201710.27
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Understanding A Senior’s Motivations for Aging in Place

When we think about aging in place, the approach tends to be problem-solution driven. When diminishing vision is the problem; the solution is larger buttons on the phone and remote controls, and larger type for everything else. When mobility becomes a problem, the solution is often grab bars and walking aids. For nearly every problem related to aging in place, a solution has been devised. While this approach increases safety and independence, it may not lead to the psychological fulfillment that ultimately motivates seniors to age in the comfort of the family home.

The main shortcoming of the problem-solution approach to aging in place is that it tends to be reactionary and interventionist — viewing seniors as static, constrained by their surroundings and resigned to the diminishment of age. In reality, seniors are incredibly adaptive. As age diminishes their abilities, seniors alter behaviors and mindsets, and devise new tools to help them accomplish their daily tasks. They do so often to mitigate the need for outside assistance from family, friends and neighbors. Interior designer Gloria Stafford set out to better understand the transactional nature of aging in place. In her dissertation, “Aging Alone in the Family Home: Exploring Place Attachment and Personal Adaptation,” Stafford interviewed 10 seniors to understand aging in place through their eyes. Her interviews paint a picture of needs, desires, wishes and fears that are every bit as dynamic and complex as the push and pull we all feel throughout adult life.

By shifting our focus away from the problem-solution approach, we can create strategies that more effectively meet the needs of seniors who wish to age in place.

Motivations for Aging in Place

For most seniors, their desire to age in place can be broadly grouped into three categories: maintaining their autonomy, continuity of the lifestyle they have built, and enjoying a sense of normalcy amid their diminishing abilities and reflection on the finality that lies ahead. Continuity, autonomy and normalcy are all closely linked for seniors and tend to build upon and reinforce each other. However, as age progresses, seniors evolve these motivators to match their abilities and the realities of their advanced age.

Autonomy

Autonomy fuels normalcy, as seniors have experienced freedom of choice since adulthood. In later years, as Stafford’s research surfaced, a senior’s autonomy is more about not “succumbing to the directives of outside players” than it is about controlling their affairs as they did earlier in life. This can explain why a senior is more willing to get a ride to a doctor appointment or seek assistance with managing bills and shopping for groceries while being steadfastly opposed to a senior living community. Nine out of the 10 seniors who participated in Stafford’s one-on-one interviews could not imagine that living anyplace other than their family home would be emotionally fulfilling for them. This is true of the larger senior population in general. Studies routinely find close to 90 percent of seniors would prefer to age in place. To them, a senior community represents a loss of autonomy where they’ll be told when to rise, when to eat, what activities to partake in and so on. Having to succumb to the directives of others represents the ultimate loss of autonomy.

Normalcy

While autonomy and normalcy are closely related, both are strong and independent motivating factors. To achieve normalcy, seniors strive for feelings of comfort, for the feeling of being in control of their situation and surroundings, and for the feeling they are making progress toward achieving their objectives. Stafford writes that seniors employ both action strategies and mental strategies to maintain a sense of normalcy while aging at home.

Action strategies make use of supportive technologies or tools to accomplish daily tasks. Action strategies can also involve changing everyday behaviors or modifying the living space to compensate for tasks that have recently become too difficult or tedious to perform. Mental strategies to maintain normalcy can follow the out-of-sight, out-of-mind mentality where seniors close off rooms or box up items so they can quit thinking about these spaces and things they no longer use. Mental strategies can also take the form of lowering standards. One example of this is a senior who’s meticulously kept their house clean for decades but suddenly stops cleaning certain areas because they are difficult to reach.

Continuity

Picture of a desk with letters and photosWhen we are younger, there is a thirst for new experiences. As children, this drives us to make new friends and try new activities. As young adults, the quest for new experiences drives us to strike out on our own, meet new people, begin relationships and ultimately build a life of our own. As we age into retirement, the thirst for the new gives way to the charm of the familiar and routine. Robert Atchley, writing in Continuity and Adaptation in Aging, calls this a “persistence of general patterns.” In fact, much of the adaptation and innovation undertaken by seniors is in an effort to maintain their habits.

An example of using the persistence of general patterns can be seen in seniors who still set the breakfast table long after their children have moved away from home, as fixing breakfast in the family kitchen and setting the table brings back fond memories of earlier years. Or a widow who still looks out the front window every evening holding the newspaper as she did for years when she waited for her husband to return home from work. For seniors, continuing the habits of the past helps them feel while the world around them changes.

Supporting Seniors Who Are Aging in Place

There is no how-to guide or formula that senior care professionals, families and friends can follow to help a senior age in place successfully. Varying home environments, ability levels, resolve and adaptations render cookie-cutter approaches virtually ineffective. While home safety is paramount to those wishing to help a senior age in place, to the senior, aging in place is more of a high-wire balancing act between the desire to stay in the comfort of familiar surroundings with the all-too-real prospect of a life-threatening fall or other mishap.

Successful strategies that support safely aging in place will align the proposed change in behavior with the senior’s motivations for autonomy, continuity and normalcy. An example of this was highlighted by Stafford in her research interviews. To balance safety concerns with long-held routines, two participants described to Stafford how they modified their behavior by agreeing to open and close their window curtains by a particular time each day as a signal to neighbors they were okay. Nine of the 10 participants in Stafford’s research used “First Alert”-style alert systems. This nonintrusive tool helped ensure the senior’s safety at home without causing much change in the way they went about their daily business. When proposing an alert system, family or senior care professionals should help the senior see how this device could help them achieve a better balance between safety concerns and their desire to maintain normalcy and autonomy in their daily life.

For seniors, accomplishing the end goal is often more important than the means by which the goal is achieved. Of their own accord, seniors will usually modify a long-held behavior to continue enjoying hobbies, pastimes and routines. When proposing assistive devices, such as canes or walkers, present the device not only as a tool to increase safety, but also help the senior see how using a cane, for example, will allow for a continuation of long-held habits. Perhaps a behavior modification to use the device will be required, but reminding the individual how they have adapted throughout old age is a good strategy for getting recommendations adopted by the senior.

Next month, our aging-in-place series continues with a look at the challenges of aging in place and practical strategies you can use to overcome those obstacles.