Although the next best selling “How to” self improvement book is always right around the corner, the basics never change. The only change seems to be in the interpretation.

11 Proven Keys to Live Long and Age Well:

  1. Eating a balanced and nutritious diet
  2. Exercising regularly
  3. Getting adequate sleep
  4. Getting regular fresh air and sunlight
  5. Having social connections
  6. Being a lifelong learner
  7. Reducing Stress
  8. Working towards goals
  9. Being of service to others
  10. Maintaining a spiritual connection
  11. Having stimulating employment

As the saying goes, the “devil is in the details.” There is no lack of books defining a balanced and nutritious diet. Anyone with a sincere interest in improving their health need only go to their local bookstore. The problem comes with those details. Do you have a eating disorder, metabolic problem, thyroid issues, a need to lose weight, gain weight, an alcohol addiction, a need for probiotics, there is a book for your condition.

The list doesn’t seem all that long, just 11 key things to do, it is just so hard getting number 1 right. Maybe the goal should be to focus on getting numbers 2 through 11 right first. And for that pesky number 1 – everyone knows what foods are bad. Just don’t eat those.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing  


The conversation around the conference table was familiar. Why are our patients getting younger and younger we asked each other?  I had heard this many times before, but this time it was different. The speaker, who was so questioning about what could possibly account for this, was herself only twenty-five. Kelly was concerned for her parents and grand-parents. She said she was regularly going home and telling her Dad, “We just had another patient come in today, who is so much younger than you are.” Why is this happening she asked, “aren’t these people supposed to be old?”

We talked about the fact that these people didn’t just have one diagnosis that brought them to the nursing home. No, they had led a life that led to multiple systems breaking down.

Proven life choices that keep the elder out of a nursing home:

  • exercising and maintaining an active lifestyle
  • getting enough sleep
  • spending time outdoors, enjoying sunlight and fresh air
  • having satisfying, close relationships
  • being a life long learner
  • minimizing stress in your life
  • being of service to others
  • having employment (or volunteer positions) that use your talents and skills
  • maintaining a spiritual life – remaining close to your faith
  • eating a balanced (a variety of foods) and nutritious (focused on vegetables/fruit/protein) diet

Yes, patients in the nursing home are getting younger and younger. At the same time nursing homes are getting better at providing all the therapies, social service counseling, diet counseling, etc., to help the elder turn around their health. So much better for Kelly’s dad to make these choices now, before he has fewer options.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Studies of monkeys show how older male monkeys fit into their social group, closely resembles how well old men age. The male monkeys fit into one of two  groups, the first is the one where males are always pushing and fighting to be at the top of the hierarchy. This group doesn’t age well.  As expected there always will be younger and stronger males to take their place. These older males will then be scorned and picked on by the younger males at the top of the group.

These older males then have no choice but to leave their tribe and join another group, where they will no longer be picked on, only ignored. They will finish their days alone and friendless.  These male monkeys are like men who have a constant need to be in control.

This kind of man has a compulsive need to feel like number one, and many times will accomplish this by monopolizing conversations. Every conversation with this man turns into a monologue, and when someone tries to make it into a dialogue, they will frequently interrupt until they have successfully killed the conversation. They will enjoy being with people they feel they can push around, as long as it is a bit of a fight. They enjoy the contest and don’t want it over too soon or too easily won.  These men like the monkeys, when they become old men also are pretty much alone. They have worn out friends and family with their competitiveness.

The second kind of male monkey is very different. These males even at a young age make the choice to not join in this push to the top of the tribe. Instead, these males spend their time making friends. These males have calmer social behaviors and are accepting of the hierarchy of the tribe. Then in old age, they have their friends, especially female friends and they live longer and happier then their more aggressive counterparts.

Every study of the elderly, to see what people have in common when they have attained an advanced age, includes being social. Maintaining friendships and developing new ones is always viewed as a positive way to age. Having several and varied activities that include getting together with other people. Attending church, doing volunteer work, joining card clubs, health clubs, singing in a choir, even becoming comfortable chatting with strangers, store clerks, and waitresses. If you have always been more of an introvert, you can be the best listener in the group.  Live a longer and a happier life by avoiding social isolation.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Alice and Todd were very hesitant to talk to Alice’s parents. They had just finished the 12 Point Senior Living Assessment, and it didn’t go too well. There turned out to be red flags in pretty much every category, especially troubling were the physical safety questions. The neighborhood that Alice had grown up in now wasn’t considered a safe part of the large city.  The home would now need motion activated lighting outside as well as the improved locks noted.

