Home Alone

Maintaining independence is key to successful aging, but health care programs designed to help seniors stay active and live at home are lagging behind.

The pastoral image of a grandma and grandpa rocking on their porch might seem carefree. But it doesn't capture the darker potential of their leisure: That rocker could be killing them. "We should not view retirement as sitting and rocking away on a chair," says geriatrician Mukaila Raji of the University of Texas Medical Branch in Galveston. "Retired seniors should be vigorous and active."

Gerontologists have long known that physical activity helps seniors age gracefully and healthfully, and that most of the diseases associated with growing old threaten health not only because they physically debilitate people, but because they can be socially devastating as well. Physical ailments and social isolation take the elderly on a downward spiral in which they lose their independence and become a burden to society. Researchers are focusing on ways to keep seniors healthy by strengthening their ties within the community--and by helping the community watch out for its oldest residents.

A number of researchers in the last few years have looked at the interwoven relationships among the ailments associated with aging, such as heart disease, cognitive decline, diabetes, and depression, and examined how they contribute to debilitation. For example, unhealthy arteries lead to tiny brain strokes that exacerbate dementia. A diabetic senior with declining mental health might forget to monitor his blood sugar. And advancing diabetes can foul up the senses, which can lead to wobbliness and make people prone to falling. "The health care system is focused on individual diseases, not the complex geriatric syndromes" of the elderly, says clinical researcher Lewis Lipsitz of Harvard Medical School in Boston. The "piecemeal" approach to caring for the elderly needs to be better integrated, he adds.

In an attempt to do that--and to keep seniors out of nursing homes--the U.S. Department of Health and Human Services established the Program of All Inclusive Care for the Elderly (PACE) in 1997. The program consolidates patients' Medicare and Medicaid funding and allows health care organizations to use the money to pay for in-home and other services that Medicare and Medicaid don't normally support. But most seniors haven't picked up on PACE--only 5000 elderly in 14 states are currently enrolled.

Major diseases might decimate seniors' health, but little things such as forgetfulness or arthritis can chip away at their independence and start them down the road to isolation and infirmity. Most adults take the tasks required for daily living for granted, but older people who have trouble remembering phone numbers or whose arthritic fingers hurt when wrapped around a hoe might stop calling friends or gardening. These minor ailments can add up to functional disability. They might not be wheelchair-bound, but when seniors have trouble paying the bills or shopping for groceries, they can become unable to live on their own. "We need to think of what policies we can enact to allow people to remain in their communities," says social epidemiologist Ben Shaw of the State University of New York's School of Public Health in Albany. "We as a society can't afford to institutionalize all of the older adults."

Not only is it fiscally impractical to institutionalize everyone, keeping them at home also seems to preserve their health. Or so say researchers at the University of Washington, Seattle, who developed the Health Enhancement Program, an experimental course aimed at maintaining seniors' independence. In the study, nurses helped elderly people identify their risk factors for disability, such as how much they exercise and what diseases they have. And then they taught the seniors how to help themselves, by setting goals for exercise, checking disease indicators such as blood sugar levels, and communicating more effectively with doctors. "The nurses didn't say, 'Take a pill.' They said, 'What should you be doing about that?' " says James LoGerfo of the University of Washington, Seattle. "In the program, we force the issue of client empowerment." The researchers reported last month that motivating elders to take charge of their health led to a significant reduction in hospital stays and an improvement in how well the seniors functioned at home.

Social networks can also help older people lead happy and healthy lives in their own residences. In a 2004 study of 1100 adults living by themselves, Shaw found that elderly loners were more likely to become disabled because they didn't have a support network such as family or friends who could be called in emergencies. In some cases, the elderly refrain from carrying out simple tasks such as changing a light bulb for fear they might injure themselves in the process, he says. "They're afraid to continue to be physically active [around the house] when no one else is around to help them if they get hurt," Shaw says.

Shaw is now trying to determine how neighbors fit into social support circles. Early results of his nationwide surveys suggest that people who can rely on those who live nearby appear less likely to have functional impairments. "Neighbors might turn out to be a decent source of support," he says. If so, Shaw envisions developing "Neighborhood Watch"-type programs, in which neighbors visit daily or keep an eye out for signs of distress, such as newspapers collecting on the doorstep.

But too much of a good thing is not desirable, either, warns Shaw. A solid support network can set seniors back--if it's too strong. "Too helpful of a network leads older people to dependence. And if they're not doing stuff on their own, they can develop mental health problems."

By many accounts, the future looks better than predicted 10 years ago. "Older Americans are living longer but living healthier," says epidemiologist Vicki Freedman of the Madlyn and Leonard Abramson Center for Jewish Life in North Wales, Pennsylvania. And fewer elderly than expected are holed up in nursing homes, although no one is quite sure why. However, we still have to plan for the big wave of baby boomers reaching very old age, Freedman says. Even if the percentage of disabled elders declines, the sheer number of boomers means that the nation will still have a large group to help keep healthy and active. That shouldn't be a problem, though, because neighbors should find it easy to keep track of graying garage bands with their screaming electric guitars.

Mary Beckman is a writer who lives in southeast Idaho. She can set her watch by her elderly neighbor's daily walks down the street.