A study in the Journal of Clinical Psychiatry.
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What’s old has become new again – the halo of aging in place
Henry Cisneros discovers aging in place. In August, 2012, Kaiser Health News published an interview with former HUD Secretary, Henry Cisneros, who talked about his mother who is aging in place, following some well-considered home modifications. Cisneros also edited a book, Independent for Life – and just published an op-ed in the Miami Herald discussing this new frontier in housing, using his own mother as an example. Home modifications enabled her to remain in her home -- she insisted and he was apparently too cowardly to argue. She is described as widowed, 87 years old, requiring an alarm system, her home in a "neighborhood somewhat in decline." Her neighbors on three sides had passed away, and he admits that even though he visits her frequently (every other day, come on, now really???): "Aging in place in that neighborhood means older women living on their own." Looking ahead: he could have noted that one-third of the 90+ live alone – and while aging in place sounds pretty good, one must pause and remember life expectancy and personal expectation – half of the 65+ today expect to live to 90. And they're right. If a woman lives to 65, she is likely to live to 85. But by age 90, there is an equal likelihood of each of these scenarios: she will live alone, or with her relatives, or in some type of institution.
So people believe that remaining forever in their own home is wise? Did anyone notice this change in AARP survey results about the 45+ population? AARP has often asked the question about a 'desire to age in place' – sampling different groups over the years. Throughout their own reports, they often quote their 2005 survey when they indicate that 89% of the 50+ prefer to 'age in place', that is, they want to live in their own home for as long as possible. Recently that dropped to 75%. But in 2003, the survey respondents aged 45+ were asked a different question: "How likely do you think it is that you be able to stay in your current home for the rest of your life?" Their realistic response: 54% said that it was 'very likely’ but another 21% thought it was 'somewhat likely.' The rest were unenthusiastic. Why? I bet that after the post-war boom in building two-story colonials and one-story ranch homes, when on the phone with AARP's survey firm, responders must have glanced around their houses, many of them now multi-story and expanded with steep stairs to the basement and/or attic -- they thought about their own parents and grandparents -- and shuddered.
Aging in place is a nightmare for the 90+. Our real ages may be on the downswing. Sixty is the new 40. And working past 65 is the new normal, while the population aged 90+ is the new 85+. But away from the hype, what if the neighbors and friends die, as in the case of Henry's mother, or the house is cavernous or rickety, or it's a safety nightmare for those with declining vision, hearing, or mobility issues? The house is in a cold climate or it's out in the country; the sidewalk is icy, the suburban neighbors are an acre away or they're at work all day. Exactly what’s the upside of aging in that place? What sounds like the good life for the 65-75 year old may not work at age ninety. At the least it requires the cash of the Cisneros family and I bet he travels more than he admits. Or it demands devoted relatives with a large yard for a granny pod or an attached apartment. It mandates the willingness to spend quite a bit of time overseeing health issues, having someone to provide needed care, or moving to assisted living or a nursing home, where the care is now distributed and isolation risk is (somewhat) mitigated. So you might have been a lucky kid and your grandpa is cooler than you – or he may have been be one of the of the 85+ with dementia. Those folks – Cisneros’ vision and mother not withstanding -- are going to age miserably in place. They will make their families miserable -- or they’re going to move to a better place. Everything else is marketing.