Physician’s Corner—

We Should Have Done It Sooner

 By Dr Morton H. Silverstein

Mom and Dad have just spent some time over the holidays with their son, daughter, and the grandkids. It has been a while since they have seen each other, and Mom and Dad seem to be slipping a little. They look like they could use a bit more attention than before.

The family is concerned about the likelihood of their parents’ increasing need for care. Thinking ahead, they arrange to tour several senior living communities. They quickly find that not all facilities are created equal.

When older people live on their own and have a shrinking circle of friends, two critical needs commonly are not met: a stimulating social environment and sound nutrition. Instead of being isolated in their own home, people need to be part of a caring group and have meaningful things to do. When people have something to look forward to, they don’t dwell so much on the past. In addition, because seniors often are plagued by depression or other medical conditions, they may feel that sitting down to a good hot meal is not a priority or even possible. Malnutrition may result, further contributing to an ongoing decline in physical and mental health.

In contrast, a good retirement community should provide a strong social fabric and a life-enriching array of activities for its residents. Regularly scheduled meals, respectful of each individual resident’s dietary requirements, help to ensure optimal health so that people may be active participants in a more satisfying lifestyle.

There is, however, something that often keeps seniors and their families from deciding to make the transition to a retirement community: denial. “I’m not ready yet!” is a commonly heard refrain from prospective residents. And, adult children may feel guilty about making a stand against this denial, or they themselves may be reluctant to acknowledge the changes that come with age.

This failure to act proactively may have tragic consequences. Seniors hold on to their homes too long, isolated, with a marginal quality of life. Often, a sense of shame accompanies their loss of control over their living environment or physical condition. Because of this shame, seniors may become secretive and artfully cover up how they are actually coping. Usually it is a health crisis that forces decision. Depending on the prognosis, the person may no longer be healthy enough to qualify for a retirement community. At that point, a nursing home might be the only option remaining.

Had the senior chosen sooner to reside in a retirement facility, continual professional monitoring and maintenance of health status might have nipped the crisis in the bud. Better yet, the deterioration that caused the unfortunate situation might never have developed in the first place. This is because a good facility will place major emphasis on wellness and fitness programs.

A comprehensive array of health amenities should be available to optimize the health and well-being of residents. Absolutely vital is a fully equipped fitness center with personal trainers to provide supervision and encouragement so that residents can derive maximum benefit. A good strength-training program improves balance, muscle strength and endurance, and reverses osteoporosis by increasing bone density. This means reduced incidence and severity of falls in seniors. The resulting confidence in gait promotes a more active lifestyle that combats aging.

In so many cases, a consistent schedule in the “gym” means less medicines in the pillbox. For instance, arthritis pain may be reduced in well-exercised joints, decreasing or eliminating the need for anti-inflammatory and pain medications. Exercise helps prevent and controls adult onset diabetes, lessening the need for insulin. Strength training is emotionally uplifting and promotes a good night’s sleep. The need for antidepressants or sleeping aids may be reduced or even entirely eliminated. This is especially significant since such medications often have highly undesirable side effects.

Other well-documented effects of strength training include enhanced cardiovascular health, lower blood pressure, lower “bad” cholesterol, improved digestion, reduced constipation and colon cancer risk. Exercise also helps to prevent obesity and its many health consequences. Often, it would be better if people reached for a higher level of fitness instead of for a pill.

A truly extraordinary retirement community may offer harder-to-find wellness amenities such as aquatic exercise, massage and energy therapies, or even a day spa on site. Aquatic exercise is wonderful because it lets more sedentary individuals gently increase the range of motion of rusty joints, and it also allows the swiftest recovery from surgery or injury. Massage and energy therapies, including acupressure, acupuncture, foot reflexology, yoga, or Reiki are rejuvenating.

Where a community is located is also important. Proximity to nature long has been known to promote health. In fact, a recent scientific study has shown that a view of a single tree (versus a parking lot) during recuperation from illness or injury dramatically speeds healing.

Also key to satisfaction with life in a senior community is personal attention to detail in the living environment. Because people fear living in an institutional setting, often they grimly resist giving up their homes. When you tour a prospective community for yourself or a loved one, make sure that there is an emphasis on attractive, clean, well-maintained surroundings.

A community should afford a resident a life tailored to his or her desires and needs. Residents ideally should be given the opportunity to do the things they have always wanted to do, or to do things they used to enjoy and would like to revisit. An extensive activities calendar is desirable, with a broad spectrum of events taking place on site as well as outings of all kinds. There should be time for stimulation and quiet times, and most of all, opportunities to build rewarding relationships.

Another challenge is mobility, now that seniors live longer and often give up their driver’s licenses. A retirement community can ease the burden on adult children, since transportation to doctors and shopping, as well as housekeeping, are usually provided. Residents have their needs met, allowing adult children and their families to spend more quality time with Mom and Dad. In fact, after a new resident settles in, makes new friends, and tries new things, it is not unusual to hear, “We should have done it sooner.”

Dr Silberstein, a geriatric physician, has designed and built innovative facilities for seniors for several decades. Previously he was on the faculty of the Yale University School of Medicine and had a private practice in New Haven. He and his wife designed, built, and operate The Homesteads at Newtown Senior Living Community, which offers independent and assisted living and Alzheimer’s and memory-impaired care.