You are probably reading this because someone close to you is dying. You may wonder how you can comfort the person, prevent suffering, and provide the best quality of life possible in their remaining time. If the person can no longer communicate, you may be asked to make difficult decisions about their care and comfort. This can be overwhelming for family members, especially if they have not had a chance to discuss the person’s wishes ahead of time — or if multiple family members are involved and do not agree.

Addressing a person’s advance care wishes

If the person has written documents as part of an advance care plan, such as a do not resuscitate order, tell the doctor in charge as soon as possible. If end-of-life care is given at home, you will need a special out-of-hospital order, signed by a doctor, to ensure that emergency medical technicians, if called to the home, will respect the person’s wishes. Hospice staff can help determine whether a medical condition is part of the normal dying process or something that needs the attention of health care personnel.

For situations that are not addressed in a person’s advance care plan, or if the person does not have such a plan, you can consider different decision-making strategies to help determine the best approach for the person.

Decision-making strategies: Substituted judgment and best interests

Two approaches might be useful when you encounter decisions that have not been addressed in a person’s advance care plan or in previous conversations with them. One is to put yourself in the place of the person who is dying and try to choose as they would. This is called substituted judgment. Some experts believe that decisions should be based on substituted judgment whenever possible. Another approach, known as best interests, is to decide what you as their representative think is best for the dying person. This is sometimes combined with substituted judgment.

These two approaches are illustrated in the stories below.

Joseph and Leilani’s story

Joseph’s 90-year-old mother, Leilani, was in a coma after having a major stroke. The doctor said damage to Leilani’s brain was widespread and she needed to be put on a breathing machine (ventilator) or she would probably die. The doctor asked Joseph if he wanted that to be done. Joseph remembered how his mother disapproved when an elderly neighbor was put on a similar machine after a stroke. He declined, and his mother died peacefully a few hours later. This is an example of the substituted judgment approach.

Ali and Wadi’s story

Ali’s father, Wadi, is 80 years old and has lung cancer and advanced Parkinson’s disease. He is in a nursing facility and doesn’t recognize Ali when he visits. Wadi’s doctor suggested that surgery to remove part of one of Wadi’s lungs might slow down the course of the cancer and give him more time. But, Ali thought, “What kind of time? What would that time do for Dad?” Ali decided that putting his dad through surgery and recovery was not in Wadi’s best interests. After talking with Wadi’s doctors, Ali believed that surgery, which could cause additional pain and discomfort, would not improve his father’s quality of life. This is an example of the best interests decision-making approach.

If you are making decisions for someone at the end of life and are trying to use one of these approaches, it may be helpful to think about the following questions:

• Have they ever talked about what they would want at the end of life?
• Have they expressed an opinion about someone else’s end-of-life treatment?
• What were their values and what gave meaning to their life? Maybe it was being close to family and making memories together. Or perhaps they loved the outdoors and enjoyed nature. Are they still able to participate in these activities?

If you are making decisions without specific guidance from the dying person, you will need as much information as possible to help guide your actions. Remember that the decisions you are faced with and the questions you may ask the person’s medical team can vary depending on if the person is at home or in a care facility or hospital. You might ask the doctor:

• What might we expect to happen in the next few hours, days, or weeks if we continue our current course of treatment?
• Will treatment provide more quality time with family and friends?
• What if we don’t want the treatment offered? What happens then?
• When should we begin hospice care? Can they receive this care at home or at the hospital?
• If we begin hospice, will the person be denied certain treatments?
• What medicines will be given to help manage pain and other symptoms? What are the possible side effects?
• What will happen if our family member stops eating or drinking? Will a feeding tube be considered? What are the benefits and risks?
• If we try using the ventilator to help with breathing and decide to stop, how will that be done?

It is a good idea to have someone with you when discussing these issues with medical staff. That person can take notes and help you remember details. Don’t be afraid to ask the doctor or nurse to repeat or rephrase what they said if you are unclear about something they told you. Keep asking questions until you have all the information you need to make decisions. If the person is at home, make sure you know how to contact a member of the health care team if you have a question or if the dying person needs something.

