Growing older well, in Johnson County
Kansas is getting older, and that's an opportunity as much as a challenge. Age-Friendly MISH brings aging and health professionals together to build healthy aging into how we practise — across our care, our community and the systems older Kansans depend on.
Everything below is practical: the legal documents that let your wishes be known, how to cut your risk of falling, what depression looks like later in life, and how to keep moving. Take what's useful.
Advance directives
An advance directive is a legal document that records the medical care you want and who should decide for you if you can't. Planning ahead means you get the care you want, avoid suffering you don't, and spare the people who love you from guessing during a crisis.
Durable Power of Attorney for Health Care Decisions (DPOA-HC)
Sometimes called the Healthcare Power of Attorney. A signed and notarised or witnessed document that names someone to make health care decisions for you during a period of disability or incapacity. That person is called your health care agent, proxy or surrogate.
Durable Power of Attorney — forms
The powers you grant usually include
- Decisions about going into hospital
- Choice of doctors
- Long-term care
The document may also cover
- Refusing or withdrawing consent for life-sustaining procedures, even when the person is in a coma or persistent vegetative state
- Consent for organ donation and autopsy
Requirements
- You must be an adult — at least 18 — and competent when you sign. Competence is assumed unless there is actual notice to the contrary.
- Witnesses must be at least 18. They cannot be your agent, cannot be related to you by blood, marriage or adoption, and cannot have a financial interest in your medical care or estate.
- The DPOA-HC may take effect only when a physician determines you lack the capacity to make or communicate decisions.
- Your health care agent cannot cancel your Living Will.
Living Will
A signed and notarised or witnessed form stating in advance that your dying should not be artificially prolonged in the case of terminal illness. Only you can make this decision, or someone you have named as your Durable Power of Attorney for Health Care. Relatives — and even a legal guardian — do not have that authority. The form is authorised by Kansas law.
Living Will — forms
- You must be an adult, at least 18, and competent when you sign.
- Witnesses must be at least 18, cannot be your agent, cannot be related to you by blood, marriage or adoption, and cannot have a financial interest in your care or estate.
- It applies only once two doctors have diagnosed and certified you as terminally ill — one of them your attending physician. Terminally ill usually means death is likely within six months whether or not life-sustaining measures are used.
- It does not apply to someone in a coma or persistent vegetative state unless they are also diagnosed as terminally ill.
Patient's Do Not Resuscitate (DNR) Directive
A signed, dated and witnessed form in which an adult states in advance that if their heart stops beating or their breathing stops, no medical procedure will be carried out to restart them. Other appropriate emergency care from pre-hospital providers, or care directed by a doctor, may still be given. This form is authorised by Kansas law.
DNR Directive — forms and information
- You must be an adult, at least 18, and competent when you sign.
- Only the patient can sign it, and it must be signed in front of a notary public.
- Your attending physician must also sign it as medically appropriate — unless your church or religion recognises treatment by spiritual means only.
Physician's DNR order
Distinct from a patient's DNR Directive. A physician's DNR order — sometimes called a "no code" — is a doctor's own order in a medical care facility, adult care home or emergency medical service. It may be a separate document or simply an order in your record. Informed consent should come from you or your health care agent.
Choosing your agent
Your agent becomes your substitute voice. It should be someone you trust and who is close enough to you to know what you value about quality of life — and someone who will take the time to listen and learn how you feel about IV fluids, feeding tubes and other life-sustaining treatment. Being willing isn't the same as being ready; have the conversation before you need it.
Fall prevention
One fall doubles your chance of another, and the fear of falling makes people less active, which makes falling more likely. It is not an inevitable part of ageing — most of the risk is modifiable.
Check your risk
The CDC's Stay Independent checklist takes a few minutes. Score 4 or higher and you may be at risk — take the score to your doctor and talk it through.
Postural hypotension
Postural — or orthostatic — hypotension is when your blood pressure drops as you go from lying to sitting, or sitting to standing. Less blood reaches your organs and muscles, and you become more likely to fall. Many people have no symptoms at all.