Other areas that came to light were that her parents were hoarding expired medications. The elderly couple admitted that mom had fallen a few times, and they just didn’t want to bother anyone because she really wasn’t hurt. And the list went on. It now seemed to the Alice that it was only a matter of time and one of these issues would result in possibly a debilitating injury for her parents, or worse. It also seemed to the concerned daughter, that this over whelming list wasn’t going to be well received by her elderly parents.

The two couples sat down to go over the list together, and before they even got to the concerns over medications and nutrition. Mom smiled at them all and said “When do we leave?” It turned out that Mom and Dad had also been concerned about their many challenges that were piling up. Now that their daughter had opened the conversation, they were more than ready to make some big changes.

It turned out that her parents had always hoped to move to a warmer climate, to a senior living community. What they had needed was someone to step in and help them with the decision that the time was now. The four of them came up with a plan to check out some communities according to location, budget, and services. They wanted to make sure once settled they would not be having to make another move anytime soon. Once they found a place where they not only could have their own apartment, but also offered a continuum of care that they could add services as needed, they were ready to make the move.

A year later the elderly couple were happily settled. Mom had been the church organist for many years back home. Now she volunteered in the senior community to entertain on the keyboard during parties. Dad had joined the chess club, and they both were making use of the community pool. Alice was comfortable with this safe community where her parents now lived, but she was hanging on to that 12 Point Senior Living Assessment.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


12 Point Senior Living Assessment (continued):

6.      Reduce the Risk of FALLS. This is always the place where the children or family will get more buy in for a home          assessment. Every senior knows of someone who fell and their life changed dramatically. And they are right,                the goal is not to fall, not to get hurt, not to have a fracture. The statistics show that a fall increases the                            likelihood of spending your remaining days and possibly years in a nursing home.

Are the floors free and clear of clutter, extension cords, piles of old mail, magazines, general debris, are there               scatter rugs? Are there motion activated night lights and adequate room lighting? Are there pets that dart                      around the indoor living space that could be under foot? And most of all, is there a history of falls, has this                    senior  fallen before? Do not assume that you would know if the senior has fallen, many a senior if able to get up          independently will not tell anyone they have fallen. The question must be asked.

Please go to the “search” button on this site and search “falls” or go to the falls category, this is a topic that                     cannot be over stated.

7.    Emergency – smoke detectors. Are there functioning smoke detectors? Is there a system in place to change the              batteries on a regular basis. As in Part I under cooking, this is the time to look for indications that something has       been  burnt – pot holders, dish towels, cutting boards, etc.

8.     Neighborhood safety. How close is the nearest neighbor, does the senior know the neighbor? Do you know the             neighbor? Would the neighbor be willing to check on your senior if you called them? Does the senior feel safe in           the neighborhood? Safe in their home? Safe going out at night? Does the senior, if they drive, feel safe going to              their car? This is the time to take a look at door locks and window security. Is there a system in place to ensure            that the senior cannot get locked out of their home by mistake?

9.     Water Temperature. Check the water temperature, make sure it is set below 120 degrees. As a person ages, they            may lose the ability to accurately feel water temperature due to diseases. Checking the water temperature on a             regular basis reduces the chance that this costly mistake will be made.

10.    Money Management. Are there stacks of bills sitting around or sitting in bags? Have you found money hidden               in interesting places? One elderly man decided to hide his money in a family Bible, to quickly forget where he               had hidden it. Are all of the seniors services in good working order, any indication that a service has ever been             interrupted?

11.     Does the senior have a healthcare/financial power of attorney in place? Is the power of attorney well informed            of the seniors wishes? Is there a living will? Make sure that if a decision has been made to have a “Do Not                       Resuscitate” form in place, that it is posted in a visible location if needed.

How often this assessment is completed is a judgement call. If the senior is very highly functioning, it will just give a heads up on what things to be looking out for. Over time, what started as an annual check can begin to be twice a year and for some areas, turn into monthly checks.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



To have a geriatric assessment team visit the home of a senior can be expensive, and a luxury not always available, in every part of the country. Having your own assessment tool and annually checking areas of the senior’s life and environment can go far in keeping ahead of changes, and needs. If unable to complete the assessment at one visit, break it into smaller parts. The importance is to not rush through the assessment. But as you go through the assessment make notes and brainstorm corrections.