It can be difficult for doctors to accurately predict how much time someone has left to live. Depending on the diagnosis, certain conditions, such as dementia, can progress unpredictably. You should talk with the doctor about hospice care if they predict your loved one has six months or less to live.

Cultural considerations at the end of life

Everyone involved in a patient’s care should understand how a person’s history and cultural and religious background may influence expectations, needs, and choices at the end of life. Different cultural and ethnic groups may have various expectations about what should happen and the type of care a person receives. The doctor and other members of the health care team may have different backgrounds than you and your family. Discuss your personal and family traditions surrounding the end of life with the health care team.

A person’s cultural background may influence comfort care and pain management at the end of life, who can be present at the time of death, who makes the health care decisions, and where they want to die.

It’s crucial that the health care team knows what is important to your family surrounding the end of life. You might say:

• In my religion, we . . . (then describe your religious traditions regarding death).
• Where we come from . . . (tell what customs are important to you at the time of death).
• In our family when someone is dying, we prefer . . . (describe what you hope to happen).

Make sure you understand how the available medical options presented by the health care team fit into your family’s desires for end-of-life care. Telling the medical staff ahead of time may help avoid confusion and misunderstandings later. Knowing that these practices will be honored could comfort the dying person and help improve the quality of care provided.

Discussing a care plan

Having a care plan in place at the end of life is important in ensuring the person’s wishes are respected as much as possible. A care plan summarizes a person’s health conditions, medications, health care providers, emergency contacts, end-of-life care wishes, such as advance directives, and other decisions. A care plan may also include your loved one’s wishes after they die, such as funeral arrangements and what will be done with their body. It’s not uncommon for the entire family to want to be involved in a person’s care plan at the end of life. Maybe that is part of your family’s cultural tradition. Or, maybe the person dying did not pick a person to make health care choices before becoming unable to do so, which is also not unusual.

If one family member is named as the decision-maker, it is a good idea, as much as possible, to have family agreement about the care plan. If family members can’t agree on end-of-life care or they disagree with the doctor, your family might consider working with a mediator. A mediator is a professional trained to bring people with different opinions to a common decision. Clinicians trained in palliative care often conduct family meetings to help address disagreements around health care decisions.

Regardless, your family should try to discuss the end-of-life care they want with the health care team. In most cases, it’s helpful for the medical staff to have one person as the main point of contact.

Here are some questions you might want to ask the medical staff when making decisions about a care plan:

• What is the best place — such as a hospital, facility, or at home — to get the type of care the dying person wants?
• What decisions should be included in our care plan? What are the benefits and risks of these decisions?
• How often should we reassess the care plan?
• What is the best way for our family to work with the care staff?
• How can I ensure I get a daily update on my family member’s condition?
• Will you call me if there is a change in his or her condition?
• Where can we find help paying for this care?

There may be other questions that arise depending on your family’s situation. It’s important to stay in contact with the health care team.

To learn more, please visit https://www.nia.nih.gov/health/end-life/making-decisions-someone-end-life.

Many older adults share a common concern: “Can I trust the health information I find online?” There are thousands of medical websites. Some provide up-to-date medical news and reliable health information, and some do not. Choosing trustworthy websites is an important step in gathering reliable health information.

Where can I find reliable health information online?

The National Institutes of Health website is a good place to start for reliable health information. The Centers for Disease Control and Prevention website is another one.

As a rule, health websites sponsored by federal government agencies are accurate sources of information. You can reach all federal websites by visiting www.usa.gov. Medical and health care organizations, hospitals, and academic medical institutions may also be reliable sources of health information.

Your health care provider can also suggest ideal sources of online information. If your doctor’s office has a website, it may include a list of recommended links.

Questions to ask before trusting a website

Searching online, you will likely find websites for multiple health organizations, including many you may not recognize. The following questions can help determine which ones are trustworthy. Many of the answers can often be found in a website’s “About Us” section.

