Life cycle changes are inevitable and as we age, we need to face some that are not so pleasant. Cognitive decline may clash with cognitive dissonance. Those in the latter chapters of their existence with fewer years ahead of them than behind them, may resist adjusting to the possibility that they don’t have the same stamina as they once did. This doesn’t mean that when we reach a certain age, we inevitably shut down physically, emotionally, intellectually, or sexually. People who actively engage in life, as best they can, are able to remain vital longer.

Maintaining a solid sense of self while facing these adjustments is crucial. Older people may question their value in society and in their families if they can no longer complete the tasks they once had. Allowing for a role reversal can be daunting, as the caregiver becomes more reliant on others for care and even decision making about their loved one’s future.

A 90-year-old psychotherapist friend still lives independently, with support of local neighbors, friends, and family to drive her when she is feeling aches and pains and feels unsafe to drive. She did, however, just lease a new car after hers was totaled in an accident that she didn’t cause. She still teaches, sees therapy clients, writes, volunteers and attends social gatherings and has a keen wit that she uses when people try to place her in a box marked ‘Old Lady.’ She refers to herself as a Queenager. She is astute enough to know when to slow her pace and if she forgets, those who love her remind her of the importance of good self-care. Her son works in an administrative position at an assisted living facility and if he saw evidence of concerning decline, he would let her know.

Another woman nearing that age, had been living on her own in a house that showed evidence of her hoarding disorder, fell, and required a hospital stay and rehab. She wanted to return to her home, but her son and daughter-in-law knew she would not be able do so safely. She had been neglecting her self-care and needed help with her ADLs (Activities of Daily Living), such as cooking, cleaning, and bathing. Even as she moved in with her family members, she spoke every day about going back home. The paradox was that she did very little to follow medical instructions to strengthen herself. Her daughter-in-law reminded her that if she decompensated to the point that they were unable to provide care for her at home, they would reluctantly look into nursing home care.

Aging in place is not always possible for our loved ones. A couple who lived in a separate part of the country from their children had planned ahead and purchased long term care insurance, which allowed them to hire live-in caregivers to provide for their needs during the last five years of their lives. Although both were in and out of the hospital during that time, they could always return to their familiar surroundings. When they each passed, 2 1/2 years apart, it was in the home that they had lived in for nearly two decades after they retired.

Although nursing homes in general have a reputation for providing less than stellar care with underpaid and under-appreciated staff, a social worker who was employed by two long term care homes during her career had witnessed what could be considered ‘the mother standard of care,’ which is the way you would want your own mother to be treated. Since loneliness is a major factor for those who enter nursing homes, it is crucial for staff to warmly welcome new residents and treat them like beloved family members.

Certain skills, such as driving, require manual dexterity, keen vision, on-target reaction time and the ability to make moment to moment decisions for the safety of all those on the road. For some in the senior demographic, surrendering their drivers license may feel like the beginning of the end of their independence. Driving carries with it a sense of freedom to come and go as they please and a privilege that they earned many decades ago. The Department of Motor Vehicles has guidelines for surrendering a driver’s license.

The couple described above recognized that they were no longer able to safely drive. He had been a professional truck and bus driver for his career and was diagnosed with Parkinson’s, so his tremors made it necessary for him to surrender his license. A year or so before she died, she knew that her vision and reaction time had decompensated.  She was more than willing to have her caregiver ‘drive Miss Daisy’.

Ways to assist an older person in your life to deal with the changes:

• Have conversations in preparation for an eventual need. This is not an easy lift since both parent and child may be uncomfortable with the topic.
• Include them in the decision making.
• Encourage good self-care, which includes healthy eating, rest when needed, being in nature, breathing in fresh air, exercise as they are able.
• Provide reminders to take medication and setting up a system that will work for them.
• Explore an exercise program such as Silver Sneakers (often provided under Medicare plans), chair yoga or a senior stretch class.
• Since isolation is endemic among seniors, it is important to see to it that the person engage socially as they are able. Hobbies, interests, volunteering, or time at a senior center can help stave off loneliness.
• Listen as they share their concerns and fears, and hold space for whatever emotions arise. Imagine yourself in their place.
• Working with a therapist who has experience counseling older people can improve the quality of life for your loved one.

Here’s to aging well!