SCALING back The Many Sides of Downsizing in Later Life

by Amy Phariss

continued from page 1

Families and individuals have a lot to think about as we age. We think about our health, our safety and our ability to live independently. Downsizing inevitably becomes part of the conversation. For many families, the idea of downsizing is appealing for several reasons. Downsizing makes sense financially, as smaller homes cost less to maintain and even downsizing vehicles can cut costs. Neuroth and Bridges went from a two-car family to a one-car family, cutting down on car insurance, maintenance and repairs. Decluttering and minimizing are also appealing for many people who feel their lives have become too complicated by caring for stuff at the expense of spending time with people. The reasons for downsizing have a lot to do with choosing how we want to spend our time, money and energy. For many Americans, particularly those 65+, downsizing is a serious consideration. Researchers, who interviewed 40 older adults who recently downsized, write, “…downsizing is a major transition that deeply engages multiple steams of personal, family, social and cultural life.” What seems like a simple life decision is a complex life transition.

Downsizing isn’t just about decluttering the china hutch and clearing out the garage. The experience of downsizing is both mental and physical.

Understanding both the logical and the emotional sides of downsizing can help families make the best choice with loved ones and experience downsizing in a positive, empowering way.

Exploring the why of downsizing is often the first step in the process. According to research, the most common reason for downsizing among older adults is for healthrelated concerns. Research published in the

Journal of Aging Studies reports, “…having a stroke or a hip fracture were the two strongest independent predictors of housing relocation in later life” (Luborsky et al, 2011). For couples or individuals who must downsize due to health concerns, the experience is often quicker and less within their control than expected. Research shows that approximately 20% of moves among people 65 years and older happened two years earlier than expected or anticipated. This means people have to downsize in a reactive state, which can feel disempowering and overwhelming.

Other reasons for downsizing include desire to be closer to family (many of whom may live in other states), maintenance issues with the current home, too much space in the home, financial factors, no longer liking the location of the home, and the home no longer meeting physical needs (accessibility, safety, etc.). These reasons are, in many ways, challenging both emotionally and physically. ONC readers Bridges and Neuroth recently downsized for the second time in as many years, to be closer to family and better healthcare resources. Bridges says, “I was surprised how hard it is mentally, how taxing it is to your brain.” Getting ahead of the game is one of the most often suggested tips for lessening the stress of downsizing and making the most of the experience, which can be exhausting but also exciting and joyful. In fact, decluttering and downsizing can have noticeable positive impacts on mental health and overall quality of life.

Physically, downsizing is just a lot of work. There are garage sales to plan, items to sort, clothes to donate, appliances to give away and a garage full of yard tools no longer needed. It can be daunting to even think about the work ahead let alone get busy and organized in doing that work. Bridges says, “I was shocked by how much work it is to go through every, single thing and try to make decisions about how to keep it or not. I took so many carloads to the Goodwill, truckloads. We used to go almost every day for a while. After giving away 1/3 to ½ of what we had before our move, I had to give away a boatload more after we got here.” The physical nature of sorting, moving, carrying, loading and unloading can be exhausting.

As demanding as downsizing can be physically, the emotional side of downsizing is often overlooked. Many of the reasons we consider moving and downsizing have to do with changes in health and wellness. Maybe a spouse had surgery and can no longer care for a large home. Maybe you’ve been diagnosed with a chronic illness, impacting your ability to live alone. Or maybe you’re just too tired to spend hours each weekend mowing, weeding and caring for the yard. Your energy could be spent in other ways, which you realize means downsizing.

Emotionally, health issues can be draining and demanding. We are affected by our own diagnosis as well as the health issues of our spouse. A diagnosis of a health issue that compromises our ability to live independently can be very hard to manage. We must consider our physical environment as well as how this diagnosis effects our social lives, our relationship with a spouse, our mobility and our daily actives of living.

Feelings of loss, sadness, frustration, anger and grief are common with many health diagnoses, particularly those that force us to consider downsizing.

A worry of becoming a burden on others also factors into the decision to downsize, particularly if downsizing involves moving to a care facility to help with health management. Many people worry about loved ones feeling overwhelmed by care taking tasks, so the idea of downsizing may be more to benefit others than for oneself.

The emotional considerations of other reasons for downsizing are equally significant. For some individuals, the desire to be near adult children and grandchildren can be emotionally conflicting. They may love the idea of being near grandchildren but also feel sadness and frustration leaving communities, homes and relationships behind. The move, often, is bittersweet. For couples, the emotions of downsizing can create hostility and frustration. One person in the couple may be ready to downsize or pursue another lifestyle, while the other partner is just fine with the status quo. What does a couple do? How do they make a decision that may seem logical and make financial sense, but which feels sad, isolating or beyond one’s control?

