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Many of our columns have touched on the value of maintaining one’s independence throughout the aging process, for as long as possible. The mental health benefit of independence and self-reliance, can’t be over-estimated.

However, those who are 75, 85, 95 often face decisions that pit independence against safety. Examples abound: Continuing to drive a car despite failing sight, slower reaction times, and a history of accidents comes to mind, as explored in a recent column.

Another example: Self management of medications vs. accepting help from a family member, friend, or health professional. “I always remember to take my pills,” he or she might say, yet the pill box is still half full at the end of the week! Depending on the prescriptions and the illnesses, this could have minimal impact or it could lead to a life- threatening medical crisis.

Doing one’s own laundry, cleaning, shopping, cooking, sidewalk sweeping, snow shoveling—all healthful, stimulating activities—unless a physical condition makes them high risk.

What about the need for a cane or walker and the adamant refusal to use one? “A walker? No–I don’t need one, don’t want one and won’t use it if you get me one! Walkers are for old people!” the 85 year old wobbling woman tells her daughter repeatedly. Of course, falls and broken bones, especially hips, can lead to temporary or permanent loss of independence!

Let’s take a closer look at falls and hip fractures. Research studies show that the average age of patients who have hip fractures is about 80 and they are often related to the presence of osteoporosis and arthritis. Hospitals treat over 300,000 hip fractures in the U.S. every year among those over age 50. About twenty five percent of those who have a hip fracture don’t live more than a year! Of those who live, 60% have reduced mobility and independence. One review of 82 research studies concluded that “most patients who survive do not return to the level of mobility and independence they had before the fracture.” So, which is better, to risk a fall, a possible hip fracture and almost certain loss of mobility if not one’s life, or use a cane or walker if needed, and suffer some initial embarrassment?

What can family and friends do in these instances? While encouraging, supporting the independence, point out the specific risks involved which could lead to accidents that will likely limit independence. Your loved one might better accept the advice from a physician than a family member.

Start with small steps. Tossing out the slippery throw rugs that many elderly use is a great first step. Adding grab bars to the bathroom, investing in an “alert device,” and setting up a reassurance calling service can all reduce risks.

“Ok, Mom, what If you just try the walker in the house for a few days? See if it helps—see if it gives you more stability and confidence when walking.” you could suggest. You might avoid pre

As you know, normal aging is often related to some memory lapses. The key questions are, when does memory loss become serious and is there any way to prevent its progression?

If you misplace your car keys or your glasses once or twice a day, that could be quite normal, for a 70, 80, 90 year old. If you find your car keys and try to open a can of soup with them, that could indicate a more serious problem. If you can laugh at yourself when you find a misplaced item, that is a good sign. If you can devise a strategy for NOT losing them in the first place, that is even better.

Keeping the keys or glasses in the same place all the time helps and saying out loud as you do it—”I’m putting the keys on the hook by the door,” makes it easier to recall where you put them, for example. Using multiple senses helps you remember. Say it, hear it, see it, touch it, and write it down if necessary.

Making word games to help you remember people’s names works well too. “That was Mrs. Smith, Mrs. Smith—Smith’s Pies, Smith’s Pies,” you say, linking her name with something familiar.

Long-term research studies have shown that those who use their minds the most, use their memory the most, are less likely to have serious memory loss, leading to dementia/Alzheimer’s disease.

Reading or doing crossword puzzles is much better than watching TV. Writing a poem or playing Scrabble is far better than dozing off in a rocking chair. Learning new dance steps is a good way to keep the mind active, studies have shown.

You know the important message about exercising regularly, even in small doses. The same is true with exercising your mind. It is never too late to increase your mental activity, your memory activity. Making it fun, with something you enjoy, works best.

If you or someone you know has serious lapses multiple times, such as leaving the car running in the garage, leaving the oven on past a meal, getting lost in the immediate neighborhood, further evaluation is promptly necessary.

So, get out your dancing shoes, the puzzles, the books, the chess set!