Aging in Place: How to Deal with Resistance

As we’ve previously noted, over 80% of older adults say they want to remain at home as the age. The CDC has defined “aging in place” as the ability to live in one’s own home and community – safely, independently, and comfortably – regardless of one’s age, income, or ability level.

Yet as cherished as the goal of remaining in the home is for millions of Americans, one recent survey found that individuals are not making practical decisions that support this goal. Design consultant M.J. Lee found that only 24% or baby boomers and 38% of non-boomers had made any home modifications age they aged, while an additional 12-13% had relocated to a more accommodating home environment. In total, 57% of those surveyed had not taken any action at all. While some indicated they were in the planning stages, a surprising 30% believed that no actions were necessary to prepare them for aging in place.

From a common sense perspective, it seems preferable to have needed environmental modifications of other adaptations in place before they are needed. Before the fact, they become preventive in nature. After the fact, they are often a crisis response; e.g., after a fall – sometimes too little, too late.

Family members and professionals often find it difficult to broach the subject of aging adaptations with older adults, fearing that their concerns may be met defensively. Resistance to taking action is not uncommon, as we all want to think of ourselves as fit and independent. Sometimes making concrete plans can feel like an admission of vulnerability.

So what are concerned loved ones to do? Patrick Roden, Ph.D. proposes the use of classic decision-making principles to guide a discussion process. In the article, The Anatomy of Consumer Resistance to Aging in Place, Roden advocates for using the Consumer Decision Model to help seniors process their aging-in-place needs. The Consumer Decision Model is an adaptation of the Health Belief Model, first developed in the 1950s by public health scientists. This model is based on the premise that an individual’s likelihood of adopting a healthy behavior is based upon:

1. The individual’s recognition of the threat of illness or disease;

2. His or her belief in the effectiveness of a recommended intervention or behavior.

In the final analysis, a person’s course of action may large depend on perception of both the benefits and barriers that are related to the particular health behavior; e.g., following a particular diet or exercise program, making architectural modifications to one’s residence, etc.

As applied to the aging in place decision dilemma, Roden says that seniors use four main criteria in determining whether to accept health recommendations. They are:

1. Susceptibility; i.e., how likely is the individual to experience the particular concern; e.g., falling, missing medications, etc.?

2. Severity; i.e., how serious will the consequences be if the concern does occur?

3. Effectiveness; i.e., how effective will a specific adaptation be in addressing the concern?

4. Cost; i.e., how expensive will it be to implement the adaptation?

Roden stresses that the answers are based upon the senior’s perception, which may or may not be the reality of the situation. He recommends that loved ones open a conversation based on these four criteria areas and explore the reality of the situation vs. current perceptions. A calm discussion of facts can make all the difference.

M.J. Lee, on the other hand, believes that it is sometimes better to emphasize the importance of maintaining a community-focused, independent lifestyle, rather than stressing health concerns and physical decline.

Whether the concern is related to health frailty or community independence, both family members and health professionals can utilize decision-making principles to open low-stress communication about aging in place.