Letting go can be difficult. Even if downsizing is an overall positive choice, it doesn’t make it an easy choice. Bridges says, “Letting go of the past is harder than I imagined. I have to remind myself to buy clothes for my life now, not for the life I used to have or an imaginary life.” As we age, we must constantly let go of the past and be mindful of the present. We no longer need the clothes we wore while working. Perhaps we don’t need as many kitchen appliances with fewer people to cook for. Maybe the house is full of furniture that no longer gets used or is cumbersome to keep clean.

For us to embrace the new, we must let go of the past. This is an emotional experience, often full of nostalgia. Taking time and creating space for these emotions is important to make peace with the past and make space for the new.

Embracing new friends, communities and activities is a joyful, exciting process. When we’ve settled the past, we’re better able to enjoy the present and the future.

The mental effects of downsizing aren’t only emotional. The mental load of considering when and how to downsize is considerable. There are many decisions to make and plans to implement. In fact, decision fatigue often sets in for many before the actual physical impact of downsizing take effect. Decision fatigue happens when you get tired after making a series of decisions in a row. Eventually, with enough decisions, you get tired. It becomes harder to make the next decision and then the next.

According to psychiatrist Dr. Lisa Maclean, “By the time the average person goes to bed, they’ve made over 35,000 decisions and all those decisions take time and energy and can certainly deplete us.” This happens often with important life events, including downsizing. The number of decisions to be made can feel overwhelming. Where do you want to move? What type of house or space do you want to move into? What will you take? When would you like to move? Who will help? Who will approve or disapprove? How much will it cost? Which mover do you want to use? What day is best for packing and unpacking?

The list goes on.

The mental toll can be even more tiring than the physical toll, which surprises many.

The idea of physically sorting through items and hauling furniture up and down stairs seems like the biggest challenge, but the emotional and mental side of downsizing can be even more overwhelming.

The key, Bridges and experts agree, is to prepare. Bridges notes, “Don’t wait until you’re in a crisis mode to start the process. You need to be ahead of the game. It’s hard physically and mentally and emotionally. So, don’t wait and put it off until a time when there is more stress.” Finding and setting aside time to think about downsizing can help, especially before a crisis forces us into action.

Here are some tips for tackling the mental and emotional load of downsizing to avoid mental fatigue and overwhelm:

Start early – begin the process when you have the most options. Starting conversations with loved ones well before a crisis hits. Conversations can simply be explorations. Without the stress of a crisis (health or otherwise), conversations and considerations can come from a place of curiosity and openness rather than restriction and pressure.

Declutter at your own pace – decluttering can feel overwhelming; however, reducing clutter can have many benefits. According to professor Dr. Susan Krauss Whitbourne, clutter can lead to lower subjective wellbeing, unhealthier eating, poor mental health, less efficient visual processing and less efficient thinking. So, reducing clutter slowly and at your own pace can actually improve your overall quality of life and prepare you for the bigger tasks of downsizing. You’ll have more mental space and capacity for conversations, decisions and action.

Ask the right questions – there are so many decisions to make and questions to ask when downsizing. Sit down and consider what downsizing means for you and ask questions that will get you to the best possible outcome. Some good starting points might include: what are my values at this stage in life? What is important to me? What do I want my next 5-10 years to look like, and how can this move help support that? What do I want to let go of? What do I want to look forward to? If I could describe my next 5 years in 3 words, what would those words be? How can I get there? With these questions, you can build a great roadmap toward happiness and purpose rather than reacting simply to painful or sad events.

Make lists – avoid keeping track of everything in your working memory, which can be easily taxed and tired. Make lists. Make to-do lists. Make done and dusted lists. Make lists of people who can help, realtors who specialize in downsizing, movers with 5-star reviews, family members who will be receiving Aunt Martha’s dishes. Just take the information out of your brain and put it on paper, where it isn’t taking up mental energy.

Embrace the emotion – there is a lot of nostalgia involved in downsizing. Prepare for the fact that you will feel many emotions, some easy, some hard. You’ll feel sentimental, sad, angry, frustrated, excited and many more. The experience of downsizing can be surprising for many who have lived in the same home or area for many years. Bridges says, “It was really sad to see that a lot of our pictures have degraded over time. I would pull out boxes of picture and was sad to see that they weren’t the same anymore. Now, I am scanning all the pictures and making a disc. And now, I put a big bowl on my coffee table, and I throw a big pile of pictures into the bowl. When the grandkids come over, they love looking at them.” Find ways, like Bridges, to experience the sadness and turn it, if possible, into a positive.