1. What is the purpose of the website, and who owns or sponsors it?

Why was the site created? Is the purpose of the site to inform or explain, or is it trying to sell a product or service? Understanding the motive of the website can help you better judge its content. The goal of any trustworthy health information website is to provide accurate, current, and useful information versus trying to make a sale.

Knowing who pays for a website may provide you with insight into the mission or goal of the site. For example, if a business pays for the site, the health information may favor that business and its products. Sometimes, the website address (called a URL) is helpful for identifying the type of agency or organization that owns the site. For example:

• .gov identifies a U.S. government agency
• .edu identifies an educational institution, such as a school, college, or university
• .org usually identifies nonprofit organizations, such as medical or research societies and advocacy groups
• .com identifies commercial websites, such as businesses and pharmaceutical companies

While many commercial websites do provide accurate, useful health information, it can be hard to distinguish this content from marketing and promotional materials in some cases. Any advertisements on a site should be clearly marked as such. Watch out for ads designed to look like neutral health information.

2. Who wrote the information? Who reviewed it?

Website pages often, but not always, identify the authors and contributors. If the author is listed, are they an expert in the field? Look for health care professionals or scientific researchers with in-depth knowledge of the topic. Does the author work for an organization and, if so, what are the goals of that organization? A contributor’s connection to the website, and any financial stake they have regarding the information on the website, should be made clear.

If the material is not authored by an expert, has the information been reviewed by a health care professional or other credentialed specialist? Dependable health information websites will share sources and citations.

Trustworthy websites will also have contact information — an email address, phone number, and/or mailing address — that you can use to reach the site’s sponsor. Look for this information at the bottom of web pages or in a separate “About Us” or “Contact Us” page.

Be cautious about testimonials, individual blogs, and posts on discussion boards. Personal stories may be helpful and comforting, but not everyone experiences health problems the same way. Also, there is a big difference between information written by a single person interested in a topic and a website developed by professionals using researched and peer-reviewed scientific evidence.

No online information, even if it is accurate and trustworthy, should replace seeing a health care professional who can thoroughly evaluate your unique situation and provide specific advice.

3. When was the information written and updated?

Look for websites that stay current with their health information. You don’t want to make decisions about your care based on out-of-date content. Often, the date the information was created and reviewed or updated will appear at the bottom of the page. Pages on the same site may be updated at different times, and some may be updated more often than others. Older information isn’t useless, but using the most current, evidence-based information is ideal.

4. Is your privacy protected? Does the website clearly state a privacy policy?

Read the website’s privacy policy. It is usually at the bottom of the page or on a separate page titled “Privacy Policy” or “Our Policies.” If a website says it uses “cookies,” your information may not be private. Cookies are small text files that enable a website to collect and remember information about your visit. While cookies may enhance your web experience, they can also compromise your online privacy, so it is important to read about the information the website collects and how the organization will use it. Many websites will ask you ahead of time if you want to accept cookies, but others may not. If you are concerned about the potential use of information gathered by cookies, you can choose to disable the use of cookies through your internet browser settings.

5. How can I protect my health information?

If you are asked to share personal information, be sure to find out how the information will be used. Secure websites that collect personal information responsibly have an “s” after “http” in the start of their website addresses (https://) and often require that you create a username and password.

Be careful about sharing your Social Security number. Find out why your number is needed, how it will be used, and what will happen if you do not share this information. Only enter your Social Security number on secure websites. You might consider calling your doctor’s office or health insurance company to give this information over the phone rather than providing it online.

Taking these precautions may help protect your information:

• Beware of health fraud scams and pay attention when browsing the internet. Do not open unexpected links. Hover your mouse over a link to confirm that clicking it will take you to a reputable website.
• Always use a strong password. Include a variation of numbers, letters, and symbols. Some websites may allow you to use a phrase as well. Create a unique password for each website and change it frequently.
• Use two-factor authentication when you can. This security feature requires the use of two different types of personal information to log into your mobile devices or accounts.
• Don’t enter sensitive information over public Wi-Fi. Learn about how to safely use public Wi-Fi networks.
• Be careful about the information you share through social media sites. For example, don’t share personal information, such as where you live or your contact information, on a public channel.

