Obstacles to Independence Part 2

4. Running out of Friends / Loneliness

I was watching Grace and Frankie, a wonderful series on Netflix and one of the episodes was about Grace going to more and more funerals. A common theme of ageing is the idea that eventually you may outlive your friends. Along with this is the fact that many people find it increasingly hard to make close friends as they grow older.

But as one needs more and more help with the activities of daily living, whether or not one has a stable of friends available to share the burdens can make a big difference. So, the loss of friends may mean a loss of independence.

5. Driving

Especially in North America, much of life requires getting from place A to place B by car. When you can't drive anymore, this means that simple activities like going grocery shopping can become much harder. Socializing becomes harder. The reality of the situation is that there are very few options for seniors who lose their right to drive. I know many people never have had a car, but for those who did and lost their right to drive the impact can be devastating.

With Uber or Lyft, suddenly the older adult can go where they want when they want (thus regaining autonomy). [Of course, you need to live somewhere they have these services, and have enough money to use them.]

6. Will Power & Attitude

Staying independent took significant willpower and hard work. When parts of the body are hurting, it takes willpower to go out and engage with the world. And to overcome possible physical challenges.

7. Energy Levels

A common theme: "We just can't get as much done in a day as before". So, activities of daily living that used to fit easily into a day start to loom large.

8. Cooking & Eating

Some see cooking and eating as necessary evils, and some as pleasures to be indulged every day. A friend of mine is a chef, and he thrives in the kitchen, he loves to cook and his world revolves around eating. I can cook, but I don’t spend time on it and sometimes it is a burden to have to cook. The key seemed to be arranging life so that meal preparation is not a burden.

Not being able to feed yourself was, of course, one of the physical health challenges that could impact independence largely.

Obstacles to Independence

There are a number of obstacles that can interfere with a persons desire to remain independent autonomous and to have self-determination
1. Money

Money tops the list in terms of obstacles to staying independent. If you don’t have enough then you could become dependent on others. If you have enough then you can get all sorts of personalized help which helps you retain your autonomy.

In the absence of sufficient money, many of my friends worry that they would have to move to a less favoured town or less desirable location and that they would be less able to participate in social events that might cost money. And that without adequate funds they would not be able to access sufficient help to "stay independent".

2. Physical Health

Physical Health is clearly one of the primary causes of loss of independence. Becoming dependent could be from a number of reasons, the first is falling.

·       Falling

My friends and I are not afraid of falling. It is not the fall itself that matters so much, but rather the consequences. A fall could result in a broken hip, which often leads directly to greatly reduced mobility if not worse outcomes. Or hitting one's head, which also can lead to grave consequences.

Falling is prevalent among my age group so an industry has arisen to warn people of the consequences and try to help prevent them, from falling. Our workshop on Preventing falling is one of the most popular.

·       Mobility

Lack of mobility, whether after a hip fracture or as a consequence of various other conditions, can be a significant barrier to independence. If you can't get where you want to go when you want to go there, that can be a major lifestyle limitation.

·       Hearing and Vision

Poor vision and poor hearing could be major impediments to independence. When people have trouble seeing, they restrict their movements and their interactions with others. If they cannot hear and do not wear corrective devices, people will avoid conversations with them and over time will isolate them from social activity. This isolation may lead to a loss of autonomy and independence.

3. Mental Health (Dementia)

One of the most asked for workshops that COSCO Health and Wellness Institute gives is on memory. For many of my generations loss of cognitive ability and dementia came up frequently. Very few seniors under the age of 85 will have major problems with mental ability, it is still a very scary condition.

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.

Computers, Health and the Net

Can the Internet and computers help keep us healthy? It depends on how it is used and what sites we rely on to get our information. A recent study found that computer-delivered interventions show that using the computer and the Internet can work in some areas but not in others. Data from 75 randomized controlled trials, published between 1988 and 2007, with 35,685 participants and 82 separate interventions were included in the study. The researchers found that Computer-delivered intervention (CDIs) can lead to immediate post-intervention improvements in health-related knowledge, attitudes, and intentions as well as modifying health behaviors such as dietary intake, tobacco use, substance use, safer sexual behavior, binge/purging behaviors, and general health maintenance.

The researchers believe that computer-delivered interventions may help some participants organize previously latent motivation and behavioral skills at a critical moment, leading to improved health behaviors.

CDIs do not provide benefits in all contexts; the evidence does not support the use of CDIs to improve physical activity, weight loss, or diabetes self-management. Nonetheless, there is sufficient evidence to continue to investigate the benefits and limits of CDIs, to explore patient- and intervention-characteristics that facilitate health behavior change, and to determine the long-term effects of CDIs.

The research also looked at how long the changes might last. Some would argue that health behaviors are likely to recur (some would say “relapse”) when environmental conditions change (e.g., during increased stress), and the influence of the intervention wanes. The researcher found that computer-delivered interventions often exhibited uniform impact on outcomes despite the variability in follow-up duration, suggesting that the impact of computer-delivered intervention can be durable.