Symptoms, when they appear
- Dizziness or lightheadedness
- Feeling about to faint, passing out, or falling
- Headaches, blurry or tunnel vision
- Feeling vague or muddled
- Pressure across the back of the shoulders or neck
- Nausea, or feeling hot and clammy
- Weakness or fatigue
When it tends to happen
- Standing or sitting up suddenly
- In the morning, when blood pressure is naturally lower
- After a large meal, or alcohol
- During exercise
- Straining on the toilet
- When you're unwell
- If you become anxious or panicky
What can cause it
- High blood pressure
- Diabetes, heart failure, atherosclerosis
- Some diuretics, antidepressants or blood pressure medicines
- Parkinson's disease and some forms of dementia
- Dehydration
- Vitamin B12 deficiency or anaemia
- Alcohol dependence
- Prolonged bed rest
What helps
- Tell your provider about any symptoms, and ask whether any medicine could be reduced or stopped.
- Get out of bed in stages — sit up, sit on the edge, then stand.
- Take your time changing position, including getting out of a chair.
- Sit down to wash, shower, dress or work in the kitchen.
- Move your feet and clench your hands before standing; march on the spot afterwards.
- Always have something to hold on to as you stand.
- Don't walk while you feel dizzy.
- Drink six to eight glasses of water or low-calorie drinks daily, unless you've been told to limit fluids.
- Avoid very hot baths and showers.
- Try sleeping with extra pillows to raise your head.
Medication safety
There are many medications linked to falls, particularly in older adults. Ask your doctor or pharmacist to review everything you take — prescription, over-the-counter and herbal. Good medication management reduces the interactions and side effects that lead to falls.
The basic approach: stop medicines where possible, switch to safer alternatives, and reduce what remains to the lowest effective dose.
Categories most strongly linked to falls
- Anticonvulsants
- Antidepressants
- Antipsychotics
- Benzodiazepines
- Opioids
- Sedatives and hypnotics
- Anticholinergics
- Antihistamines
- Medications affecting blood pressure
- Muscle relaxants
Talk to your doctor or pharmacist about a plan for any changes, how side effects will be monitored, and whether there are non-drug options for the conditions being treated.
What else you can do
- Work through the six steps to prevent a fall.
- Consider home modifications that prevent falls and delay disability and difficulty with self-care — see aging at home.
- Ask whether physical therapy is right for you. It builds strength and balance.
- Find an exercise class at your community centre. Tai Chi in particular is shown to reduce falls, and is gentle enough for anyone.
- See an eye care provider. Better glasses mean fewer falls.
- Make your home safer — lighting, railings, and moving what you use often within easy reach. Start with the CDC home fall prevention checklist.
Depression and aging
Older adults face health challenges and life changes that can raise the risk of depression. But depression is not a normal part of getting older. It's a treatable medical condition, and with the right treatment most people feel better.
If you or someone you care about is in crisis
Call or text 988 — the free, confidential, 24-hour Suicide & Crisis Lifeline — to speak with a trained counsellor. You can also chat at 988lifeline.org.
In a life-threatening situation, call 911 or go to the nearest emergency department.
It is not the same as the blues
Depression is a genuine medical condition, treatable like diabetes or high blood pressure. It isn't low mood, and it isn't grief after losing someone. Around 4% of adults aged 70 and over have depression.
What it looks like
People experience depression differently, so this list isn't exhaustive:
- Feeling sad, empty or hopeless often or all the time
- Losing interest in things that used to be enjoyable
- Weight or appetite changes
- Trouble sleeping, or sleeping too much
- Irritability, frustration or restlessness
- Low energy or constant tiredness
- Feeling worthless or excessively guilty
- Trouble concentrating, remembering or deciding
- Thoughts of suicide or of hurting yourself
Who is more at risk
- People with medical conditions such as heart disease or cancer
- People whose daily functioning has become limited
- People with sleep problems
- People with more than one health condition — and most older adults have at least one, while half have two or more
Why it often goes untreated
Older adults frequently don't seek help. They may assume the symptoms are just ageing, feel shame about it, or not realise treatment would work. There are practical barriers too — cost, transport, a shortage of mental health services. And clinicians sometimes mistake the symptoms for physical illness, or aren't trained to screen for depression in older patients.
