Two Elders in my life, Eldo and Harriet, taught me about the dignity of risk – one aspect of resilience and independence that is often overlooked as people age.  It’s far too common for well intentioned helpers to pressure older adults – especially those with functional challenges – into a safety bubble. The dignity of risk simply allows people regardless of age or functional ability to continue making the choice of how to live – how to balance personal risk with safety.

Eldo’s Story

At age 82 Eldo fell off a haystack and broke his back and neck.  His friends were devastated, convinced Eldo was “done”; but when I walked into his hospital room the first thing he said to me was, “Bleep de bleep (use your imagination) I can’t believe I ruined my whole summer of horseback riding!”

I was amazed! He didn’t get the memo saying he was finished riding. He was just furious that he’d messed up his whole summer!  Next, Eldo called in the nurse to tell her the neck brace was causing him a lot of pain.  She was patronizing, “Well, you can’t expect it to be comfortable”.  He replied very directly, “I’m not asking for comfortable, I’m asking for tolerable.  Get the orthopedic on the phone”.

I knew the building blocks of resilience included optimism and hope, self-efficacy (belief in one’s ability to impact outcomes) and a sense of control. But here it was in living color as Eldo took charge of his recovery. He knew he would recover, and he knew what he needed and asked for it!  A different neck brace brought him immediate relief and a sense of control over his destiny.

Seven weeks to the day after he broke his back, Eldo was riding again. His mindset of full recovery, his rejection of negative expectations of aging, and the “dignity of risk” all played a role in his recovery. Recovery is far more than just physical and his doctor – a horseback rider himself – realized how critical it was for Eldo to live his passion. How different the outcome could have been if his doctor, family, and friends had insisted he retreat to the safety of his recliner.

Harriet’s Story

When my son Cole was born I needed part‑time childcare. Harriett was interested in the job, but I was a worried.  She had significant physical challenges; advanced osteoporosis with spinal kyphosis (the rounded upper spine people often call a dowagers hump). After making a career out of advising people to focus on possibilities, not disabilities, could I live it?  So we had a frank talk. “I’m concerned. I don’t want you or Cole to get hurt.  How can we make this work?”  With equal parts amusement and determination she said, “Oh, I’ve had a bad back my whole life and took care of my own kids. I don’t know why it would be any different now”.  Harriet was 80 years old at the time.

So we came up with adaptive strategies.  We put the crib next to the bed so Cole could climb out of the crib, onto the bed, and then to the floor – no lifting required. Harriet watched him from the time he was 4 months old until he went to school, and like Eldo she taught me a lot about the dignity of risk. In her 90’s she used a walker and lived in a second floor apartment with no elevator. People often pressured her to move to a ground floor apartment to which she replied, “I want to see the mountains when I wake up in the morning. I’ll scoot up on my butt if I have to!”  She lived there until she was 100 years old.   

 So, Harriett, frail with many physical challenges, and Eldo, out riding horses in the mountains had two very different aging experiences. Yet they shared a common trait – the ability to use the tools of resilience to live life on their terms. And they were both afforded, no – demanded, the dignity of risk.

First published at Silver Nest  www.silvernest.com 

On October 1st Medicare started to penalize hospitals for patients who are readmitted into the hospital within 30 days of discharge for the same diagnosis. This is initially designed to curb the percentage of Medicare patients who are routinely readmitted for three primary conditions; heart failure (24.7%), heart attack (19.7%) and pneumonia (18.5%). The healthcare industry is tracking all diagnosis readmissions, and bracing for other diagnosis to be added to the penalty list.

There’s no doubt serious issues will arise within this new accountable care environment, one being that some hospitals are choosing not to officially “admit” Medicare patients, instead classifying them as “under observation”. Unfortunately, to the patient there is no clear indication they are just under observation, and many older adults have found themselves with large bills for post-acute rehabilitation stays because since they were never officially admitted to the hospital they are not eligible to receive Medicare reimbursement for rehab services. Be aware and ask for clarification of the satus of any hospital stay.

On the positive side, this is quite simply the biggest boost to the business case for prevention and wellness promotion that I’ve seen in the 20+ years I’ve been in the field of older adult wellness. For the past 5 years I’ve been advocating for senior living to take a leading role in changing the way people view and experience aging. And this is a golden invitation for senior living to become the champions of recovery, re-claiming vitality after a health crisis, and reframing possibilities – regardless of challenges. All the pieces and parts are there – it’s just a matter of claiming that “space” in the healthcare continuum. 

I'm happy to report that the fight against ageism got both a boost and a spotlight last week! I recently co-wrote a chapter titled, Media Portrayal of Ageing, for a book published by the Global Council on Ageing. The book, Global Ageing, Peril or Promise?, was launched at the Global Economic Summit in Davos, Switzerland on January 26th, and Margaret Chan, Director-General of the World Health Organization called it a "must read".

See below (News & Updates) to download a pdf of the whole book or download the chapter Media Portrayal of Ageing. The chapter explores how ageism got a foothold in society and how media and marketing images reinforce negative stereotypes that influence health beliefs and behaviors. It also offers some practical solutions for confronting and re-scripting the negative story of aging.

The "X" Factor
Age has less to do with who a person is and what they're capable of than almost any other single factor, yet it often becomes a direct or indirect barrier to an individual reaching his or her personal potential.

For example, consider that young people with disabilities receive resources, opportunities and social support to overcome disabilities and excel in spite of them. Yet adults who are challenged with a disability later in life are often simply given tools to cope with disabilities. There's a profound difference between a mindset of coping with, versus overcoming, challenges – one that directly impacts expectations, interactions and outcomes.

The successes of the disability movement come from their mindset of looking at possibilities rather than disabilities. As individuals and as a society, we can work for the same kind of positive change in expectations and opportunities for older adults challenged by functional limitations.

"I believe the health care crisis is not going to be solved by government programs," Kay continues, "but instead by individuals inspired into action for their own well-being, and by companies worldwide who mobilize resources to reach out to their customers with healthy lifestyle strategies."

I recently finished the 2nd edition of my book Exercise Programming for Older Adults, originally published in 1995.  The new title is Exercise and Wellness for Older Adults, 2nd edition (2010).  The new book retains the same format by offering background and research into adult wellness, and lots of practical programming strategies.  It provides chair exercise, low-impact aerobics, water aerobics, arthritis exercise, and a new section on strength and power training exercises.  It also makes a significant shift from primarily "exercise-based" to a whole-person wellness approach incorporating all six dimensions of wellness- physical, social, emotional, intellectual, spiritual, and vocational.  A new section focuses specifically on challenges and opportunities unique to wellness programming in seninor living settings.

There is one major difference between the 2010 and 1995 editions - my fundamental change from an age-based approach to a function-based approach.  Over the past 15 years it became very clear to me that age is just a number that has less to do with who a person is and what they're capable of than almost any other factor you could name. The old book made statements like, "older adults need _____, or older adults want _____".  I'm embarrassed by these generalizations now and have made a studied attempt to eliminate generalizations based on age and any other ageist thinking.  I added a new chapter on the psycho-social aspects of aging and wellness to help readers make that same shift.   I really hope this new book will be the practical guide you need to create and improve your exercise and wellness programs for mature adults.  Follow the Products tab at www.kayvannorman.com for more information.