Take a moment to think about your death. It’s one of the few things in life we know will happen. How do you picture it? Are you surrounded by family and friends? Are you at home? Are you asleep (this is what I hope for)? Few of us will picture ourselves in a hospital with tubes sticking everywhere, and fewer still will include any pain in that vision, which unfortunately is all too common.
Now just back up a tiny bit from that point to how you want to live your years leading up to that point. A lot of people say they want to “live independently”. But what exactly does that mean? Is it living at home, being able to walk to the local store and bring home a bag of groceries, or being able to drive one’s entire life? And what are people doing to ensure that happens?
Unfortunately, for many people they don’t end up realizing that vision of living independently. As we get older, many of us will have multiple chronic diseases. Any one of which can impair how one lives their life.
I’m not bringing this up to be pessimistic, but to highlight a point in our lives in which we may have some control over, yet we don’t take it. We all know we are going to die at some point, and we can’t change that. Hopefully death is many years off for all of us, but what we do now and in later years can influence if we do live independently, or as close to it as possible, right up to our death. The key is we need to work at it.
Many of the tasks that define living independently are physical in nature, such as walking to the grocery store. Other things can require much less effort but are still physical in nature and may require a certain level of coordination such as preparing meals, brushing one’s teeth, taking the garbage out or washing the dishes. Even driving requires physical ability to do it safely and many jurisdictions have retest requirements for the elderly to ensure their safety and that of others.
These might seem like trivial tasks now but as we age, many of these activities of daily living become harder and harder until they’re not possible to do unassisted, thus challenging one’s ability to live independently. For some it means having a family member or friend do certain tasks for them, for others, it could require living in a care home.
Now in some cases, certain illnesses may lead to reduced physical ability and even frailty, and perhaps even loss of mental ability, which make living independently impossible. Other times, however, one’s lack of being physically fit can lead to frailty and loss of coordination, and/or exacerbate it.
As we age, it’s common for physical activity to decline. Initially this was thought to be due to age-related changes in abilities and strength but we now know that a lot of this decline is voluntary. People who remain active throughout life experience about half of the declines in fitness compared to people who aren’t active.
Decreased activity with age may result from changes in our life that are either directly or indirectly related to doing less activity. Take most jobs and careers. A lot of us will start in a frontline work setting where we’re on our feet and walking about. As we progress through the ranks of our career, the jobs become more sedentary, we spend more time sitting and get less activity while others do the frontline work for us.
Another example is downsizing, where people move to a smaller home such as an apartment from something like a house, commonly due to things such as kids moving out. This isn’t to say that people should stay living in a place that is far too big for them, but going from a place with a yard and multiple stories to a single story apartment will result in less daily activity that many of us are never aware of.
In some cases there is the belief that as we age we need to do less. We feel we shouldn’t walk as far, or lift as much. True, when we’re in our 60s we’re not going to be as strong as we were in our 20s but most of us underestimate what we can do. Some of us might also feel more vulnerable with age and may wish to avoid walking alone at night out of safety concerns.
All of these subtle changes together decreases our fitness and strength. As that happens, we become unable to do certain activities, which means we can do even less, which then further decreases our fitness, and so on in a circular fashion. So by cutting back on what we do, we are effectively reducing what we can do. It’s basically a use or lose it scenario. Over time, this may make some of those activities of daily living mentioned above challenging. We may no longer be able to carry the groceries or vacuum the house. Reduced fitness and strength also increases our risk for falls and sarcopenia (a wasting of body muscle).
In the US, more than one in four people 65 years and older fall each year, and about 20% of falls result in an injury. Falls are the greatest cause of hip fractures and can also result in severe head injuries. These injuries have their own outcomes of long-term impairment and early death. There are a number of risk factors for falls with two of the most prominent being lower body weakness, and difficulties with walking and balance. Both of these can be prevented through regular activity as highlighted in current recommendations for preventing falls.
The other is sarcopenia, which affects approximately 10% of people in their 70s and increases dramatically with age. Again, exercise and physical activity are recommended for preventing sarcopenia, and exercise, specifically resistance (or strength) training, is used to treat people with sarcopenia.
The good news is that it’s never too late to begin exercising. While being active throughout one’s life is ideal, beginning later in life can still have great benefits as demonstrated by these women starting Parkour in their sixth decade, one of whom was able to stop using her walker. And exercising doesn’t mean getting to a gym, wearing a tank-top and yelling as you lift weights. It can be as easy as using light weights while sitting in a chair or using elastic resistance bands or doing water aerobics. The goal is to be able to keep up with your activities of daily living, not become a Ninja Warrior (unless you want to).
It may be stating the obvious, but if we all want to live independently later in life, we actually need to work at that now and be aware of changes in our life that may unnecessarily decrease our activity so that we can look for opportunities to make that back up.