If you're worried about someone
- Encourage them to get help, and ask what support they need
- Offer to go with them to see a health care provider
- Join them for walks or other activity — it helps their mood, and it gives you time together
Treatment works
Medication, psychotherapy, or a combination of the two. Most older adults see their symptoms improve once treated. More about the 988 Suicide & Crisis Lifeline.
↑ Back to topicsMobility and transport
Independence usually goes when getting around goes. Planning for that before it happens is far easier than reacting after.
Make a mobility plan
The CDC's My Mobility Plan toolkit walks you step by step through keeping your mobility and independence as you age.
National Aging and Disability Transportation Center
NADTC works to make transport available and accessible for older adults, people with disabilities and caregivers, with resources and training for communities and individuals. It's a programme of the Federal Transit Administration, administered by Easterseals and USAging.
Bone health
Strong bones matter at any age, but they need more attention as you get older. Falling bone density leads to osteoporosis, which raises your risk of fracture — and a fracture is often what turns a fall into a loss of independence. Ask us about bone density screening.
Home safety
A safer home prevents falls and delays disability and difficulty with self-care. The most effective approach is unglamorous: walk through each room with a notepad and fix what you find.
Getting help in an emergency
- An emergency phone tree. Decide now which family members, friends and caregivers get called, and in what order. Keep the list somewhere accessible — by the phone, or saved in your mobile.
- A medical alert device. A wearable button connecting to a 24-hour monitoring centre. Users report a stronger sense of security and independence, including people not at high risk of falling.
- A door camera or intercom. Being able to see and speak to whoever is at the door means you can take your time answering it — rushing to the door is a common way people fall.
Room by room
Entryway and outside
- Overhead lighting at the entrance
- Handrails along all steps
- Ramp, if needed
- Clear path from parking to the door
- Lightweight doors that open easily
- Doorknobs that are easy to turn
- Low-profile mats that aren't a trip hazard
Hallways and stairs
- Motion-detection lighting
- Handrails throughout
- No throw rugs — vinyl if you need something
- No cords crossing walkways
- Nonslip stair treads
- Stair lift, if needed
Kitchen
- Working smoke and carbon monoxide detectors
- Appliances in good repair, no frayed wires
- Poison control number somewhere visible
- Short sleeves and fire-resistant fabric when cooking
- Cut-resistant gloves and a rubberised chopping board
Living areas and bedroom
- Clear walkways
- No low tables or furniture to trip on
- Phone or charging point beside the chair and the bed
- A bed that's easy to get in and out of
- Clutter-free bedroom for better sleep
Bathroom
- Grab bars by the toilet and in the shower or bath
- Nonslip mat on the tub or shower floor
- Nonslip mats around the bathing area
- Lever taps instead of round handles
- A raised toilet seat
- Walk-in shower or bath, if needed
Everywhere else
- Plan and practise a fire escape route
- Replace electric blankets with frayed cords
- Keep an up-to-date medication list
- Store medicines somewhere cool and dry, and check expiry dates
Footwear and floors
Nonslip footwear with a closed heel and a textured sole is one of the cheapest interventions there is. A firm sole is better than a soft one — it transmits more sensation from the foot, which improves balance. On the floor, the biggest culprit is the throw rug: it bunches under a walker, a cane or a foot. Remove them from high-traffic routes, or replace them with low-profile vinyl. Fix larger area rugs to the floor.
Portions of this section are adapted from the National Council on Aging's guidance on home safety for older adults. MISH does not endorse or receive any benefit from specific products or brands.
↑ Back to topicsBring these to your next appointment
Your fall risk score, your medication list, your advance directive — all of it is easier to work through with your care team than alone. Bring what you've filled in.