Reach for help – family, friends, church communities and other social communities are all resources for life transitions. Asking for help can ease the burden of life changes. You can also hire help including hiring people for packing up household goods, cleaning your home, professional organizers and movers who load and unload your household goods. Aging Life Care™ professionals are also experts in downsizing later in life. Aging Outreach Services’ Jennifer Tyner is a Lead Care Manager and Aging Life Care™ Professional. She says,

No one likes to be in pain. In fact, I have spent the past 20+ years helping people get out of pain. The most common question I hear is “How can I get this pain to go away?” The answer to this is simple. We first need to know Why you are hurting. Then we can figure out how to stop the pain. So, why are you hurting? There are many different reasons for pain to occur in our bodies. Pain can be due to a problem in the Muscles, Joints, Tendons, Organs or Nerves. It can also be due to Medication, Psychological reasons, or Nutrition

Managers are the experts on downsizing into a facility.

Not only do we know the typical layout of the local facilities, but we also are aware of what furniture and supplies the facility may offer you to use as well as other amenities. We are knowledgeable on state regulations on what is allowed in facilities and how it should be stored. Additionally, we can help you understand how to store and present your sentimental items that may help with reminiscing in the future. We can help give families peace of mind that mom and dad have everything they need when they move!”

Sara S. Morrison,

Many health care professionals diagnose pain by Special Tests. During these tests, your practitioner will use their hands to push, pull and twist the areas that are causing you pain. These tests are very useful to find what structure is causing you pain. If you place stress on a structure and it increases your pain, it is likely that structure is contributing to your symptoms. Although helpful, many of these special tests are only 60-80% accurate. While this may look good at first, changing the way the question is framed will show that this also means they are 20-40% inaccurate. Misdiagnosis of pain can be very costly. At best it keeps you in pain longer, while in other cases it can allow symptoms to intensify. When you are dealing with pain, missing your favorite activities and sleepless nights… you want to be as accurate as possible!

There is both an art and a science to downsizing. The science is often the physical nature of the experience: sorting items, selling a home, moving furniture. The art of downsizing shows up in the emotional aspects of decision making, reflecting on the past and embracing the future. Though it may be a tough balance at times, navigating all aspects of downsizing can help make the experience positive

The addition of Diagnostic Imaging in Physical Therapy has revolutionized the way pain is addressed. By utilizing Diagnostic Imaging, PT’s are now able to look inside you and empowering. Avoiding crisis-based decisions, enlisting the help of loved ones and focusing on what is being gained rather than lost can all help smooth the transition of downsizing and turn an often difficult experience into a real adventure.

Sources:

Berg, Sara. “What Doctors Wish Patients Knew About Decision Fatigue.” American Medical Assocation. 19 Nov. 2021. DOI: https://www.ama-assn. org/delivering-care/public-health/what-doctors-wish-patients-knew-aboutdecision-fatigue

Costlow, K.M. “When Less is More: Downsizing, Sense of Place, and WellBeing in Late Life.” University of Alabama. 2019. DOI: https://ir.ua.edu/ bitstream/handle/123456789/6695/file_1.pdf?sequence=1 and diagnose your pain with over 98% accuracy. That means that we can find the real problem, or problems, and address them from the beginning. No more trial and error. No more “try this for a few months and if it doesn’t get any better we will try to get an MRI”. With the addition of Diagnostic imaging, your Physical Therapist can now say “From my evaluation it looks like you have a problem in ____. We are going to do a Diagnostic Ultrasound and confirm this and fully check your joint.” In a matter of a few days, we can have your test performed, results given to you and a new, more comprehensive plan to improve your pain.

Luborsky, M.R., Lysack, C.L. & Van Null, J. “Refashioning One’s Place in Time: Stories of Household Downsizing in Later Life.” Journal of Aging Studies. 1 Aug. 2011. 25(3): 243-252. DOI: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3134333/

Diagnostic imaging in physical therapy includes:

1. Musculoskeletal Ultrasound (MSKUS)

Whitbourne, S. K. “5 Reasons Why Clutter Disrupts Mental Health.” Psychology Today. 13 My 2017. DOI: https://www.psychologytoday.com/us/ blog/fulfillment-any-age/201705/5-reasons-why-clutter-disrupts-mentalhealth

MSKUS is a safe, non-invasive, and painless diagnostic tool. It is used to diagnose structures such as tendons, muscles, bursas, ligaments, nerve entrapment/pinching and joint structure changes. Like a video, MSKUS captures real-time images of body structures and can assess a joint/area while it moves. This feature is especially useful as many times pain does not occur at rest, only with movement.