12 Point Senior Living Assessment Tool:

  1. Stairs, inside and outside the home. Are they in good repair, with adequate lighting and hand rails. Watch the senior go up and down the stairs, watching for signs of decreasing strength and balance. If the senior is in a wheelchair are ramps in place, is it difficult to maneuver in and out of doors and doorways?
  2. Bathroom assessment. Is the toilet a taller, chair height making it safer to transfer on and off. Are there ample and secure grab bars in locations where they will be of use to the senior? Many older people stop having a tub bath, and if they do not have a shower, they may switch to a sink bath. There should be a bath mat on the floor of the shower, a shower chair and supplies located in places of easy access. This is an area that also needs plenty of light.
  3. Medication storage and usage. A complete list of the senior’s medications should always be readily available. In an emergency situation, emergency personnel will want to know what medications the senior is taking. Where are medications stored? Are medications sorted into a daily medication container? Who is responsible for filling th container?  When you visit is the container on the right day and time indicating that the senior is taking their medication correctly? Is there a plan in place to check expiration dates and have a routine refill of prescription medications. Are refills delivered, or is there a plan in place for someone to pick them up?
  4.  Nutrition and cooking. Is there adequate food in the home? Is the food preparation area clean, are there cleaning supplies present? Are all of the appliances in working order? Are there any signs around of fire, burn pots and pans, burn areas of cutting boards, or dish cloths? Is there any evidence of spoiled food present? Who handles the trash and garage removal, does that system seem to be working well? Who does the grocery shopping, is there evidence of a balanced diet with fruit and vegetables available?
  5. Emergency numbers. Are emergency and family phone numbers posted by the phone, as well as programmed into the seniors’s phone?
  6. Home Temperature. Is the home warm in winter and cool in summer, is the equipment on a regular maintenance schedule?

Taking care of these issues on regularly scheduled visits will ensure that the senior can remain in their home, as well as give peace of mind to the family.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


She was just pausing at the entrance of the grocery store, I paused as well to ask if I could be of assistance. She said no, she just needed to stop for a minute for her eyes to adjust to the dim light of the store on this sunny August day. She shared that she was now 86 years old and she had to be more careful. How very fortunate she was, shopping alone, car in the lot, very attractive slack outfit on and gray hair piled on top of her head in a very fetching bun.

As anyone knows who finds themselves sitting with a group of seniors chatting about their health issues, people do not age in the same way at the same rate. Even identical twins will age differently. If we all aged exactly the same everyone would become more and more alike as they get older, and that is not the case.  Older adults vary in the same way younger people do in their attitudes, recreational activities, how they look, and social connections.

But physically there are some similarities:

  1. Vision, as with the lady in the grocery store, aging causes a greater sensitivity to glare. Adapting to changes in light levels is slower and there is greater difficulty seeing in lower light.
  2. Heart, the heart muscle thickens with age and the body’s ability to extract oxygen from blood diminishes.
  3. Arteries, stiffen with age, making it more difficult for the heart to pump blood forward through arteries that are less elastic.
  4. Lungs, between the ages of 40 – 70 breathing capacity diminishes about 40%.
  5. Brain, the aging brain loses axons and neurons that connect with each other.
  6. Kidneys, gradually become less efficient in removing waste from the blood.
  7. Bladder, the bladder capacity declines.
  8. Body fat, with aging fat tends to settle more in the deeper organs of the body causing more of a apple shape.
  9. Muscles, without exercise muscle mass will decrease about 23% between the ages of 30 and 70.
  10. Bones, bone mineral is lost and replaced throughout the life time but at the age of 35 you no longer replace as much as is lost.
  11. Hearing, it becomes harder to hear higher pitches with aging, and background noises make hearing more difficult.
  12. Personality, does not change with the aging process. However seniors who experience chronic pain, or a significant loss are at risk for depression.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


“Sit down Gladys, please sit down.” Gladys was the 102 year old former Army nurse living in a small 15 resident, senior care cottage in Clearwater, Florida. Yes, Gladys was a little confused at times, and she did forget that she needed help to walk. But from the time she was up in the morning,(dressed for the day in one of her many flowered dresses and comfortable, sensible shoes) all she heard was to “sit down.”

