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Adjusting to change can be especially difficult for elderly

Author: Helen Dennis, Specialist on Aging

Question: My 84-year-old cousin has been a widow for 10 years. She has been independent, positive, outgoing, attended lectures and all kinds of events – until she fell and injured her elbow. Although she recovered from the fall and injury, something has changed. She has stopped driving and now has a housekeeper who drives her. A relative pays her bills and balances her checkbook, although my cousin is mentally sharp. I think she is depressed and feels useless. Her children would like her to move out of her three-story home which she is resisting because of change and cost. How can I be helpful without being intrusive?

– S.H.

Dear S.H.:

As we age, the changes we encounter can test the best of us.

Let’s consider some reasons why older adults may appear to take a path of least resistance.

Possible medical problems: The first thing to do is to rule out medical issues by having a thorough exam by a physician.

Lack of strength: We know that part of the normal aging process is losing muscle mass – which is accelerated without exercise. With less muscle we lose strength and can easily avoid doing things that take too much effort. Strength-building exercise is a remedy.

Longer time to recover from an injury: With age, it takes longer to recover from illnesses and injuries. Unfortunately, there are few shortcuts, except to stay as active as possible as long as it

is safe and approved by a health care professional.

Fear of falling: Once older adults fall, they may be fearful of falling again. The Centers for Disease Control reports that 35 percent of those age 65 and older fall each year. For 2010, the CDC estimates the adjusted cost of falls was more than $28 billion. Fear of falling can easily lead to less physical activity. That reduced fitness can bring about the very thing older adults fear – falling.

Learned helplessness: This concept was developed by psychologist Martin Seligman at the University of Pennsylvania. Older adults who no longer feel they have responsibilities may become conditioned to be more dependent than necessary.

Decreased self-reliance: One of the more feared aspects of aging is becoming dependent on others. Giving up driving often is one of the first significant indicators that aging may require an increased dependence on services. There is no question, this requires an individual to adjust while exploring other forms of transportation.

Depression: One of the causes of depression identified by the National Institute on Aging is feeling a loss of control over your life. Feeling that lack of control can occur with physical limitations and with limited or no responsibilities. Without help, depression can last for weeks, months or even years.

Costs of relocating to a new residence: The costs can be high and unaffordable for many. MetLife’s Mature Market Institute recently published a study indicating that the 2011 national average yearly cost for assisted living was $41,724. In California, the average yearly cost was almost identical. Nationally, private nursing home rates were $239 daily, or $87,235 annually, according to the MetLife study. In California, the average cost of a private room in a nursing home was $91,250 a year according to a study by Genworth; a semiprivate room was $77,745 a year. Home-health aides and homemaker-companion service rates were $21 and $19 per hour, respectively.

Taking risks seems too difficult: Holding on to what you have and what you know is reassuring. Perhaps one reason is that there may be little time to recover from a bad decision – whether related to finances, housing, getting a new housekeeper or even taking a walk.

Here are some possible action steps:

• Consult with a geriatric case manager for an assessment of your cousin and her environment.

• Meet with your cousin’s children and discuss what might be causing these changes.

• With permission, consult with your cousin’s physician.

• And finally, have a conversation. Ask your cousin, “What’s going on? I care about you and know something’s not right.” Your cousin may be waiting to have such a chat.

For more information on depression, Providence Little Company of Mary Medical Center San Pedro is hosting a lecture on Understanding Senior Depression and Memory Loss on June 14. For reservations, call 800-618-6659.

S.H., clearly you care, which is a gift for your cousin. Harness your resources and be bold, yet sensitive. You can always apologize later.

Best wishes and thank you for your important question.

Copyright 2011 Helen Dennis. All rights reserved.

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