Treat Me, Not My Age: A Doctor's Guide to Getting the Best Care as You or Your Loved One Gets Older

Most dwellings in existence today can be modified to meet the needs of just about everyone at every age. What's more, you don't need to spend a ton of money to do it. Here are some quick fixes that can extend not only the useful life of your home but maybe your own life, too.

The bathroom: This is the most dangerous place in the home, what with hard surfaces, water that makes floors slippery, nothing but your birthday suit between you and the tile and tub, and, to top it all off, poor access to a telephone should something go wrong. Even if money is tight, this is the one place where spending more may be worth it (for example, changing to shallower tubs or replacing them with walk-in showers so you don't have to be an Olympic hurdler to bathe). A simple fix, installing grab bars, will make it easier to enter and exit the tub or shower and use the toilet, and reduces your chances of a preventable fall. (Hate the industrial chrome look? Well, they now come in a variety of tasteful colors to match your décor, so you can be safer without feeling like you're in the disabled-access stalls at the public library's restroom. One of my patient's artistic daughters even described her "rails" as "cool.") Many people find it easier to bathe while seated in a bath chair, using a handheld shower hose that attaches to the tub spout or shower arm. Be sure the bottom of the bathtub has antiskid strips or a mat. And one more thing: Don't forget to equip your tub faucet or boiler with anti-scald devices, which either prevent your water from getting too hot at the source or sound an alarm to tell you that the bath you're about to sit in is dangerously toasty.

Lighting: As we age, we need more light to compensate for changes to the visual system. When was the last time you updated the lighting in your home? (And I'm not talking about sconces and lampshades; I mean the actual illumination.) Simple changes like using higher-wattage bulbs (make sure they're safe for the fixture you're putting them into) or adding additional lights in strategic locations can make a world of difference. And don't overlook "path lighting" in corridors, as many falls occur not in rooms but en route from one to another.

Flooring: The surfaces on which we walk can interact with gait changes to produce potential difficulty. My preference: Use the same or similar surfaces throughout the dwelling, because it is often at "transition points" between rooms (and surfaces) that falling occurs. Area rugs can be a huge danger, especially if they slide or have edges that curl up to produce trip hazards. If you insist on area rugs, use double-sided carpet tape to make sure they lie flat at every point and don't slide. Deep carpeting is a bad idea. (Most geriatricians and physical therapists are not expecting "shag" carpeting to make a comeback anytime soon, and we're just delighted.) A better choice is a nonslip flooring surface that can be easily installed. And while the slipperiness (or "grippiness") quotient of the flooring surface is important, there are other factors you should be thinking about, too. Vinyl has more "give" on impact in a fall than porcelain tile, for example, and lowers the chance of a fracture if you do slip. (Like a glass or an egg that you might drop, you want to "bounce" rather than "crack.") Vinyl also is warmer than tile and easier to stand on for long periods of time. And let's not forget color and glare: Shiny surfaces are tough for people with certain kinds of visual problems, and darker surfaces may make any obstacles on the floor difficult to see.

Bright colors: The use of color in almost any home furnishing, surface, or item can work wonders as we age. It can make it easier to find items (like a red coffee mug on a white coffee table) or avoid missteps (a bright-colored bedspread that contrasts sharply with the floor color so the edges can be safely identified). Never choose the same color for a seating surface and the floor: Your butt could easily miss the target.

Furnishings: Chairs should have arms and not be too deep, so that it's easy to rise from them; the same goes for couches. Rather than replace what you have, get higher cushions that you can't sink into. Again, contrast the colors of seats with the colors of floors to avoid accidents.

Kitchen items: Can openers, potato peelers, jar openers, scissors, and other utensils are available in ergonomically designed models that are easier to use as we get older—less force and manual dexterity is needed to get the jobs done. A great Web site that includes reviews of these products is run by the National Resource Center on Supportive Housing and Home Modification: www.homemods.org.

Simple technology fixes: Some incredibly cool technology is on the horizon to keep us boomers happy, healthy, wise, and safe, but you need not wait to get cracking. Right now there are simple and inexpensive technological improvements you can take advantage of to make your life easier and better. For those with visual impairment, there are telephones with large number buttons. For those with hearing loss, there are doorbells and phones that flash lights rather than "ring" and clocks that vibrate your pillow instead of sounding an alarm. If you don't want to spend money on an expensive hearing aid, Walkman-like devices available at your local electronics store for less than fifty bucks can change your life—a great way to test-drive a hearing aid.*

Many state and local governments and private community agencies that serve older adults can provide financial assistance for modifications like grab bars or for simple apartment repairs. To find out if there are low- or no-cost government services for eligible adults, check with your local department of aging, found either in the phonebook or through the Eldercare locator, which can be accessed by calling 800-677-1116 (weekdays from 9 a.m. to 8 p.m.) or found on the Web at www.eldercare.gov.

* These devices can be found on the Web, but if you're not an Internet consumer, Radio Shack has a version. It's called amplified stereo listener with 3-band equalizer (model: 33-1097 | catalog #: 33-1097).

Deciding When It's Time to Move

I love the idea of staying at home, and I love environmental modifications with that goal in mind. But I'm also a pragmatist. Even if you're Bob Vila, you may ultimately run up against the simple fact that the effectiveness of modifications wanes over time if your mobility and/or other problems outstrip them. And that, my friends, brings us to one of the most difficult responsibilities of an aging specialist: knowing when to encourage a patient to pick up stakes and move, or helping people get older loved ones to come to the realization that the time has come. And even if you've gotten everybody on the same page, the story's not over. You've got to know what the options are. Which brings us to the next chapter.