many projects and interventions that encourage or allow aging in place, Lien says. “From developing e-health apps or programs that older adults can access on their mobile devices at home, to exploring barriers and supports to mobility, many faculty members are working on making aging in place a possibility,” she says.

Researchers in UB’s Center for Inclusive Design and Environmental Access (IDeA Center) in the  School of Architecture and Planning offer design and consulting services to families and individuals, social service agencies and not-for-profit organizations seeking to better accommodate homes or other facilities to the needs of elderly and disabled persons. Center staff can assess the safety and convenience of the home and make recommendations for the redesign of bathrooms, entryways and other home areas, says Danise Levine, registered architect and assistant director. 

Staff also can advise people on whether they should spend the money necessary to modify their home or if they should look for new housing that’s more accommodating to their needs, Levine says, adding that people purchasing new housing sometimes ask center staff to assess the property before purchase to see if it can be modified at a reasonable cost.