Photo by Centre for Ageing Better.

If you are an aging person or someone you love is an aging person you are probably aware of the difficult decisions that lie ahead regarding how to maintain quality of life, or “healthspan”, for as long as possible.

Shorter life spans in the US

The US suffered Covid deaths at a rate twice that of other developed countries.

Life expectancy has fallen steadily in the US since peaking at 78.8 years in 2014. There was a downward tumble during the first two years of the Covid-19 pandemic in 2020 and 2021 to 76.4 years, with a slight rebound when Covid excess deaths leveled off in 2022 to 77.7 years.

Despite outspending all other industrialized nations per capita on healthcare, the US suffered Covid deaths at a rate twice that of other developed countries, and the blame falls on our high incidence of comorbidities linked to lifestyle choices. It is those same choices, together with surging numbers of opioid drug overdoses, that, according to the Mayo Clinic, find Americans looking forward to not only shorter overall lifespans, but less healthy golden years as well.

Add to that the skyrocketing cost of end-of-life care and nursing homes, and the stripping of affordable insurance away from millions of low and middle-income citizens under the current administration, and many boomers are finding themselves with ever-narrowing “Sophie’s choices” as they grapple with everyday issues of aging.

Countries in the European Union enjoy 5 more years of life on average than Americans.

It’s both depressing and maddening because it doesn’t have to be this way. Countries in the European Union enjoy 5 more years of life on average than Americans and can rely on universal healthcare as a basic human right. In most cases, long-term and nursing home care is also covered, at least in part.

Given that it is unlikely our current generation of elders will see a change in US policy in time to improve their lot as they prepare to meet their maker, what remains is a clear choice to do whatever can be done to maintain independence as they age.

Americans were shown in a cross-cultural study conducted in 2010 in the US and Japan to favor independence as a sign of health and self-determination. Being “put in a home” is seen as a defeat, even a death sentence, and in our current system, one’s life savings are often used up to pay for end of life care before any kind of government insurance kicks in, further dispiriting and casting a shadow on one’s self-worth.

The silver lining here is that doing the things now that promote long-term independence also will stretch your healthspan, and vice versa. Adopting an attitude of actively improving your health now will build your independence skills and keep you out of the dreaded “home” for as long as possible.

Ways to maintain independence

Here is what doctors and social workers list as some of the most important ways to maintain your independence.

Improve your diet

Eliminate ultra-processed foods and replace them with fresh whole foods, including plenty of protein, up to .5 grams of protein per pound of body weight. Protein helps maintain muscle mass as we age. Include plenty of fiber and antioxidants. Fiber is important for healthy digestion and reduces inflammation which is present in all kinds of chronic disease and cancers. Antioxidants also reduce inflammation and fight off diseases caused by free radicals (unstable molecules caused by some metabolic processes but also increased to dangerous levels by pollutants). For brain health, include plenty of vitamins E and K, folate, omega-3 fatty acids, even coffee and dark chocolate in moderation. Keeping up cooking and food prep skills keeps the brain active and maintains and improves hand-eye coordination.

Stay engaged

Statistically, living alone can lead to early death. The happiness indexes are higher for those living in partnerships, community, or among family. Loneliness and boredom can lead to depression and decreased activity. If you are a loner by nature, staying engaged may look less like social activities and more like finding something meaningful to do such as volunteering or sharing your skills in connection with others. We might take pride in living independently, but there is a fine line between independence and loneliness.

Stay fit

Sedentary existence exacerbates many health issues. Frailty is a greater cause of catastrophic falls than poor numbers on a DEXA scan. Move all your major joints through a full range of motion every day. Engage in resistance training (the heavier, the better) at least twice a week. Walk 30 minutes or more 3 times a week.  Work on balance in a variety of ways, including dynamic balance and steadiness when distracted. Being able to stand on one foot for 30 seconds is admirable, but won’t help you much when you trip over a broken slab of sidewalk while walking down the street looking at your phone.

Get your affairs in order

No one relishes creating a will and filling out advance directive forms, but in a crisis, the lack of these documents can rob you of your independence and create stress for you and your family. There are many simple low-cost resources on the internet. 

If hospitalized for more than a few days, avoid staying in bed all day. As soon as it is safe, get up at least three times a day, walk around the room, down the hall, whatever is allowed. Avoiding the deconditioning effects of a long hospital stay applies not just to elders but to anyone undergoing a long-term convalescence.

Avoid over-medication

Between 66 and 70 percent of Americans take at least one prescription medication every day.

Between 66 and 70 percent of Americans take at least one prescription medication every day. When the FDA allowed prescription drugs to be marketed directly starting in 1997, what had formerly been a decision arrived at on the personal doctor-patient level turned into an issue of consumer demand with patients requesting the anti-depressant, cholesterol control pill, ADHD remedy, etc.

Pharmaceutical companies rake in huge profits, but the numbers don’t show better health outcomes than in countries where 50-60% of persons take prescription meds (Germany and France) or where just 30% take them (Japan and China). The non-profit Lown Institute, a think-tank for putting caring back into healthcare, estimates that 150,000 Americans will die prematurely from medication overload over the next ten years. “Polypharmacy” as overmedication is also known, can lead to confusion, dizziness, internal bleeding, preventable hospitalization, falls, and other adverse side effects. In these days of healthcare staffing shortages, providers may miss contraindications, and many older patients are not necessarily their own best advocates when it comes to speaking up about their concerns.

Talk to your most trusted provider about your medications and make sure you understand what they do, when and how to take them, what the risks are, and whether any of them could be reduced or eliminated.

Maintain or establish internet and cellphone literacy

The fast-paced world of e-connectivity leaves a lot to be desired, especially if you recall with fondness days gone by when the daily fishwrap and nightly dose of Walter Cronkite were all that was needed to keep pace with the world. Being able to make and receive calls on a cell phone and look things up on the web are essential life skills now, whether we like it or not. By all means, avoid doom scrolling, but boost cognitive health by learning a new language, brushing up on math skills, or solving puzzles. Join a group for support or socialization. Is no one in your one-horse town besides you interested in worm charming? There’s a group for that online.

Keep up your housekeeping

Cleaning tasks are a light fitness opportunity and a way to maintain a healthier environment by reducing dust and clutter. There are many devices made to assist elders with certain tasks that become difficult or impossible when mobility is compromised. Consider installing grab bars in your bathroom, use a device to make your toilet seat higher, buy an electric can opener. Think about the things that are starting to be difficult and look for solutions….on the web.

Spend time in nature

Mental health experts are finding through studies and research that reconnecting to mother earth has health benefits ranging from physical to spiritual. According to Harvard’s TH Chan School of Public Health, time in the natural world improves sleep, reduces depression and anxiety, lowers blood pressure and reduces risk of chronic disease, all of which improve your chances of lasting independence.

Making even baby steps, but being consistent and persistent about it, will increase your chances of maintaining independence as long as you like.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.