It is not surprising that people age two want to walk. Or that people twenty-two, fifty-two, and sixty-two, want to walk for that matter. No matter what your age, walking means independence. Walking builds the kind of strength you are not able to build any other way. Walking provides weight bearing that builds bone and protects against osteoporosis. Walking gives any person the chance to feel their muscles move, and know they are alive.

Walking for the elderly, is protective of their overall health in so many ways. Walking reduces the incidence of urinary tract infections, protects against pneumonia, supports appetite, maintains muscle mass, gives the elderly opportunities for socialization and most of all maintains the ability to walk.

The good news for Gladys was that her attempts to stand, and then to sit down again several times daily, was maintaining her thigh muscles. She instinctively reached out for the arms of her chair when she stood and because of the constant practice she was quite steady going from sitting to standing. But more than that, no matter how many times she was asked to sit back down, Gladys’ spirit was still visible in her ongoing attempts to get going.

It was kindly pointed out to Gladys’ direct caregiver, that going out first thing in the morning and taking a walk, before it became hot might be a good idea for Gladys. All she needed was someone to take her arm and give just a little support from time to time to help with her balance. Didn’t seem too much to ask for this woman who had given so much, to so many, during her career. But no, now that twenty-something girl was in charge of her and the “girl” didn’t think Gladys needed to walk. So it began again, “Gladys please, please sit down.”

If you know of a Gladys who wants to walk but everyone around her is afraid she will fall please go to www.merrywalker.com and see some safe ambulation devices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


You can’t remember where you parked your car!  You arrive at the shopping center with your friend. You park, walk in, and are in conversation about where you might want to eat lunch. Hours later, when returning to that store, you don’t remember which door you came in. Not only that, once you remember the door,  you walk outside to try to get your bearings, and you still have no idea where your car is. Lucky for you, you have a key fob and can locate your car by the beeping horn.

In the same way, you may constantly be searching for; keys, pen, glasses, cell phone, pretty much anything a person lays down without thinking. You start wondering if you have Alzheimer’s disease. You start to question yourself, and worry about past lapses in memory.

The truth is, that as we age we can start to have problems with distraction. The memory is like a bank, you make deposits and when you need that information you make withdrawals. In this scenario, you never made that deposit into your memory bank. Due to the distraction of talking to a friend you never made a mental note of where you parked.  Which door you came in, and what merchandise was located at that entrance.

The inability to think or reason your way out of this situation could be a sign of mild cognitive impairment, but could more likely be due to stress. The awareness that you are having trouble focusing, and thinking through this problem are good things. Awareness is a good thing. When a person no longer thinks things through, weighs the pros and cons, uses critical thinking and their common sense seems to be out the door, that is the loss of reason. Losing the ability to reason, is cause for concern, not occasionally forgetting where you parked.

So should losing your car in parking lot, lead you to making an emergency appointment with your doctor? Probably not, what is more telling is how you handled it.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Phil lives alone unless you count his dog, Clare. Phil now is seventy-three and most people would have considered him in better than average shape. He is not one for exercise but he always has watched what he eats, and was blessed with good genes. However, Phil made some very bad decisions.

It happened on a very nasty night in the Midwest. There was a ugly ice-sleet storm raging outside when Clare needed to go out. Phil did his usual thing at night he took Clare out into the backyard. Too bad his usual thing was to walk Clare in his underwear. So when Phil fell, he was too embarrassed to call out to his neighbors for help.  So there he lay with an injured leg, shoulder and arm, out there on the ice.

Because Phil didn’t want to call for help it took him two and a half hours in the cold, on the ice, to pull himself to his back door and drag himself in.   This experience caused Phil to be hospitalized for five days and is now in a nursing home due to the pneumonia that set in while hospitalized.

What seniors can do to protect against falls:

  • if you live alone (and are even if in very good condition like Phil) wear an alert button
  • think ahead, make good decisions and be proactive – is it really a good idea in any weather to be outside in your underwear
  • prepare for the weather – when in snow, ice, sleet – carry a small bag of salt, sand or gravel to throw out in front of yourself as you walk
  • for those who have to go out in all weather – consider rubber ice cleats that easily attach to the bottom of any shoe or boot – they are easy to put on and off and very in expensive

It really didn’t seem like it would be Phil who would be in a nursing home, at least not until a very old age. Bad weather got him there, and a fall, but more than that it was bad choices.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing