Most older Americans want to stay in their own homes rather than move into institutional care, and according to an Orlando-based orthopedic surgeon, the odds of achieving that come down to a handful of daily habits rather than luck.
Dr. Vonda Wright, a double board-certified orthopedic surgeon, author and authority on active aging and mobility based in Orlando, Florida, says three problems most often push older adults out of independent living: difficulty rising from a chair and caring for oneself, memory decline, and incontinence that makes personal hygiene unmanageable. The AARP has found that three in four Americans aged 50 and older would prefer to age in place rather than move into assisted living or a nursing home.
Wright argues the conversation about preserving independence too often focuses only on mental and physical health while ignoring what she calls the missing piece.
“The missing piece in most conversations between mental health, physical health and independence is your skeletal longevity,” Wright said.
Keep Moving, Even in Pain
Wright says the human body “craves mobility,” noting that walking is the first physical skill people ever learn. The Centers for Disease Control and Prevention recommends low-impact activities such as walking, cycling and water exercise for older adults looking to preserve daily function.
“Even when your hips hurt, even when your knees hurt, you should move on the ground, or get in a pool in chest-high water,” Wright said.
While she does not recommend pushing through a new injury or severe pain, Wright rejects the idea that rest is the best remedy for chronic aches.
“Rest doesn’t cure anything. When you have, for instance, arthritic knees, do you know what can help? Building the muscles around your knees, building the muscles in your hips to support your knees. So rest is not the answer for feeling better — staying strong and mobile is,” she said.
Strength Training Has No Age Limit
Building muscle helps older adults maintain the ability to get out of a chair, climb stairs and carry groceries — the small, everyday tasks that determine whether someone can live on their own. Wright says there is no age at which it becomes too late to start.
“Even if you feel like you’ve declined or your parents have declined, there is no age or skill level when we can’t become more mobile, when we can’t build muscle or reconnect the neuromuscular pathways,” she said.
Wright points to research from Dr. Maria Fiatarone at Tufts University showing that even people in their 90s can regain physical function. In a 1990 study, nine nursing home residents who completed eight weeks of high-intensity resistance training increased their muscle strength by an average of 174%, along with gains in muscle size and mobility.
The National Institute on Aging recommends that older adults perform muscle-strengthening activities at least twice a week, covering all major muscle groups with recovery time in between. Resistance bands, hand weights and body-weight exercises are all viable starting points, and beginners should consult a doctor or physical therapist as needed.
Eat Enough, Especially Protein
Wright warns that older adults often eat less than they should, which undercuts their ability to maintain energy and build muscle — something she has observed firsthand with her own parents, both 86.
“It’s something I see even happening to my 86-year-old parents; they’re just eating less and less. And we cannot fuel the muscle we want to build [and] the energy we need without a protein-forward, adequate-calorie diet,” she said.
The National Institute on Aging notes that while calorie needs may decline with age, nutrient needs do not. The agency recommends older adults get protein throughout the day from sources like seafood, dairy, fortified soy products, beans and lentils, with specific needs varying by weight and activity level.
Reject the Assumption of Inevitable Decline
Wright says one of the biggest obstacles to independence is a mental one — the belief that aging automatically means losing vitality.
“The most common mistake I see seniors making as they age is assuming that aging is an inevitable decline from vitality to frailty. They just assume that a certain number of birthday candles predisposes them to sitting on a couch the rest of their life. The reality is that there is no age or skill level when you’re done,” she said.
She encourages people to start planning for long-term independence decades before they need it.
“We need to start thinking about that in our busiest times of life, in our 30s, our 40s, our prime times of working. It’s part of a long-term, lifetime plan to live where you want to live, with whom you want to live, when you want to live there,” Wright said.
Ask, Don’t Assume
Wright also advises adult children to have direct, honest conversations with aging parents about what help they actually need, since many parents avoid asking for assistance out of fear of becoming a burden.
“I think this is a time for really open, frank conversations. What do you want help with? How can I help you? How could we get help for you if possible?” she said.
Wright’s own parents live with her family. When she noticed their meals suffering during her travel schedule, she arranged for help rather than letting their independence erode.
“I have half of their meals delivered every week because I’m not going to be home to shop or cook. They remain independent, but with assistance. And that’s what works for us,” she said.
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