By Trudy Strewler Hodges
Special to Life After 50

The population of older adults in the Pikes Peak region has grown 50 percent since Innovations in Aging released its 2015 aging study, and by the year 2040, it stands to grow nearly 75 percent more. Unfortunately, it doesn’t mean we understand how to talk about aging any better today than we did years ago. Conversations about aging and about end-of-life issues are not easy, and most Americans haven’t given much thought to their preferences.

Today, there is even an international organization devoted to having these tough conversations called Death Over Dinner, and its premise is that age- and death-related topics don’t have to be morbid. In fact, it’s often an excellent idea to talk about one’s preferences before it’s necessary.

Atul Gawande, author of “Being Morta,” says, “… our most crucial failure in how we treat the sick and aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have opportunities to refashion our institutions, our culture, our conversations in ways that transform the possibilities for the last chapter of everyone’s life.”

Indeed, how an aging person wants to live is his or her choice, and the family’s role is to make it possible. It’s all about quality of life, independence, dignity, security, autonomy, identity, choice, purpose, and more. Judaism and Christianity sum it up in the fifth commandment, “Honor Thy Father and Mother,” which in today’s vernacular we might state simply as, “Honor Your Elders.” It is allowing our parents and loved ones to express themselves, set goals, and share their care needs and desires.

While the graying of America is nothing new, Americans have not paid attention to a growing number of risk factors older adults face, which accentuate the need for such conversations. One such risk factor is loneliness. According to the AARP Foundation’s “Framework for Isolation in Adults Over 50,” those who are lonely have a 59 percent greater risk of functional decline and a 45 percent greater risk of death than those who remain socially engaged. And yet 29 percent of people over age 65 live alone, and twice as many women live alone as men. An estimated one in five adults over age 50 are affected by isolation.

Other risk factors that make conversations about aging necessary might involve mobility or sensory impairments, major life transitions or losses, limited or low financial resources, cognitive challenges, and more. Regardless of the risk factors, the No. 1 reason to have a conversation is that 87 percent of adults over 65 want to stay in their current home (AARP PPI, “What Is Livable, Community Preferences of Older Adults,” April 2014). All other factors are important, but they are secondary to one’s desire to age in place. If we are going to honor our elders’ wishes, then we must do what we can help them remain where they want to be.

According to the American Senior Housing Association, a 78-year-old living independently without a major health crisis could live 15 more years in his or her own home. In contrast, average life expectancy in assisted living is 21-30 months and skilled nursing just five to 14 months. Once someone enters long-term care, life expectancy is reduced by 50 to 75 percent.

As Gawande says, “Home is one place where your own priorities hold sway. At home you decide how you want to spend your time and how to share your space.” Of course, that means we must determine how best to provide the care necessary to keep our loved ones at home. Today 30 million households nationally have discovered this secret and provide care for an adult over age 50.

It all begins with a plan and a conversation, and a plan can be empowering. When others know your desires, you retain more control over the choices. When you are ready, choose a discussion starter, such as these:

• “As time has gone by, I have been thinking about my desires for this stage in my life.”
• “I have some strong feelings about what is now important to me, and I want to share that vision with you.”
• “Please help me maintain my independence and dignity as I age.”
• “I want to be the ‘author’ of my story as much as possible.”
• “I know you will help me with the priorities that I have identified in thinking through this stage of my journey.”

Finances will be a necessary part of the conversation, but one’s needs and desires are paramount and must be shared first. And what most of us seek or wish to retain are comfort, everyday pleasures, companionship, help achieving modest aims, choice independence, dignity, autonomy, freedom, sunlight, and ongoing learning. As Gawande says, “All I ask is to remain the writer of my own story. In stories, the end matters.”

It’s time to talk.

Trudy Strewler Hodges is the Director of Home Care for Envida, a nonprofit that promotes access and supports independent living with dignity. She is founder and former executive director of CASA of the Pikes Peak Region and has devoted her life to advocating for those who need someone to hear them.