-Virginia Foxx

I returned from Europe two weeks ago, which always gives me a fresh perspective on my own country. As I was doing some pre-Fourth of July-Holiday tasks I got caught up in the bustle of shopping and completing my to-do list. I was in an old school hardware store watching customers buy plastic American flags, charcoal briquettes, portable grills, and soft drinks—the usual stuff.

I began to notice a trend with the folks around me that I didn’t notice overseas—while waiting in line to check out, it struck me how heavy our citizens are. This really isn’t a revelation, but I was somehow acutely aware; obesity was everywhere…

I stopped in to get a sandwich at a local shop and the three sandwich makers behind the counter were all obese—two were morbidly obese. The lady ahead of me in line was over-weight (asking for extra toppings on her sub) as was the couple behind me…I then made my way to the car and noticed more overweight kids waiting at the bus stop.

The ironic thing to me was this is a civil holiday for the celebration of the anniversary of the beginnings of national independence. July 4 is the commemoration of the adoption of the declaration of the Congress of the Thirteen United States of America, onthe 4th of July, 1776, by which they formally declared that these colonies were free and independent States, not subject to the government of Great Britain.

Yet I wondered just what does Independence mean to me and the average American? Can being in a state where your body isn’t fully available to you—be considered freeing? Or a state of independence?  So I turned to the internet for a definition:

1. (noun) independence

the state or quality of being independent; freedom from dependence; exemption from reliance on, or control by, others; self-subsistence or maintenance; direction of one’s own affairs without interference.

-Princeton’s Wordnet

Free to Make Choices Affecting Aging in Place  

With this definition it’s clear we are “free” to make choices that may not serve to further our independence down the road—a choice many of us are making. In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women (for specific breakdown of data see JAMA: Obesity Trends link). Essentially, one third of us are obese, which is defined as a BMI of 30.0 or higher.

Despite all the information concerning the health effects of being over-weight, many continue down that path. The issues are complex and call for systems thinking when designing interventions—it’s even difficult to write about here for fear of offending or alienating readers. But if I truly believe in helping others at the best chance at successful aging in place, then I’m compelling to discuss obesity as it relates to living independently.

Each day we are faced with countless “choice points” about our lives; to take the stairs, order the light lunch, or stop at one dessert. Often we are stuck making “better-bad choices,” as time limitations force picking between the lesser of two evils. These choice points have an accumulative effect—if we make the hard choices now, life can get easier later. If we make the easy choices now, life can get harder later on—and with each decision our future independence hangs in the balance.

Aging in Place with Bowling Balls

Consider this as you ponder Independence Day; at 42lbs “over-weight,” you’re negotiating stairs, bathtubs, kitchens, and chores like yard work (*ADLs)—carrying the  equivalent of 3 average size bowling balls!

Think what that does to:

1. Your energy level

2. Your cardiovascular system (extra vessels to feed all that adipose tissue = extra work load your heart)

3. Your skeletal system (knees, hips, back)

Just to mention a few systems affected…

So many of the things we blame on aging have nothing to do with getting older. What’s misuse or disuse, and what’s normal aging? Loosing 42lbs means not being burdened by 3 bowling balls! How might that improve your odds of aging in place successfully?

You can consider remodeling your home with Universal Design, and there are all kinds of high tech gadgets and wonderful products available on the market which can facilitate aging in place—some are reasonably priced, some expensive, and some even priceless; but none as effective as mindful living and making choices that will honor your future independence.

How we live determines how we age.

See

UK has its own problems with Obesity

BMI Calculator

JAMA: Obesity Trends

Battling Obesity in America(video) Nothing New Here

Learn more about the Declaration of Independence (video)

UK has its Own problems with Obesity

Ray Charles: America the beautiful

BMI Calculator

JAMA: Obesity Trends

Battling Obesity in America(video) Nothing New Here

Learn more about the Declaration of Independence (video)

Morbidly obese

(nonaffiliated link)

as mindful living and making choices

*Activities of Daily Living

Photo credit: (photo communitymedical.org)

Design is intelligence made visible.- Alina Wheeler

Each year I attend the ASA conference on Aging and reoccurring themes begin to emerge and persist throughout the week; this session remained true to form. A mantra I picked up early; “Design is for all.”

Design on the Brain

Each of us has a brain equipped with a tightly bundled grouping of nerve cells about the size of an apple wedge located from the top of the spinal cord into the middle of the brain. This part of our brain contains about 70% of its estimated 200 billion nerve cells; or a total of 140 billion cells—and is called the Reticular Activating System (RAS).

Your RAS is a hockey goalie to consciousness—the gatekeeper screening the type of information allowed through and filters everything else that you don’t pay attention to. And it also hones in on what’s important to you. Buy a 1966 Mustang or the new Adison leather large Marielle drawstring shoulder bag, and you begin to magically see them everywhere. Why? Your RAS has now alerted your brain to bring them to your attention.

My RAS for the conference was programmed to “DESIGN” and I was rewarded; because design matters to an aging population.

Democratization of design

Much of the discussion focused around “Inclusive Design” or “Universal Design” that will accommodate all users regardless of age or level of physical functioning. More than once I heard speakers say: “It’s not just design for the elderly, good design helps everyone.”

Not a new idea, in fact, the barrier-free movement in the 1950s began a process of change in public policies and design practices in response to veterans returning from service with disabilities. The movement has evolved as the democratization of design for all; both in structure and beautiful aesthetics.

