Aging Gracefully Takes Planning, Positivity
BROOKINGS, S.D. – By 2030, one in five Americans will be in the 65 and older age group. Some will embrace the milestone and look forward to the years to come, while others will diverge, only seeing the negatives in their next chapter of life. However, Leacey Brown says 65 isn’t the magic number we should be looking at in terms of aging, as the process begins decades earlier.
“There’s just something about aging that people don’t really want to talk about it, but the truth is we really need to start thinking about aging and thinking about being older and thinking about how we want that part of our life to look when we’re younger,” Brown says.
While the risk of developing a disease or disability does increase as we enter the last third of our lives, the SDSU Extension Gerontology Field Specialist says neither are inevitable outcomes of the aging process. She argues that people can age well and in place, but it takes planning, a different mindset and following the recommendations of their medical providers.
“Research tells us that how a person thinks about aging predicts a lot of their outcomes,” Brown says. “In short, if you have a crummy outlook on getting older, you’re going to have a crummy experience. It doesn’t mean aging is going to be all roses and daisies and it’s going to be wonderful and nothing bad is going to happen. There will be challenges — losing spouses, losing career, loss of friends, physical decline — those things are hard, and they are more prominent in older people, but we can still have a good quality of life.”
Older population to reach historic levels
A Florida native and an Air Force veteran, Brown decided to stay in the Midwest after her enlistment ended in Minot, North Dakota. She enrolled at Minot State University and studied sociology and psychology. After graduating with a bachelor’s degree in both fields, Brown realized she wanted to pursue a master’s in gerontology.
The study of aging processes and individuals across the life course, gerontology examines the physical, mental and social changes in people as they age; the societal changes that stem from an aging population and how to best apply this knowledge to policies and programs.
“Where a person lives, the built environment, and services and resources available also are explored by a gerontologist. Research suggests that communities needed to be constructed in a way that accounts for the changes of aging. Housing is a great example of a barrier to aging well. Access to transportation is another important factor,” Brown says. “Gerontologists look at individual aging, but we also explore the context where the individual is aging and how that influences their outcomes.”
A broad field, gerontology will continue to be an important research sector now and in the future. By 2034, the United States Census Bureau projects older adults will outnumber children for the first time in U.S. history. With the decline in birth rates and advances in public health, people age 65 and older are expected to reach 77 million strong, with those 18 and under making up 76.5 million of the country’s population.
Since joining SDSU Extension in 2012, Brown has been narrowing her focus to assist South Dakotans with aging well, aging in place and falls prevention. Some of the educational information is for older adults themselves; while other material is geared towards those that are caring for them.
For example, Brown has been teaming up with NDSU Extension to host a Gerontology Lunch and Learn webinar series this winter. Each webinar addresses areas such as communicating with people who have Alzheimer’s or dementia, purposeful aging and respite care.
“If you are caring full time for someone with dementia, you can almost never leave because that’s just the nature of it. They need respite care though, those breaks, so respite care could be hiring someone to come into your house and take care of your loved one while you leave or respite care could be maybe they go to a facility for a week, so you can take a vacation,” Brown says. “That’s really important for people who are doing that full-time care, especially for someone with dementia, but it could be other things where maybe your loved one is really frail and they can’t prepare meals, so you bring in somebody to maybe do the meal prep and you can take a break.”
According to the Substance Abuse and Mental Health Services Administration, aging well is the product of eight wellness areas. If one of these areas is neglected, then wellness in other areas will likely be affected:
Physical wellness: Incorporating movement daily, eating nutritious foods and getting the recommended amount of sleep.
Emotional/mental wellness: Coping with stress and daily life challenges.
Social wellness: Maintaining a sense of connection and belonging to a well-developed support system.
Intellectual wellness: Engaging in creative activities and expanding knowledge and skills.
Vocational/occupational wellness: Discovering satisfaction and enrichment from work, whether volunteer or paid.
Spiritual wellness: Finding meaning and purpose in life.
Financial wellness: Sustaining a satisfactory financial situation now and in the future.
Environment wellness: Occupying a pleasant home and living in a community that provides sufficient stimulation and support.
Not aging-in-place ready
For most older South Dakotans, meeting the last wellness area is crucial. Aging in place is a high priority for adults age 50 and older. Unfortunately, Brown says architectural barriers in current private housing designs may make that goal difficult to achieve.
