A ‘Wholistic’ Approach to Aging Well

On: June 20, 2016

By Pamela Leland, PhD

A new employee recently asked me what was the most pressing issue that we faced as an organization that serves Elders here in West Chester. She was surprised by my response as she assumed it would be our current building project – which is, indeed, a key priority!

Yet without hesitation, I responded that it was “affordability” … how do we continue to be an affordable and accessible supportive living community at a time when the gap between the cost of care and available financial resources is growing wider? This led to a robust, and somewhat unsettling, discussion of our need as a society for a wholistic and comprehensive approach to aging.

Much has been written about “successful aging.” First coined in the 1950s, the phrase gained popularity in the 1980s. It is a multidimensional concept that is defined as (1) the avoidance of disease and disability, (2) the maintenance of high physical and cognitive function, and (3) sustained engagement in social and productive activities.

The dilemma of this definition is that it is focused on the actions of the individual. It implies that we have control over our own aging. It doesn’t acknowledge the role that “genetic luck” plays in our physical health and well-being. Nor does it account for the role that public policies and public funding play in creating the opportunities and context for “successful aging.”

What does “aging well” – successful aging – mean to you? For me it embodies two critical elements: the first is having our health; the second is having the ability to choose where and how we age.

Having our health – physically, mentally, socially, spiritually – is critical. Being free from disease, maintaining one’s cognitive abilities … these allow people to be more fully engaged in the community – as the definition of “successful aging” asserts. This is something over which we also have significant influence. Much of our own health is driven by five key behaviors – (1) eating nutritious food, (2) getting enough sleep, (3) moving our bodies, (4) managing our stress and (5) engaging in relationships with others. Through our own efforts, we can reduce our risk of disease, strengthen our overall well-being and increase our longevity.

But our physical health is also due to the luck of genetics. Our own efforts of prevention will only take us so far and can’t undo the genetic risks for cancer, heart disease, dementia and other debilitating diseases.

The second component of “aging well” is the ability to make our own choices, to assert some control over how we live as we age. It is when we look to this other aspect of aging that we see the degree to which larger forces impact us and our own aging processes. For example:

Do you have the resources (personal, social, financial) to decide where you live – whether that is to remain in your own home or to live in a communal living environment? If needed, can you adapt your physical environment to support your independence, i.e., create wider doorways, install ramps, handicapped accessible bathrooms, etc.?

Can you access the services you need to live as independently as possible … whether that is home care or home health care, or needed assistance with the Activities of Daily Living (ADLs) in the least restrictive community environment?

Can you access preventive health services … or are you limited in some way so that going to doctor only happens when it reaches a crisis or emergency?

Do you have access to transportation so that you can get out and be engaged in the community … whether it is your own car or an extensive, reliable public transportation system?

Can you ambulate throughout your community without a concern about walking hazards and risks of falls?

Can you access resources for psychological support and/or for spiritual support?        

For those with sufficient personal and financial assets, “successful aging” is much easier and more likely. Individuals and families can choose where to live, can purchase the various services to support these choices, and take full advantage of what the market makes available.

For those who lack the resources, however, the options are much more limited … or maybe don’t exist at all. This is where the problem of affordability comes in. Services to support older adults cost money. Indeed, specialized services like home health, nursing or dementia care cost thousands of dollars each month … whether delivered in your own home or in a communal living environment.

For organizations like ours, who seek to be an affordable and accessible residential living environment, the challenge is to develop and deliver programs and services to those who need them while also operating in a fiscally responsible manner. We must meet two bottom lines – one of mission and one of margin. We can’t do this without public policies and public funding that allow us to reduce the out-of-pocket costs to those we serve. We also can’t do it without the generosity of individual and organizational donors.

Indeed, as one organization, as a local community as well as a larger society, our ability to support Elders, to help older persons “age well,” is dependent on all of us. We need a wholistic approach to aging, one that recognizes that (1) there are, indeed, things that we can each do in pursuit of our own health and well-being, but (2) also realizes that it is incumbent on all of us to create the conditions upon which we can make choices over how we live as we age. We must be advocates for aging resources in our local communities. We must work to create policies and funding streams at the state and federal levels that will expand both personal and community resources.

We are all needed to ensure that every older adult has the opportunity to age well.