Michael Graves, FAIA, famed designer and professor at Princeton University, became a reluctant expert in medical equipment design when an acute neurological disease left him unable to walk or do self-care. Graves turned this into a best-worst experience for design that functioned better (structure) and delighted the senses (beautiful aesthetics).

Graves was noted to have said while lying on a gurney in the hospital in the throws of his acute illness:  “I can’t die here, it’s too ugly.”

His point speaks directly to the heart and soul of the barriers to adoption of countless potentially life-enhancing tools. Gerontophobia (fear of aging) keeps my own mother from using a walker which would make possible ambulation to strengthen her muscles, stimulate her brain with exercise, and facilitate balance—and what’s most personal is most universal, she is not alone in her desire to not look old. The sad irony is that this kind of stigma which leads to adoption-failure actually has the opposite effect—and is a “secondary ager” which speeds up the aging process (atrophy).

Design Matters: OMHU

Design matters with caregivers and patient outcomes; this has been well established in the literature on environment and health effects. And with the proliferation of new technologies for aging in place, the same barriers in design concerning both structure and aesthetics apply.

One company, OMHU (means “with great care”) exhibited an empathetic understanding and nonpatronizing approach to mobility aids. They’ve successfully combined materials from the world of performance; bicycles, hockey sticks, skateboard, and high performance athletic shoes—and from these made a cane which delights the senses.

Emphasis is on performance; not disability and yet OMHU is not denying the need either—after all it’s a cane. They get it, and the underlying philosophy which infuses this product is clever and evokes the will to live…and aren’t we all in this for a better experience of aging?

We live in a world that will never be young again—each generation will grow older than the one before. This is important because the demographic transition means a future filled with more and more old people.

Robert L. Peters said: Design creates culture. Culture shapes values. Values determine the future. I for one would like to see more emphasis on matters of design, not as a nicety, but as a guiding principle of gerontology; our future depends on it.

See:

Adaptability: Universal Design Michael Graves

Free Subscription to HealthCare Design

Image:

http://www.g-mark.org/award/image/2008/08A01010_1.jpg

(photo http://www.classicmoviegab.com)

“A mother can take care of 5 children yet 5 children can’t take care of one mother.”

-unknown

I came across the film Make Way For Tomorrow (1937) by Leo McCarey. The movie is about an elderly couple, Barkley (Victor Moore) and Lucy (Beulah Bondi) Cooper, who are forced to separate when they lose their house to foreclosure; and none of their five children is willing to take both parents in.

Barkley is not able to find work due to his advanced years and with foreclosure eminent the elderly couple summons the adult children to break the news. A temporary solution is for the parents to split up and live with different family members; which proves to be untenable for all parties.

As Barkley continues to search for work so he and his wife can live independently, the scenario predictably deteriorates into a human tragedy:

When Lucy continues to speak optimistically of the day that he will find work, her teenage granddaughter bluntly advises her to “face facts”; that it will never happen because of his age. Lucy’s sad reply is to say that “facing facts” is easy for a carefree 17-year old girl, but that at Lucy’s age, the only fun left is “Pretending that there ain’t any facts to face…so would you mind if I just kind of went on pretending?”

-Wikipedia

Although the film ran over 70 years ago the topic is more relevant than ever as the aging population and the economic down-turn spell CRISIS for many seniors and their families.

Elderly Foreclosure

The global economic depression has hit boomers hard—as over 684,000 homeowners age 50 and over were delinquent, in foreclosure, or lost their homes last year. This is especially troublesome for the older adults who are on fixed income and limited time horizons for recovery. Not to mention the coming tough times for federal assistance programs for seniors; as pressure on aging services to poor and frail ramps up.

3 Stories: The Faces of Foreclosure

For a growing number of Americans the “Golden Years” are a fanciful dream that died with a personal loss or economic fates; never to be realized despite years of working and planning. Here are three stories to put a human face on the hardship faced by older adults:

Patricia 5 years in her home

Cole 28 years in his home

Andree 20 years in her home

These stories are heart-breaking, increasingly common place, and in need of solutions.

Saying Goodbye to Aging in Place?

We can discuss aging-in-place remodeling and elegant universal design options, but unless individuals like these have a “place” to age in–it does little good as they are evicted from homes where their dreams once resided.

In a review of Make Way For Tomorrow, Jamie S. Rich finds the film more hopeful because it shows us two people who can make the best of the worst times, who are resolute, and who never let go of what matters, even if they have to say goodbye to it.

Which many will have to do…

Watch the Film Make Way For Tomorrow

http://www.youtube.com/watch?v=V_MrZojHUdQ (10 parts)

See

One Away: Seniors in Trouble

911-Foreclosure Update

Foreclosure Threatens Elder-Care Homes

More Families Move in Together During the Housing Crisis

How to Cope with Elderly parents moving in

Equal Justice Works: Elderly Hard Hit by the Mortgage Crisis

How to Live With Needful Aging Parents

Lessons Learned By Moving an Elderly Parent Into A Boomer’s Home

How to Prepare When Elderly Parents Move In With Adult Children

Help

NRMLA: ReverseMortgage.org

HUD Reverse Mortgage Frequently Asked Questions

Reverse Mortgage as a Foreclosure Intervention Tool

Legal Aide for the Elderly

The Elder-Care Team

Support Our Seniors

“Marriage is a wonderful institution…but who wants to live in an institution?”

-Groucho Marx

Valentine’s Day

Valentine’s Day traces its origins to an annual Roman pagan celebration, called Lupercalia, which was held yearly on February 15. Seems the lovers’ holiday has its roots in raucous annual Roman festivals where men stripped naked, grabbed goat- or dog-skin whips, and spanked young maidens in hopes of increasing their fertility, says classics professor Noel Lenski of the University of Colorado at Boulder.

