Independence and seniors

In many cases, the word independence for seniors is not even what matters most. But rather the words autonomy and self-determination are more important.

To have a discussion of independence for senior, we really need to talk about what it means to be independent because independence means quite different things to different people.

There is a clinical approach to thinking about independence, which involves two measurements. The first is a set of specific “Activities of Daily Living” such as activities related to personal care such as bathing, getting in and out of bed, walking, using the toilet, and eating. The second measurement is the Instrumental Activities of Daily Living which includes activities related to independent living, such as preparing meals, managing money, shopping for groceries and personal items, performing housework, and using the telephone.

According to this way of thinking, if you can handle all Activities of Daily Living” and Instrumental Activities of Daily Living yourself without help, you are definitely independent. As you need more and more help with these you reach a threshold after which you are no longer classified as "Independent".

In other words, for the practitioners and clinicians, it is about how much help you need with the basic activities of life

So if you might need quite a bit of help with some of the activities of daily living and your life is organized so that the help (person or machine) is available as and when needed, and you can pretty much get done whatever you want to get done when you want to do it, then you have a high level of autonomy.

In contrast, if you need to wait until a helper is available, and you have to adapt to their schedule, then that is going to feel quite a lot less "independent"

One of the most interesting aspects is the interplay between safety and autonomy. A friend of mine said to me, "some people are so focused on safety that it can get in the way of living". He then talked about the idea that some care homes have cameras. This might increase safety, for example, early fall detection, but is a life worth living if you are under constant surveillance? He thought not.