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Staying Independent But Also Safe

Many of our columns have touched on the value of maintaining one's independence throughout the aging process, for as long as possible. The mental health benefit of independence and self-reliance, can't be over-estimated.

However, those who are 75, 85, 95 often face decisions that pit independence against safety. Examples abound: Continuing to drive a car despite failing sight, slower reaction times, and a history of accidents comes to mind, as explored in a recent column.

Another example: Self management of medications vs. accepting help from a family member, friend, or health professional. "I always remember to take my pills," he or she might say, yet the pill box is still half full at the end of the week! Depending on the prescriptions and the illnesses, this could have minimal impact or it could lead to a life- threatening medical crisis.

Doing one's own laundry, cleaning, shopping, cooking, sidewalk sweeping, snow shoveling—all healthful, stimulating activities—unless a physical condition makes them high risk.

What about the need for a cane or walker and the adamant refusal to use one? "A walker? No--I don't need one, don't want one and won't use it if you get me one! Walkers are for old people!" the 85 year old wobbling woman tells her daughter repeatedly. Of course, falls and broken bones, especially hips, can lead to temporary or permanent loss of independence!

Let's take a closer look at falls and hip fractures. Research studies show that the average age of patients who have hip fractures is about 80 and they are often related to the presence of osteoporosis and arthritis. Hospitals treat over 300,000 hip fractures in the U.S. every year among those over age 50. About twenty five percent of those who have a hip fracture don't live more than a year! Of those who live, 60% have reduced mobility and independence. One review of 82 research studies concluded that "most patients who survive do not return to the level of mobility and independence they had before the fracture." So, which is better, to risk a fall, a possible hip fracture and almost certain loss of mobility if not one's life, or use a cane or walker if needed, and suffer some initial embarrassment?

What can family and friends do in these instances? While encouraging, supporting the independence, point out the specific risks involved which could lead to accidents that will likely limit independence. Your loved one might better accept the advice from a physician than a family member.

Start with small steps. Tossing out the slippery throw rugs that many elderly use is a great first step. Adding grab bars to the bathroom, investing in an "alert device," and setting up a reassurance calling service can all reduce risks.

"Ok, Mom, what If you just try the walker in the house for a few days? See if it helps—see if it gives you more stability and confidence when walking." you could suggest. You might avoid pressing for major changes overnight unless something critical like medication mismanagement warrants that.

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