The Celebration was disapproved of by the Roman Catholic Church and thus linked the festival to the legend of St. Valentine. Even so, the Holiday’s popularity persisted into the fifth century A.D; at least 150 years after Constantine made Christianity the official religion of the Roman Empire.

In the third century A.D., Roman Emperor Claudius II, seeking to bolster his army, forbade young men to marry. Valentine, according to legend, defied the ban and performed clandestine marriages. Valentine was executed in A.D. 270 – on February 14.

The first known Valentine’s Day card was sent in 1415 from France’s Duke of Orleans to his wife when he was a prisoner in the Tower of London following the Battle of Agincourt.

The tradition of hand-written Valentines gained popularity in the U.S. during the Revolutionary War. Mass production soon began in the early 1900s; and Hallmark started selling the cards 1913.

Attention Men

The Holiday gears much of its commercial focus on men: In the U.S. males will spend nearly twice as much on the holiday as U.S. females. In 2010, the average man spent $135.35 on Valentine’s Day gifts, while a typical woman spent $72.28.

How sweet it is; about 47 percent of U.S. consumers will exchange Valentine’s Day candy, at a cost of about $1 billion. Nearly 75 percent of that billion comes from sales of chocolate (chocolate has been linked to romance at least since Mexico’s 15th- and 16th-century Aztec Empire).

This year is expected to generate $14.1 billion in retail sales in the United States. Given these billions of dollars and all the effort and energy expended to say “I love you,” is there something we as boomer men can do that ismore lasting than say a box of (high calorie) chocolates?

Aging in Place is a Women’s Issue

Women in most developed countries still outlive men by 5 to 9 years; although men do get old—women get older. For that reason aging in place is an important issue to the women in our lives.

Fact: Widowhood is more common among older women than older men. In the United States, about 700,000 to a million women are widowed each year. Approximately 75 percent of widows are 55 or older; and widows account for 53 percent of women 75 to 84, according to U.S. Census data.

Women tend to spend their savings on their husbands’ care, and then live alone for 15 to 20 years with far fewer resources. Medicare pays only about half of older people’s health costs; the term for this is “spend down.” The time to give the gift of aging in place independence is before this happens—while you’re both home to enjoy the benefits of being home by choice—together.

A Valentine’s Legacy of Independence

It may not seem romantic but loving your spouse means being there for her now and in the future by leaving a legacy of independence. The thought of her loosing the safety and comfort of home is unpleasant at best…This year skip the chocolates and flowers; instead make an appointment with a CAPS trained remodeler for a home assessment.

Then make dinner for her and after take her by the hand look lovingly into her eyes tell her your expression of love this year will be different—lasting…Turn down the lights (using the rocker switches you just installed), light the candles and describe your future together in an accessible home with beautiful Universal Design features. After all, as Groucho says: “Marriage is a wonderful institution…but who wants to live in an institution?”

She’ll love you for it…

• No Ordinary Moments
• How Do I Love Thee? Let Me Count At Least 2 Ways
• Boomers: What is Real?
• Aging in Place Behind the Wheel
• When Aging in Place is Untenable

I can’t die. It would ruin my image.
- Jack Lalanne

A man’s health can be judged by which he takes two at a time – pills or stairs.
~Joan Welsh

I read an article online from SmartMoney titled; Hanging On at Home. The piece begins with the jugular question: Where will people live as they grow old?

The author goes on to describe a summary of the social forces that have shaped the living conditions of seniors prior to WWII, up to the present. He then provides five suggestions for “cutting through the clutter” of aging-in-place information on the web.

Not to cloudy the waters further, but I’d like to add a sixth suggestion…

Jack Was Right

Many of the targeted audience for the SM article grew up watching black and white images of a sincere, high-energy-buffed-guy in a tight-fitting jump suit, giving motivational chats, leading invigorating workouts, encouraging deep breathing and healthy living; all accompanied by lively organ music.

The sets were simple (a steel office chair and a poster board) but the concepts were not—and they still ring true today.

Jack Lalane was right; he knew that many people’s lives were just suicide on the installment plan. Jack recognized our changing disease states which have gone from acute (i.e., pneumonia which was once called “the old man’s friend”), to chronic (i.e., diabetes which isn’t cured only managed over long periods); and many were due simply to neglect.

Functional Aging

Aging in place requires more than just making a few simple changes such as replacing doorknobs with pull handles or installing ramps and no-step thresholds. These strategies are important, but functional aging is a key element in extending independence.

Lalanne described “functional aging” in his The Hands of Time episode. The goal was to die “young,” as late in life as possible…which is really the difference between extending life vs. extending health; they are not the same thing.

Much attention has been paid lately to the biomarkers of aging and how they can be affected by lifestyle. One key biomarker (measurable physiological factor related to aging) is aerobic capacity.

Aerobic capacity (age and weight specific) is how exercise physiologist measure uptake and utilization of oxygen by the body; the term used is VO2max. This is an essential factor for aging in place, because if you have a VO2max of less than 10ml/kg/min you can’t live independently at home because of the inability to do activities of daily living (ADLs).

The Bad News

As we age, under normal conditions (meaning no underlying diseases like lung cancer) our VO2max after age 30 decreases by 1% each year. So a 70 year old has a 40% decrease in VO2max.

The Good News

Exercise can decrease that 1% yearly decline in VO2max after age 30, by half. So a 70 year old may only experience a 20% decrease in VO2max.