“A lot of people tell us over and over again that they would like to stay in their home for as long as possible, which makes sense,” says Brown. “Your home is where your memories are, and your stuff is. We all feel more comfortable in our own home and the idea of not being in that space is very scary for people. But the fact of the matter is, as we get older, our risk of developing a disability is high and especially before the end of life, it’s likely we will experience frailty.”
In 2018 SDSU Extension and NDSU Extension conducted a joint survey with more than 600 Dakotans (https://extension.sdstate.edu/housing-across-life-span-consumer-knowledge-preferences-and-barriers) to explore consumer knowledge, motivation and barriers to accessible housing. The report found that most participants were aware that the current stock of homes was not appropriate for aging in place, but had limited knowledge about design solutions, such as universal design.
Universal design emerged in the 1980s as an approach to home design that aims to create products and environments to be used by people of all ages, sizes and abilities, with minimal need for specialized disability-specific features (e.g., lower counter type height). While converting a home to universal design may seem like a rather daunting or expensive approach, Brown says implementation in new housing could address the need for older adult housing and help to avoid costly structural renovations in the future.
She says part of the problem when describing universal design is that people’s interpretations instantly go to the accessibility factor and fail to see how it fits their family and situation. For example, a no-step entrance benefits a person using a wheelchair or walker, as well as a parent pushing a stroller or a person delivering furniture.
For these reasons, Brown recommends the adoption of visitability in the housing stock of South Dakota. The goal of a visitability is to ensure that a person with a disability could visit a home. Below are recommended features to include in a home to make it visitable.
One zero-step entrance into the home
One bathroom and bedroom on the same level as the zero-step entrance
Bathroom wall reinforced for grab bars
Minimum 42-inch wide hallways and 36-inch passageways
Electrical wall outlets/receptacles should be 15 inches above the finished floor
Wall switches controlling light fixtures and fans shall be a maximum 48 inches above the finished floor
All exterior and interior doors shall be 32 inches in width
“People are often ‘well I don’t have a wheelchair, I don’t need that,’” Brown says. “Well right now you don’t, but what happens if you do, either permanently because you’re facing the end of life or you temporarily get injured when working on the farm. It’s really changing the mindset of it’s not about aging and disability; it’s the fact that our bodies are fragile, and they can break at a moment’s notice.”
Brown says South Dakotans need to work together to find ways to modify the existing stock. For example, government agencies and other businesses (e.g., insurance broker) could offer incentives to increase the inclusion of visitability features in new and existing homes. Example of incentives include tax credits, reduced-price or waived permit fees, reduced-price long-term care insurance, mortgage discounts, priority review of building permits that include visitability, etc.
Fall Prevention Coalition
Falling should not be accepted as a normal part of growing older either, Brown says, but it is a problem. Between 2007 and 2016, South Dakota ranked fifth in the nation for deaths from falls among older adults. Falls can lead to depression, loss of mobility and loss of functional independence. According to the Centers for Disease Control and Prevention, about $50 billion is spent each year on medical costs related to non-fatal fall injuries and $754 million is spent related to fatal falls.
“When an individual experiences a fall, it has a domino effect on their quality of life,” says Brown. “Beyond the challenges from recovering from the falls, older adults who have experienced a fall often develop a fear of falling again.”
In 2020, SDSU Extension joined more than 20 other state organizations to form the SD Fall Prevention Coalition. By collaborating and providing evidence-based solutions for falls prevention, the group’s vision is to reduce the number of fall-related deaths by 5%, and fall-related hospitalizations by 10% by 2025 or 2026.
In addition to hosting exercise fitness programs such as “Fit & Strong!” and “Walk With Ease,”(https://extension.sdstate.edu/news/focus-your-health-2021-sdsu-extension) SDSU Extension also has released a video series through the South Dakota Fall Prevention Coalition. Each of the five videos highlight simple exercises that can be done at home to strengthen the body, as research has shown that body weakness is a leading cause of falls.
Whether she’s addressing falls prevention and aging in place, or family caregiving and life planning, Brown says her mantra is “aging is good — it’s not easy, but it’s part of the journey of living.”
“I do hope that we can have more positive conversations around aging in our state. One of the big things that I try to do when I’m communicating about aging is say ‘as we age, as we get older,’ trying to keep myself included in this conversation, because aging doesn’t magically start when we turn 65, we start aging when we are born,” Brown says. “When we’re proposing solutions for more nursing homes and assisted livings, how many people actually want that? Some people love it but there’s others that feel that would be uncomfortable. How can we create solutions that we all want as opposed to what we think older people need?”
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