5 habits that could help keep you out of a nursing home, from an orthopedic surgeon

Three in four Americans aged 50 and older would like to remain in their 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, who is based in Orlando, Florida, said there are three main problems that can make it difficult for older adults to age in place.

Those include difficulty getting up from a chair and caring for themselves, memory problems, and incontinence that makes it hard to manage personal hygiene.

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"The missing piece in most conversations between mental health, physical health and independence is your skeletal longevity," Wright said.

Staying independent with age requires attention to the entire musculoskeletal system, including the muscles, bones and tendons, according to the surgeon.

Wright shared the following habits as most important for maintaining independence outside of a nursing home.

The human body "craves mobility," Wright said.

"When you think about it, it's our first skill. We learn to walk when we're 1," she pointed out.

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For older adults, staying active can help preserve the ability to handle everyday tasks independently. The Centers for Disease Control and Prevention suggests low-impact activities such as walking, cycling and water exercise.

"Even when your hips hurt, even when your knees hurt, you should move on the ground, or get in a pool in chest-high water," Wright suggested.

While the doctor does not recommend exercising through a new injury or severe pain, she pushed back against the belief that rest is the best way to address pain.

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"Rest doesn't cure anything. When you have, for instance, arthritic knees, do you know what can help? Building the muscles around your knees, building the muscles in your hips to support your knees," she said. "So rest is not the answer for feeling better — staying strong and mobile is."

Strength training can help older adults maintain the ability to get out of a chair, climb stairs and carry groceries — everyday tasks that support independent living.

There is never an age or skill level when it’s too late to build muscle, according to Wright.

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"Even if you feel like you've declined or your parents have declined, there is no age or skill level when we can't become more mobile, when we can't build muscle or reconnect the neuromuscular pathways," she said.

It’s even possible to build muscle sitting in a wheelchair, she noted. "Some of the very first research done by Dr. Maria Fiatarone at Tufts University showed that even at 90 years old, you can regain function."

In that 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%, and also showed improvements in muscle size and mobility.

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.

Some 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.

Older adults tend to eat less, which can undermine efforts to maintain energy and build muscle, Wright warned.

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"It’s something I see even happening to my 86-year-old parents; they're just eating less and less," she said. "And we cannot fuel the muscle we want to build [and] the energy we need without a protein-forward, adequate-calorie diet."

Although older adults may require fewer calories, they still need enough nutrients to support their health, according to the National Institute on Aging.

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To help maintain muscle, the agency recommends that older adults consume protein-rich foods throughout the day, including seafood, dairy, fortified soy products, beans and lentils. Specific calorie needs will vary based on each person’s weight and activity level.

Wright urged older adults to challenge assumptions about what they can and can’t do as they age.

"The most common mistake I see seniors making as they age is assuming that aging is an inevitable decline from vitality to frailty," she said.

"They just assume that a certain number of birthday candles predisposes them to sitting on a couch the rest of their life. The reality is that there is no age or skill level when you're done."

Wright suggested that people should start working toward future independence during their busy working years.

"We need to start thinking about that in our busiest times of life, in our 30s, our 40s, our prime times of working," she said. "It’s part of a long-term, lifetime plan to live where you want to live, with whom you want to live, when you want to live there."

The doctor recommends that adults directly ask their aging parents what assistance they need and to explore available support, including community programs.

In many cases, she said, parents do not want to be a burden to their adult children, so they never ask for anything.

"I think this is a time for really open, frank conversations," Wright said. "What do you want help with? How can I help you? How could we get help for you if possible?"

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As an example, Wright said her elderly parents live with her family. When she noticed their meals started to suffer while she was traveling, she arranged for support to help them continue managing their lives.

"I have half of their meals delivered every week because I'm not going to be home to shop or cook," she said. "They remain independent, but with assistance. And that's what works for us."