The Sixth Suggestion

So, while you’re doing that elder-friendly home evaluation, embracing the concept of universal design, emphasizing fall prevention, comparison shopping-remodelers, and staying aware of public trends…PLEASE don’t over look taking care of yourself physically (and mentally).

As Jack might say; you know students, your body needs to be available to you…

See:

Time to Remodel that “House”
(photo soloflex.com)

On the horizon is a DVD player so he can watch M*A*S*H reruns and other programs and movies he so enjoys.  And he’s on the waiting list for “Honor Flight” next year, a program that transports World War II veterans to see their memorial in Washington, D.C.

(Pilar Touch20 by Delta)

 Design is a plan for arranging elements in such a way as best to accomplish a particular purpose.
-Charles Eames

Design’s fundamental role is problem solver.
-Fast Company, 2005
 
I visited Rejuvenation-Portland for the first time several weeks ago; when I entered the store my heart actually began to race—like when knocking on the door of a blind date. Beautiful aesthetics has always had that affect on me. My mind went calm as the visual took over and I began to experience a delight of the senses.

The Aesthetic Experience

“Aesthetic Arrest” was first employed by James Joyce in A Portrait of the Artist as a Young Man. Joyce posits the idea: when we are in the presence of great beauty, our minds go still…
 

(Lascaux Caves in SW France: Beautiful cave paintings dating back some 17,000 yrs.)

The Mythologist Joseph Campbell in his lectures on Joyce spoke to this phenomenon: “The aesthetic experience is a simple beholding of the object….you experience a radiance. You are held in aesthetic arrest.” This radiance, the perception of beauty, is regarded as a communication of the hidden power behind the world, shining through some physical form.

This “hidden power behind the world, shining through some physical form” has many names; what it’s called is not important—that you experience it is.

Communicating through the Senses

Author Virginia Postrel notes that aesthetics is the way we communicate through the senses. It is the art of creating reactions without words, through the look and feel of people, places, and things. In other words, aesthetics shows rather than tells, delights rather than instructs. The effects are immediate, perceptual, and emotional. 

For example, the other day I was driving past the bus stop near my home and glanced over just in time to witness an elderly Russian man with a deeply weathered face smelling a bouquet of Safeway flowers thrust to his nose by a younger woman. It caused me to pause; I felt lifted… it was delightful.

Making Special (Think Martha)
Theorist Ellen Dissanayake defined art (aesthetics) as “Making Special,” a behavior designed to be “sensorily and emotionally gratifying and more than strictly necessary.” She thinks that the instinct for “making special” is universal and innate; an aspect of humanity’s evolved biological nature. Even primitive societies with challenges to basic needs, desired beauty in their environments; be it for ritual, religious, or pleasure purposes:

For as far back as there are written records we find evidence of the awe and exhilaration people feel upon seeing or hearing something beautiful. The earliest poems contain loving descriptions of landscapes, of the play of light on water, of the beauty of the human form, of the proportions of man-made structures. The power of music to enthrall the senses is one of the oldest subjects of myth. And, of course, among the earliest traces of human life on earth are innumerable carvings, wall paintings, graffiti, and other decorations, all attesting to humanity’s attempts to modify its environment so as to make it more “beautiful.”
-Mihaly Csikszentmihalyi and Rick E. Robinson/ The Art of Seeing: An Interpretation of the Aesthetic Encounter (1990)
 
Today we are living in the age of Aesthetics; meaning our western culture has become so affluent that our basic needs are covered. Modern manufacturing has solved the problems of lowering costs, making goods/services widely available, functional and energy saving—we have advanced beyond mere function alone; and now our desire for form (aesthetics) is driving demand; and is the differentiator in a crowed market place. This has been termed: “The Aesthetic Imperative.”

Freedom, Beauty, and Pleasure
Postrel quotes an influential industrial designer: “Good design is not about the perfect thing anymore, but about helping a lot of different people build their own personal identities.” Form follows emotion” now supplants “form follows function.” Emotion now tells the user what they will find functional. The role of a chair is now beyond a place to sit—it is to make life enjoyable.

Modernist design once promised efficiency, rationality, and truth; in the age of aesthetics freedom, beauty, and pleasure are now the mantra. Design’s role for aging-in-place remains one of accomplishing a purpose and problem solving; fortunately for those aging in the age of aesthetics, concepts such as universal design are informed by the aesthetic imperative. In order for age-friendly product developers to compete and survive in the booming mature market place they need to design not only for function, but to delight the senses with non-stigmatizing design. They must understand that we buy on deep biological emotion: Designers turn obstacles into beauty–or perish…
 
See:
For a visual and audio Aesthetic Experience; listen to Kissing by Bliss
(Photo: thedecoratingdiva.com)

As we grow old, the beauty steals inward.

– Ralph Waldo Emerson

I recently had the pleasure of experiencing a Historical and Architectural cruise of Chicago with my wife and in-laws. The promotional quote notes: “If you have only two hours in Chicago this is how to spend it.” After the tour I can’t disagree; from start to finish it was a delight.

Adaptive ReUse

Pushing off from the North Pier Docks at River East Art Center, our enchanting tour guide (part professor/part stand up comedian) began with a discourse on “adaptive reuse” of the North Pier. He had me from hello…

According to Wikipedia;

Adaptive reuse is the process of adapting old structures for purposes other than those initially intended. When the original use of a structure changes or is no longer required, as with older buildings from the industrial revolution, architects take the opportunity to change the primary function of the structure, while retaining some of the existing architectural details that make the building unique. In local communities, unused schools or Post Office buildings have been adapted for reuse as retail stores or offices.

The analogy for aging is ripe with low-hanging fruit; the key is adapting…

Adapting the Self

Rethink the term “change,” we have a tendency to focus on what we’re losing, and not so much on what the potential gain might be (it’s the unknown). If  your old structures need adapting because they no longer serve the purposes initially intended, consider making “Adaptive ReUse” a new part of your vocabulary and a guiding mantra.

Remember, it’s about retaining some of your existing details that make you unique, while you change your primary function—in other words be a beautiful human example of Adaptive ReUse.  

 See:

The Purpose Project

Senior Corps

Global Action on Aging: Elderly Reinventing Themselves

Adaptive ReUse: Kennedy Elementary School

Photo

http://static.guim.co.uk/sys-images/Education/Pix/pictures/2008/06/23/mw4.jpg

Editor’s Note: Patrick J. Roden, PhD is the founder of Aging in Place

PS    Have you signed up yet?

National Active Retirement Association Conference – Wednesday, October 20 – Friday, October 22 – Columbia Metropolitan Convention Center * Columbia, South Carolina

International Council on Active Aging Conference – Thursday, December 2 – Saturday, December 4 – San Diego Convention Center * San Diego, California

photo toddnoordyk.com)

It’s a world of laughter
- A world of tears
It’s a world of hopes
- And a world of fears
There’s so much that we share
- That it’s time we’re aware
It’s a small world after all …
-Written by Richard M. Sherman and Robert B. Sherman

BMI (body mass index): A ratio of weight to height (weight in kilograms divided by height in meters squared) BMI = kg/m2

The other day I was working with a gastroenterologist (GI doctor) who was sporting a smart looking Mickey Mouse watch. She had acquired it on a recent family vacation to Disneyland. This sparked some conversation about the land of enchantment and some of the rides they experienced. Of course I had to ask about the Small World ride.

The line: It’s a small world after all (sorry now that it’s stuck in a circular loop in your head), has been the subject of many jokes and comments throughout the years; but what followed was a new twist to me. Seems the ride had been out of commission for repairs and the reason…

Well, there is some controversy surrounding the reason the ride was shut down in 2008. The ride has been around some 45 years and the original flume and fleet of boats made their maiden voyage during the 1964-65 New York World’s fair. The sturdy little pastel boats have been doing yeoman’s work ever since. No doubt that kind of run would even cause Cal Ripken to pit stop for some refurbishments.

According to MiceAge the Imagineers of the 1960’s designed the ride to accommodate the average man (175lb) and woman (135lb) of the era; not the adult of today who can often weigh more than 200lbs. The boats ride lower in the water and tend to “bottom out,” causing the whole contraption to stop in its tracks. The solution (prior to redesign) was to limit passengers or escort embarrassed patrons off the ride.

Several stories including one in the New York Times call on readers to draw their own conclusions. The subject is somewhat taboo and Disney denies any connection between redesign and weight of the riders.

Whether the connection is valid or not the fact remains Americans are getting heavier on average. According to the U.S. National Institutes of Health, approximately two-thirds of adults age 20 or older are overweight or obese with BMIs greater than 25, and nearly one-third have BMIs greater than 30. Less than one-third are at a healthy weight with a BMI of 18.5 to 24.9.

In my own experience as a nurse I’ve witnessed hospitals having to equip ceilings with steel I-beams to support mechanical lift systems to get obese patients in/out of bed. A recent staff development in many care settings are the “Lift teams.” These are designated staff whose sole job is working the lifts and turning patients—in order to save nurses from back injuries.

Kaiser Permanente purchased a fleet of love-seat sized wheel chairs years ago to accommodate the increased girth of its members. I once took one of these devices to a presentation at Nike World Head Quarters…they couldn’t believe their eyes as I rolled it in the room.

At issue are not just the obvious effects of BMI on health and longevity but control of one’s own experience and for this discussion that means aging in place.

It’s About Control (but not what you might think)

In an article from Newsweek (Feb/23/2009): Stress Could Save Your Life, author Mary Carmichael writes about the connection between control and stress. Carmichael notes a classic study where scientists put two rats in a cage, each locked to a running wheel. The first rat could exercise whenever he liked. The second was yoked to the first and forced to run when his cage-mate did.

The exercise that usually decreases stress and encourages neuron growth in the brain did just the opposite in the second rat—the reason…control. Psychologists know that one of the biggest factors in how we process stressful events is how much control we have over our lives. A body rendered un-available due to high BMI can place limits on personal control (mobility and independence). Much of the appeal of aging in place is about choice—to make the issue relevant is to frame it as matter of control.

Research has shown that by avoiding a further increase from 28 kg/m² to 32 kg/m², a typical person in early middle age would gain about 2 years of life expectancy. Two years of extra life down the road might not sound all that compelling to some, but the issue is really more one of extending health—not extending life.

Inactivity doesn’t necessarily shorten the life-span…it most definitely shortens the health-span. –Dr. Rosenburg, Tufts University

Extending the health-span can equate to maintaining mobility and independence; ultimately leading to a higher degree of control (& decreased stress) over one’s life experience. And that’s what aging in place is all about.

See:

Calculate: Your BMI
Research on life expectancy
Middle aged women and stroke
It’s a small world video

How old would you be if you didn’t know how old you were?
-Satchel Paige

I was in the mall this past Saturday. Not a place I’m accustomed to investing any time in—especially on the weekend; but necessity dictated the excursion to the Mecca of shopping known as Clackamas Town Center. My wife had some to-dos (she’s very purposeful) and I had some general notion of what I was after. Like two infantry soldiers we synchronized our watches and agreed to return to a designated spot in 2 hours.

After 30 minutes of meandering through merchandise I thought: “Two hours…what was I thinking?” Generally a malaise seems to come over me as my energy level tends to be in an inverse relationship with the amount of time spent in malls.

Feeling like Margaret Mead, or a stranger in a strange land, I began to have a subtle shift in my thinking. A little voice seemed to be saying “observe.”

With a change in my interpretive filter I notice a reoccurring theme among the bustling masses of determined shoppers…Approaching from behind I’d see two “girlfriends” walking and engaged in either cell phone conversations or chatting. Most of these pairs were dressed much alike.

As I passed them and looked over I noticed these weren’t contemporaries at all, rather, one was the daughter and the other the mother! Now, twenty years ago there was no doubt who was who—but that has all changed.

Clicking

The futurist Faith Popcorn wrote about this phenomenon over a decade ago in her brilliant book, Clicking (1996). She called it “down-aging,” which is all about throwing out the rules and constraints that dictate how we should behave by certain points in our lives. Ms. Popcorn predicted the rejection of the cultural construction of age, and the potential for personal interpretation.

Once aware of down-aging in our culture, you begin to notice it everywhere as older adults time-shift life experiences and their looks. Popcorn describes elder-moms/elder dads who are standing in the check-out line at the grocer with pampers under one arm for the baby and attends under the other arm for themselves!

Fitness and athletics is another arena where down-aging is evident. The bad news is in sports rehab clinics all across the country clinicians are seeing more geri-athletes with sports related injuries—the good news is that clinicians are seeing more geri-athletes with sports related injuries.

I ran marathons with Mavis Lindgren who began her running career at age 62, and completed her first of 90 marathons at age 72! Go to any gym in the morning and you will be surrounded by gray hair and PE uniform-looking attire.

I once overheard a 20-something blonde beauty at the front desk of a well know fitness chain express her dismay that there were too many old people at the club. Seems she was afraid of the place becoming known as an “old gym.”

I laughed to myself thinking of her disconnect with her paycheck and who comes through the door and I envisioned her drowning in the gray tsunami…just off shore brewing.

It’s almost tired to even mention how marketers have embraced down-aging from the return of many of the classics like high-top black converse sneakers (I read an interview with Daryl Hall of Hall & Oats fame, he was wearing high-top black converse without shoe strings), to increased popularity of the anti-tech toys you played with as a child-like the Schwinn Classic Cruiser bicycle. Portland is deluged now with “fixed speed” bikes, a minimalist 2-wheeler that harkens back to the basics.

As Faith Popcorn notes:
Whatever the crisis-change mechanism at work here, the underlying feeling is “there’s got to be more.” And this search for ever-more leads to down-aging. Not forgetting about your age or railing against your age, but tossing away the old ideas of what chronological age is. For down-aging is fundamentally about changing expectations, dreams, desires, visions. It’s about a constant state of growing, of saying “yes” to life and all its possibilities (p. 275).

Hyper-Habituation (Think Mick Jagger)

I think it was Albert Einstein who said: “The definition of insanity is doing the same thing over and over and expecting different results.” A possible concern with down-aging is that it can be taken too far. As gerontologist HR Moody suggests, each era has its quality of experience not to be missed–neglected it could damage the soul. This is something to consider as you lace up your sneakers and jump on your cruiser…

THE 3 AGES:

1) Chronological age-Age on your birth certificate
2) Physiological age-Age of your biology and biomarkers
3) Psychological age-Age of how you think (Young or old)

See:
 Faith Popcorn’s Brain Reserve

-Elisabeth Kubler-Ross

(photo: wings.avkids.com)

 I was handed a sympathy card the other day and informed about the death of a coworker’s parent; then asked to write something.

Most of us have had this experience; all the “usual” comments have already been written as you search for a spot to add yours. You’re left with the choice of emotional-plagiarism (“thinking of you at this time”) or struggling to find meaningful words to express the loss. For me it’s challenging, death is so final; much easier to sign birthday cards.

 Final Acts

On occasion in the ICU/CCU during quiet moments, patients would ask me why they were still alive. My answer was always part science; I’d describe the medical measures taken to stabilize the body—and part philosophical; I’d also explain whatever it is that they are supposed to do in life wasn’t done yet.

This latter point was also the dominate theme at the American Society on Aging conference this year, and dovetailed with AARP’s messaging about Awakening human potential in the second half of life, or the well worn: “Don’t die with your music still in you.”

 Doing the Work

“Charles” is a front-end boomer who was in the army as a young man, studied Eastern Philosophy for years, is a part-time carpenter—part-time writer, and captivating story-teller.

He invests much of his time in coffee shops engaging in social intercourse—so much so, he expressed concern about not writing enough. The conversation took on the theme of “doing the work.”

Not offering advice, I informed him that the gods have entrusted him with the gift of story telling—and to not corral them into written form would be the sin he would have to atone for in the end.

His solution was to employ a new coffee shop several times a week to do the work. If I had to bet, Charles will re-create his old setting; it’s in his DNA. Meanwhile, the gods will be frustrated…but redemption is always possible.

Is there something you’ve left undone? 

 It’s never too late to become what you might have been.

 See:

Not Dead Yet (the movie)

 When I grow up

 (photo bbc.co.uk)

 It was formerly a terrifying view to me that I should one day be an old woman.
I now find that Nature has provided pleasure for every state.

