Greek philosopher Heraclitus noted: “You never step in the same river twice.” In other words, change is constant. Flux is the natural order of things and requires continual adaptation or there will be consequences.

For example, take the battle of Jena which was lost 20 years AFTER the death of the Prussian king Frederick—nonetheless, he was blamed. The defeat was attributed to the Prussian army’s short-sighted reliance on perpetuating Fredrick’s historically successful tactics.

Instead, what the defeated Prussian army should have done (in hind sight) was adapt to the changes in the art of war. Had they made appropriate adjustments the outcome may not have been victory for Napoleon.

Aging in many ways is like that river in a continual state of change, and like a nimble army it takes us by surprise:
Old age is the most unexpected of all the things that happen to a man.
-Leon Trotsky (Lev Davidovich Bronstein), Diary in Exile, 1935

To cope successfully with the unexpected we must adapt to the stages of change associated with aging.

I was recently reminded of the stages of change when a psychology professor came into the clinic for treatment. He was carrying under his arm a book by James Prochaska. We began to discuss Prochaska and Carlo DiClemente’s useful theory called the Stages of Change Model (SCM). The SCM was developed by looking at how smokers were able to give up their habits. The model can be applied to a broad range of behaviors including weight loss, injury prevention, and even making home modifications as we age.

The basic idea is that changes in behavior don’t happen in one step. Instead people seem to progress through stages on the way to successful change. And each individual progresses at their own rate through the stages:

The stages of change:
  -Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed)
  -Contemplation (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change)
  -Preparation/Determination (Getting ready to change)
  -Action/Willpower (Changing behavior)
  -Maintenance (Maintaining the behavior change) and
  -Relapse (Returning to older behaviors and abandoning the new changes)

Applied to Aging In Place
For the boomers with aging parents or older adults themselves, knowing the stages can provide context to where the individual(s) is in terms of making change. For example say one spouse sees the need for home modification and the other doesn’t—telling someone who is in the “pre-contemplation stage” that they must go along with the changes may not work. The individual is not ready to make the changes yet.

Each individual has to decide for themselves when a stage is completed and when it is time to move on to the next stage:

Stage One: Precontemplation
In the precontemplation stage, individuals do not think seriously about changing and aren’t interested in help. People in this stage defend their current bad habits and do not feel it is a problem. They may be defensive in the face of other people’s suggesting to make change.

“We don’t need grab bars in the bathroom, that’s for old people.”

Stage Two: Contemplation
In the contemplation stage individuals have an increasing awareness of the personal consequences of their bad habits and they spend time contemplating their problem. Although they are capable of considering the possibility of changing, they’re ambivalent about it and weighing the pros and cons.

“Tom fell the other day in his bathroom and broke a hip. Now he can’t meet us for tennis next week…I wonder if a grab bar would have prevented his fall?”

Stage Three: Preparation/Determination
In the preparation/determination stage, individuals have made the commitment to make a change. Motivation for changing is reflected by statements such as:

“I’ve got to do something about this — this is serious. Something has to change. What can I do?  I talked with Tom and he has now installed grab bars and other universal design elements into the house…I’m going to visit maybe this is something we should do too.”
Here they make small steps toward change.

Stage Four: Action/Willpower
This is the stage where individuals believe they have the ability to change their behavior (internal locus of control) and are actively involved in taking steps to change their bad behavior by using a variety of techniques.

“I’m impressed with Tom’s aging-in-place home modifications. They were beautiful and have increased the safety and resale value of his home. I’ve called a Certified Aging In Place Specialists to come over next week for an assessment.”

Stage Five: Maintenance
Maintenance involves the ability to successfully avoid any temptations to return to the bad habit. The goal of the maintenance stage is to maintain the new status quo. People in this stage remind themselves of how much progress they have made towards change.

“This is great, we’ve made home modifications and it is a big improvement. I’m going to read up on aging in place and see if we could make more changes. This really was the right thing to do; I don’t know why we waited. We’ve really made progress towards our goal of independent living.”

Relapse
The path to successful change for most people involves the experience relapse.
Individuals here can be discouraged and feel a sense of failure.

“Tom, I tripped over the newspapers pile up on the stairs and I’m calling you from my hospital bed. I wasn’t going to let that happen and now I’m not feeling so independent…I neglected my aging in place strategy and I’m going to need to get back to it.”
The goal here is to analyze what happened and use it as an opportunity to adapt.

Whenever we contemplate change we have a tendency to equate it with loss; we first think about what we’re giving up, not what were gaining. Aging is no different and by definition means change. The SCM can act as a roadmap with guide posts along the way to help navigate the twists and turns of new behaviors. Aging in place will require adjustments and new ways of living in outdated environments.

Winston Churchill once said, “We shape our dwellings, and later our dwellings shape us.”

See 

6 Steps That Can change Your Life

(Photo desertplanet.wordpress.com)

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