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Department of Occupational Therapy Western Michigan University Kalamazoo, Michigan 49008 Maureen.mickus{at}wmich.edu

Living Dangerously. Video/2004/60 min. Directed and produced by John Kastner, in association with CBC and the Documentary Channel. Distributed by Filmakers, Inc., 124 East 40th Street, New York, NY, 10016. 212-808-4980. Online: www.filmakers.com. E-mail: info{at}filmakers.com. Rental, $85 (90-minute version, $100). Purchase, $295.

Autonomy versus safety is a recurring theme in the world of aging and disability. This theme also forms the framework for the Canadian documentary Living Dangerously, in which two older adults, Phillip and Helen, struggle to maintain their independence and identities by remaining in their own homes. This struggle is not to be underestimated. Phillip is intensely debilitated with severe osteoporosis and insulin-dependent diabetes. Helen suffers from diabetes, congestive heart failure and poor eyesight. Despite these adversities, both individuals are powerfully opposed to moving from their homes into a facility. The respective families, however, weigh in heavily on the matter, exerting substantial pressure for the transition. After a hospital discharge, Helen's son and daughter-in-law move her to a "senior lodge," and Helen grudgingly abides. This move is transitory, however, as Helen cycles in and out of her semi-private room at the facility and back to her home. Helen's vacillating causes great distress for her son as he complains his ability to enjoy his life is "slipping away" in the process. Phillip's relatives pressure him to accept an apartment near the family; but he responds to their suggestion with a pointed letter advising them to "back off."

The film's strength lies in demonstrating the complexity of the autonomy versus safety issue in later life. Both individuals are completely intact from a cognitive standpoint and appear to be well informed of the risks involved in their decisions to remain at home. From an ethical perspective, it would appear that this decision-making capability might be enough to deter interference from others. And yet there are significant physical risks related to safety as Helen and Phillip maneuver in nearly impossible settings, with little to no oversight for their daily medical needs. Phillip has lapsed into a diabetic coma on several occasions, and due to her poor mobility, Helen has fallen numerous times. Because of their social isolation, neither received immediate help.

The director portrays the characters sympathetically; for instance, viewers see Phillip gardening from a prone position or painfully shuffling down the sidewalk to conduct his weekly banking tasks. These difficulties and setbacks are seriously outweighed by an overwhelming desire for autonomy, with safety taking a back seat in their decisions to remain independent. The film challenges the viewer to question whether the family should override this risk-taking behavior. When the person at risk is truly informed, should autonomy always trump safety?

An additional strength of the film relates to its longitudinal design. Rather than providing only snapshots of these individuals and their families, Living Dangerously carries viewer along the stressors and associated tenacity of these older individuals over several years. Unlike Phillip, Helen wavers at times, wondering if she should return to the facility. The "custodialism" she experienced during her stay at the lodge is likely to have contributed to these feelings of self-doubt, questioning if she really can survive independently without all of the supportive services. The longitudinal nature of the film also exposes the growing impatience of Helen's son and daughter-in-law. The couple is portrayed as increasingly self-centered and insensitive, a slanted perspective that does not permit the viewer full understanding or empathy as to what may have led to these negative reactions.

A significant theme in this film is that the struggle faced by these individuals to remain at home is related to far more than their physical or medical needs. While the family members focus on the home and the associated isolation as the core problems, they fail to understand the psychological and social values involved. Helen's long-standing memories as a wife and mother, in addition to her dignity, are enmeshed in the home. During her time at the senior lodge, she is confronted with others who have more serious impairments, which is psychologically defeating for her. She notes most of the conversation at the lodge is "heartbreak talk" of declining health. Phillip takes pride in his gardening and work as a chemist. He confronts tremendous pain, which he tolerates for the gains in self-worth. Continuity theory suggests these efforts in retaining the patterns of one's younger and middle-aged years lead to successful aging. Although the need to adapt these activities is apparent with declining health, the need to preserve and maintain these behaviors and interests is paramount to psychological well-being in later life. For instance, in institutional or even assisted living settings, there are rarely opportunities for continuing activities such as gardening, cooking, or maintaining a chemistry lab (in Phillip's case).

Living Dangerously provides an important opportunity for viewers to examine their own perspectives on autonomy versus safety in later life. While disability and aging advocates may find themselves cheering Helen and Phillip on as they continue exercising their individual choice, choosing sides may be less clear for health care professionals, such as physicians or discharge planners, who are trained to focus on the major medical risks involved. In this way, the film is useful for examining different viewpoints, although not designed to provide solutions to these dilemmas. Additional discussions among viewers are needed that focus less on the dichotomous nature of autonomy versus safety, and more on avenues that address both concerns. For example, a myriad of assistive devices—ranging from emergency response systems to robotics—are available that promote independence in the face of disability. Simple home modifications can transform settings for persons with disabilities or prevent serious events such as falls from occurring. Education is warranted for families, who in most cases are well-intentioned, to accept the broader meaning and value of home—as it is perceived by their aging relatives. Future work must center on ways to respect choice and independent living while both mitigating and accepting risk.

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