-Mary Worley Montagu

In the ancient Western traditions dragons were often portrayed as frightening and destructive forces that the gods must battle with in the pursuit of good triumphing over evil. “Here there be dragons” is a phrase thought to be placed on maps by medieval English mapmakers depicting dangerous or unexplored territories past the edges of their known world.

The phrase might well be used to describe the unknown and “terrifying” territory of old age. Living past the age of 65 is a relativity recent phenomenon. Life expectancy for women at birth in 1900 was just 48.3 years (men = 46.3). Contrast that with one-in-five Americans being over the age of 65 by 2030 and out numbering teens two to one. Longevity, for the developed world, is the “here there be dragons” of the modern era. For World War II generation women the topography of old age is the landscape of daily life—for boomer women it’s still uncharted waters.

Do You Want to be an Old Woman?
I remember listening to the lungs of an elderly woman who was admitted for congestive heart failure (CHF). As I strategically placed my stethoscope on her chest I said: “Big breaths—Big breaths.” Her reply surprised me; in a quivering-Parkinson’s voice and a smile, she quipped: “They…use…to…be…”

This brings to mind a quote from Gypsy Rose Lee, in Barbara McDowell and Hana Umlauf, Woman’s Almanac (1977):
I’ve got everything I always had. Only it’s six inches lower.

I’ve always enjoyed telling that story because it speaks to a truth about aging. If we are fortunate enough to get old we’ll experience the physical changes which accompany age—and hopefully have a sense of humor about it.

Have you seen the recent ad from Kaiser Permanente: Do you want to be an old woman? This campaign is bold and brilliant in that it flies in the face of conventional wisdom in several important ways:
1) Marketers will tell you to shy away from using terms like “old” or “aging” when selling to boomers and beyond.
2) The traditional medical model has emphasized “sick-care” not “health-care.”

This ad turns conventional wisdom on its head and has the audacity of hope (thanks Mr. President) to ask the question straight out: Do you want to be an old woman? It’s NOT about anti-aging—in fact it’s just the opposite. Emphasizing prevention (get a mammogram) so you can live long enough to BECOME AN OLD WOMAN and experience all the unknown experiences (territories) awaiting you.

This is about “compressing morbidity” and extending health—not just extending life. And the message is delivered with the soulful sound-track of Michelle Shocked – When I Grow Up. This ad demonstrates a deeper understanding of human behavior and respects the maturing psyches of women who are living fully within their age.

When running marathons with Geri-Athlete Mavis Lindgren, I often overheard her say: “I’m having fun being an old lady,” and she meant it. Perhaps out in the uncharted edge waters of old age she had encountered a different kind of dragon, of the Asian tradition, that often symbolize power, happiness, good fortune and wealth—and had a message for those of us still waiting back on the shore…That there is pleasure at every state.

Mature Market Experts: more news and stats on boomers, seniors, and the mature market that you can use – Interior Design Key to Aging in Place.

Aesthetics; noun; a branch of philosophy dealing with beauty (Merriam-Webster)

Four years ago I read an article that changed my thinking forever. I had what Buddhist call a “satoir,” or an instant awakening.

The article: Tracing the Flow of the Greek Aesthetic was written by Brian Krause. He interviewed Dr. Harris-Cline, a professor of Art History and Classics, as well as Greek Scholar.

Before you ask: What’s this got to do with aging in place? I’ll give you the substance of the article and tie it in…

Harris-Cline had been studying a phenomenon termed “flow” as described by psychologist, Mihaly Csikszentmihalyi in the book, Flow: The Psychology of Optimal Experience (1990). Flow simply is the experience of being in what athletes call “the zone.” For a basketball player it’s shooting unconsciously and you can’t miss; for the writer it’s writing your best prose without lifting the pen to edit, or the runner who hits that sweet-spot where there is no fatigue, only a quiet zone of endless energy.

Dr. Harris-Cline applied the flow concept to develop her theory about Greek civilization. She suggested that: “The Greeks built a civilization where flow, and flow experiences, was part of everyday life.”

The theory posits that the Greeks developed a culture rich in sensual stimulation. They used incense and perfumed oils for smell; the lyre and flute for music; honey, olives, and fruits for taste.

The Greeks also appreciated the richness of touch, using hand woven fabrics from linen to wool, and created beauty and good taste in their homes. She thinks the Greeks triggered flow experiences from them and over time began to love beauty and beautiful things.

Further, the flow experience brought on by aesthetics allowed the Greeks to produce political and philosophical ideas and inspired works of art that are still held in esteem today. And also helped breed tolerance and appreciation for diverse experiences of human life.

In my opinion Harris-Cline is on to something…and the implications for aging in place and interior design are significant.

I’ve always argued that interior designers are a key element in successful aging in place. The mature market is requesting home modifications to make them more energy efficient, convenient, comfortable, and safe.

What they don’t want is to live in an institution and any changes that hint at infirmity aren’t going to be received well by many older adults, especially boomers. The demand is for non-stigmatizing and aesthetically pleasing products.

Luckily there are designers who understand this and are turning obstacles into beauty. Individuals like Cynthia Leibrock and Michael Graves are liberating mundane assistive devices and making them not only non-stigmatizing, but a delight to look at.

Interior design and aesthetics matter, they’re not just niceties but can make the difference in adopting aging-in-place modifications and even being inspired by them.

Mature Market Experts: more mature market news and stats more often – Aging In Place In NYC –

Mature Market Experts: more mature market news and stats more often – The Doctor’s Office – In the “old days” (pre-blackberry) you could find yourself being held hostage in a healthcare setting waiting room with nothing to read. Patiently anticipating the call you’d look for something—anything, to pass the time until you heard those words of liberation: ” The Doctor will see you now.”

