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It’s Not About ‘Aging,’ It’s About ‘Place’

As an occupational therapist and environmental modification specialist, for over 14 years I have learned, researched, taught, and spoken about aging in place. When I started my practice at a local senior expo, I neatly displayed my “Aging in Place” educational hand-outs, only to be confronted by a sweet gentleman in his 80s who kindly asked me, “If I stand here for a long time, am I aging in place?” Since then, and fortunately for me, Aging in Place has become a widely known phrase. But what does it really mean? The importance of the message behind the phrase must not be overlooked.

The physical environment of a home has the ability to inspire or inhibit occupational performance. It is critical to communicate this concept to a homeowner who wishes to remain in place for the long-term. Currently, housing designs are largely ‘Peter Pan’ style—they aren’t meant to be places in which we grow up. Common features include steps to enter the home, bathtub showers, sunken living rooms, raised dining areas, low toilet seats, and stairs between floors. Objectively, it is easy to see how these features can compromise safety, function and daily living skills as one ages. In reality, homeowners become attached to their homes, and these limitations are hard to see. After all, they have likely raised families and lived in the same space for a number of years with ease and comfort. Helping homeowners understand the importance of changing their home environment to fit their personal needs can have a direct impact on their overall health and well-being.

This understanding begins with an occupation-based approach to creating and designing a healthy home for life. This means knowing and identifying home and community activities that have important meaning in your daily life and working to ensure these can be maintained by a supportive home environment. Participating in daily living skills that encompass work, self-care and leisure in the home is what makes people happy and healthy. In recent studies, participation in home activities also indicates a likelihood of community involvement. Important roles, behaviors, habits, and routines in the home can only be supported by an enabling, accessible environment. Identifying desired activities should be considered within the context of, “Does the home allow them to do this now? What about 20 years from now?”

I often tell my professional audiences to listen to “I used to” when doing home consultations: “I used to read,” “I used to go visit my neighbor.” In most cases, it is likely these once-desired activities came face-to-face with a physical barrier which could not be overcome and are now no longer completed.

People who are aging or disabled naturally rely on the environment for support of occupational performance. The less environmental support, the greater the physical demand on the individual to complete the task. Here, we have an opportunity to shift the focus of the problem from the home dweller to the home itself. Our mindset should not be on the difficulties that arise with aging but on the environments that surround us. In other words, there is nothing wrong with the individual, it is the environment that needs to change. This message can be empowering to the caregiver who may be frequently challenged with assisting their loved one to bathe or enter and exit the home, or for the baby boomer who may be feeling the early onset of arthritis and is challenged by stairs or low toilet seats. It is not easy to reverse the natural occurrences of aging, but it is easy to create an environment that keeps you engaged longer and lessens the feeling of growing older.

It is important to note that when desired daily activities become compromised, listlessness along with depression can occur over time. According to the CDC, 7 million people over 65 suffer from depression, which has been linked to functional limitation. With the population of aging adults on the rise and knowing how current housing can inhibit function, it is essential for us to educate on healthy homes from an occupational standpoint. Working with occupational therapists as you consider changes in your home can help prepare you to age in place. As consultants, they work to create the best person-environment fit and consider the medical needs and occupational priorities of the clients they serve. They collaborate with professionals in the building and design industry and advocate for healthy homes that not only address efficiency and popular LEED standards but, more importantly, ones that support participation and maintain function for life.

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