Planning for Advanced Old Age: A Proactive Approach

When we work with patients around planning for an advanced old age, two emotions surface in every discussion: enthusiasm about living to an advanced old age, and fear about living to an advanced old age. In this article, we will explore how you can manage and plan for an advanced old age so you arrive at this period of your life in a way that supports what you hope life will be like and considers the realities you may face.

Defining Advanced Old Age

Surprisingly, there is no agreed upon description of what constitutes advanced old age. If we follow Social Security guidelines where age 55 is middle age, then 75–90 years of age could be considered old age. And over 90 years of age, advanced old age.

Promoting Advanced Old Age with the Healthy Lifestyle Formula

When patients express enthusiasm about living to an advanced old age and see it as a welcome challenge, they are also typically following a healthy lifestyle formula which, research tells us, reduces the risk of chronic disease, the key factor in reducing life and health spans. The formula includes:

• Regular health screenings
• Sufficient sleep
• Regular exercise
• Mediterranean diet
• Avoidance of risky substances
• Stress management
• Social engagement

So how does the healthy lifestyle formula differ from longevity medicine, the burgeoning science of extending life span if not health span? The healthy lifestyle formula is at the foundation of longevity medicine. Longevity medicine, even with its use of novel drugs and supplements, cannot correct the effects of long-term poor diet, lost sleep, limited exercise, and unrelenting stress.

The healthy lifestyle formula noted above is a central part of the research and programs at MGH’s McCance Center for Brain Health. Use the Center’s Brain Care Scorecard to find your baseline brain care score. Then apply the healthy lifestyle formula to support your longer-term cognitive health. As always, consult with your physician if you have questions or concerns about your baseline score.

As you age, and despite your best intentions, you may find that you require multiple medications. Medication management, including understanding drug or supplement side effects and interactions, is essential to avoid health complications that may put you at risk. Again, ask your physician for guidance.

Make Social Connection the Key

The U.S. Surgeon General’s Advisory shows that the impact of a lack of social connections is akin to smoking up to 15 cigarettes per day. And according to this advisory, the health impacts of loneliness are greater than the risks associated with obesity and physical inactivity.

So how do you boost your social connections? Start by learning your Lubben Social Network Scale (LSNS) score. Developed by Dr. James Lubben of Boston College, the LSNS scores social isolation in adults by measuring perceived social support from family and friends.

Research by Dr. Lubben and others confirms what you probably already know; regular social contact combats loneliness, alleviates depression, and supports healthy aging. Participating in community activities, joining clubs, volunteering, and taking classes may also help you to find a sense of purpose and belonging.

While this sounds easy to do, if you feel hesitant, start simply by finding yourself a “third place”. American sociologist Ray Oldenburg in his book The Great Good Place posited that “third places” or informal gathering places that are neither home nor work (which are first and second places) are crucial for fostering community and alleviating loneliness. Your local dog park, community center, gym or pickleball court are all examples of third places where you are likely to meet others with shared interests.

Planning for Where You Age: Home or Away?

Do you have a vision of where you will age? Will it be your primary home of many years, or will you move to a totally new location? And how important is it for you to age in place?

Long-term care insurance (LTC) is an option to consider if your goal is to remain in your home as you age. There are multiple LTC approaches available and most LTC plans cover nursing home care, hospice care, home health aides, physical therapy, and respite care.

If aging in place where you live currently is not part of your plan, continuing care retirement communities (CCRCs) are another option. CCRCs offer a range of living options, from independent or assisted living to nursing care, all on one campus. This allows for a seamless transition as care needs change. Additionally, CCRCs typically offer an almost endless variety of educational programs, gatherings, and events to support enrichment and engagement with others.

When patients express fear about living to an advanced old age, their greatest worry is entering a nursing home. For those with significant health issues, nursing homes provide comprehensive care which may be covered by a LTC policy. Being an educated consumer can do a lot to assuage concerns about this option. When evaluating nursing homes, start with some of the questions generated by this U.S. News article around key nursing home selection criteria. You will want to assess:

• Facility location and features – amenities, safety, and overall cleanliness
• Staffing – staff to patient ratio, staff retention and turnover patterns
• Quality of care – daily care routines like medication management
• Quality of life – meal plans and nutrition, social activities, privacy
• Community and family engagement – visitation policies, alternatives to in-person visits
• Legal and financial matters – cost and payment plans, Medicare coverage

Planning for advanced old age is a multifaceted process that requires careful consideration and proactive strategies in several key areas. Starting the planning process early and reviewing it regularly can help you adapt to changing circumstances and needs, ultimately leading to a more secure and fulfilling advanced old age.