The longer I live the more beautiful life becomes.
–Frank Lloyd Wright
It was a sunny Saturday morning in Portland (rare event) and I found myself in the parking lot of the mega-home furnishings store IKEA.  If you’ve never been to the store it’s really kind of a fun place to shop. The design is European and unique, the prices are affordable, and the layout is like a giant maze of visual delights.

I was enticed by one of those IKEA flyers which found its way to my front door; now I was coveting some new flatware. Seems I was not the only one as a line of fellow shoppers formed before the store formally opened. Like grade school kids on our way to recess (filled with the anticipation) we marched single file to the back of the store. Soon we were rewarded for our early arrival with a box (or 2) of shiny silverware.

Next, I made my way to the register to pay for my new found treasure. In no-time I was headed for the exit with that little dopamine lift that comes from buying something (and the perception of getting a deal). Nearing the egress, I glanced over and noticed a display of irresistible IKEA 2009 catalogs; so I picked one up, tucked it under my arm and left for home.

IKEA Knows

IKEA is successful in my opinion because they understand 3 key things:
1. Home is the most important place in the world
2. The Aesthetic Imperative
3. Affordable small indulgences 

Home

What immediately caught my eye on the IKEA catalog cover was this text:

Home is the most important place in the world.

They not only get it, they state it on the cover and have built an enormously success business on this emotional appeal.

Home for younger people acts as a kind of psychic anchor reminding one of where they came from. For older adults attachment to home is linked to preservation of a sense of personal identity; and acts as a “fulcrum” to the rest of the world.
This attachment to home is described by Rowles (1984) as a sense of physical “insideness,” and being psychologically melded into the environment stemming from years of rhythm and routine of using the space over many years. IKEA seems to understand this.

 
The Aesthetic Imperative

We live in the age of Aesthetics; meaning items not only need to work well but they need to dazzle the eye. Products can’t compete solely on function anymore; most things made today will do the job they were designed for very nicely.

So to gain advantage the product must now be aesthetically pleasing; Target has traded on this idea for years. Hiring Michael Graves to design simple everyday products gives an edge if you’re selling trash cans or fly swatters that function equally well.

IKEA is delivering multi-sensory aesthetic experiences, or what Virginia Postrel calls “immersive environments.” This brings the home experience into an almost intangible realm—which is important for boomers as spirit will come to dominate matter.

Affordable Small Indulgences

Futurist, Faith Popcorn nailed this one over a decade ago and she is still spot-on.
Small indulgences, or the trend of thinking highly enough about yourself to treat yourself, is alive and well in boomers.

When the economy is doing well one might splurge on a bottle of Veuve Clicquot champagne; but as things tighten up the small reward might be an Ellan rocking chair designed by Chris Martin for $39.99 (page 108).  Popcorn says this has to do with some deep sense of deprivation as we grow up thinking each generation will have it better than the one before; it’s a perceived quality of life issue. For a reasonable price IKEA can scratch that deep psychological itch (for a while anyway).

Aging in Place & Universal Design Market

The home not only has a supportive function of shelter, cooking, rest, storage, etc; but it has a psychological function of meeting emotional needs like the desire for beauty and sensory stimulation. IKEA knows this well and I would add a number 4 to the list; they would be wise to tap into the aging in place and universal design market–because for boomers around the globe, home is the most important place in the world.
See:
LifeSpan Design + Stunning Aesthetics = Emory Baldwin’s vision of Home
Rowles, G. D. (1984) Aging in Rural Environments. In Altman, M.P. Lawton, & J. Wohlwill (Eds.), Elderly People and the Environment (pp. 129-157). New York: Plenum Press.

In the clinical setting if a heart is beating irregularly it’s shocked (cardioverted) so it can restart into a new rhythm once again. The “shock” of this economic crisis may be the cardioversion needed for many to be liberated from “The Tyranny of Dead Ideas.”

Recall the Greek myth of Sisyphus who was cursed for eternity to roll a huge boulder up a hill only to watch it roll down again and repeat the process over and over. He would have welcomed the opportunity for a “best-worst experience” like a downturn to break the pattern.

What’s needed is A Whole New Mind to get out of competition and get into creativity. I once heard a wise man say to be successful follow this acronym: TNT; Trends, Needs, Technology

Where’s the TREND? Where‘s the NEED? Where‘s TECHNOLOGY headed?

TREND: The future belongs to maturity; 77 million + baby boomers and their aging parents

NEED: AARP surveys show 89% of their members prefer aging in place to institutional living

TECHNOLOGY: Companies like Intel are investing heavily in telemetry monitoring systems to keep older adults aging-in-place; as care shifts from the clinical setting to the home

If You Want a Big Opportunity Find a Big Problem

The nation’s aging housing stocks on average is over 33 years old. The market for Aging-in-place renovation work is expected to be one of the few bright spots for residential construction that’s been battered by the recession; according to the NAHB.

The target market is the 60-70 year old who is most receptive to Universal design and aging-in-place modifications, says Bill Owens, President of Owens Construction in Columbus, Ohio. The key is unobtrusively remodeling in a non-stigmatizing aesthetic so boomers and seniors won’t feel they are living in an institution.

As aging-in-place professionals we ask of our clients to be open to change and new ways of doing things—it should be no different for us. In these challenging economic times it takes courage to create new business opportunities, and to think with a whole new mind.

Recommendation: Book/itunes A Whole New Mind by D. Pink