Five Habits That Could Help Older Adults Stay in Their Own Homes, From an Orthopedic Surgeon

Three in four Americans aged 50 and older would like to remain in their own homes as they age, according to the AARP, and preserving that independence starts with daily habits. Dr. Vonda Wright, a double board-certified orthopedic surgeon, author and authority on active aging and mobility based in Orlando, Florida, says staying out of a nursing home depends on habits practised every day.

Wright says three main problems can make it difficult for older adults to age in place: difficulty getting up from a chair and caring for themselves, memory problems, and incontinence that makes it hard to manage personal hygiene. The missing piece in most conversations between mental health, physical health and independence, she says, is 'skeletal longevity' — attention to the entire musculoskeletal system, including the muscles, bones and tendons.

The first habit is to keep moving. The human body craves mobility, Wright says; walking is our first skill, learned at the age of one. The Centers for Disease Control and Prevention suggests low-impact activities such as walking, cycling and water exercise. Even when hips or knees hurt, she suggests moving on the ground or getting into a pool in chest-high water.

She does not recommend exercising through a new injury or severe pain, but she pushes back against the belief that rest is the best answer. Rest does not cure anything, she says; for arthritic knees, building the muscles around the knees and in the hips to support the knees is what helps. Staying strong and mobile is the answer, not rest.

Strength training is the second key habit. It helps older adults keep the ability to get out of a chair, climb stairs and carry groceries. There is never an age or skill level when it is too late to build muscle, Wright says, citing research by Dr. Maria Fiatarone at Tufts University showing that even at 90 years old, people can regain function. In a small 1990 study, nine nursing home residents who completed eight weeks of high-intensity resistance training increased their muscle strength by an average of 174 percent, with improvements in muscle size and mobility as well.

The National Institute on Aging recommends that older adults perform muscle-strengthening activities at least two days a week, targeting all major muscle groups, with recovery time between sessions. Options include resistance bands, hand weights and body-weight exercises; beginners are advised to start gradually and seek guidance from a doctor or physical therapist as needed.

Eating enough is the third area. Older adults tend to eat less, which can undermine efforts to maintain energy and build muscle, Wright warns — something she sees even in her own 86-year-old parents. Without a protein-forward, adequate-calorie diet, she says, people cannot fuel the muscle they want to build or the energy they need. The National Institute on Aging recommends protein-rich foods throughout the day, including seafood, dairy, fortified soy products, beans and lentils, while specific calorie needs vary with each person's weight and activity level.

The most common mistake seniors make, Wright says, is assuming that aging is an inevitable decline from vitality to frailty. The reality is that there is no age at which a person is done. She urges people to start working toward future independence in their busy working years — their 30s and 40s — as part of a long-term, lifetime plan.

She also recommends open, frank conversations with aging parents about what help they actually need, noting that in many cases parents do not want to be a burden and so never ask. Her own elderly parents live with her family; when she noticed their meals suffering while she travelled, she arranged for half of their meals to be delivered every week — they remain independent, but with assistance, and that is what works for her family.