6. Does the website offer quick and easy solutions to your health problems? Does it promise miracle cures?

• Be cautious about websites claiming any single remedy will cure many different illnesses. Also be wary of sites suggesting simple or unproven treatments for a disease. Question dramatic writing or promises of cures that seem too good to be true and look for other websites with the same information. Even if a website links to a trustworthy source, it doesn’t mean that the site has the other organization’s endorsement or support.

Health and medical apps

Mobile medical applications (“apps”) are a type of software you can install and run on your smartphone. Medical apps can support your health in many ways. For example, they can help track your eating habits or physical activity, access test results from a lab, or monitor a health condition. They can also provide helpful reminders to exercise or take medications. But anyone can develop a health app — for any reason — and apps may include inaccurate or misleading information. Before you download or use an app, make sure you know who produced it.

When you download an app, it may ask for your location, your email, or other personal information. Apps may also collect data about you as you use them. Ensure the information collected is relevant to the app, you know how the information will be used, and you feel comfortable sharing this information. Responsible app developers will make this information readily available before you download it.

Social media, health news, and health books

Social media websites and apps are online communities through which people can connect with friends, family, and strangers. Social media is one way people share health information and news stories with each other. Some of this information may be true, but too often some of it is not. Recognize that just because a post is from a friend or colleague, it does not necessarily mean that the information is accurate, complete, or applicable to your health. Check the source of the information, and make sure the original author is credible. Fact-checking websites can also help you determine if a story is reliable.

Evaluating health information in books is similar to finding reliable information on websites or on social media. Make sure to check who wrote the book, how current the information is, and where the content came from. When in doubt, ask your health care provider about what you read.

Trust yourself and talk with your doctor

Use your good judgment when gathering health information online. There are websites on nearly every health topic, and many have no rules for overseeing the quality of the information provided. Use the information you find online as one tool to become more informed. Don’t count on any one website and check your sources. Discuss what you find with your doctor before making any changes to your health care.

To learn more, please visit https://www.nia.nih.gov/health/healthy-aging/how-find-reliable-health-information-online.

A heart attack happens when the flow of blood in one or more of the coronary arteries (major blood vessels that supply blood to the heart), suddenly becomes blocked. When this happens, part of your heart can’t get enough oxygen.

A heart attack is usually caused by coronary artery disease, which happens when a sticky, waxy substance called plaque builds up inside the arteries, causing them to narrow. The plaque can break open, causing blood clots that, if they grow large enough, will block blood flow to the heart. If blood flow isn’t restored quickly, the heart muscle begins to die.

To restore blood flow, doctors may use a medicine to dissolve the blockage. Or they may place a thin flexible tube called a catheter into an artery in the top of your leg or arm to physically open the blockage. If the clot or plaque blocking blood flow is particularly long or has certain qualities, the cardiologist may use a catheter with a stent, which is a cylinder made of thin metal mesh that helps hold the artery open.

Heart attacks are very common. They can occur in both men and women. Each year, more than 800,000 people in the United States have a heart attack.

A heart attack is a life-threatening medical emergency that needs immediate attention. Knowing the warning signs of a heart attack may help save a life. The signs can include:

• Crushing chest pain or pressure in the center or left side of the chest
• Pain, numbness, and/or tingling in the shoulders, arms, neck, jaw, or back
• Shortness of breath when active, at rest, or while lying flat
• Fainting, lightheadedness, or sudden dizziness
• Rapid or irregular heartbeat
• Cold sweats
• Nausea, vomiting, or stomach upset
• Tiredness or fatigue
• Weakness
• Anxiety

The symptoms of a heart attack can be different in men and women. Women are more likely than men to experience shortness of breath; tiredness; weakness; upset stomach; anxiety; and pain in the shoulder, back, or arm. Women may also face more health problems after a heart attack, so it’s very important if you’re experiencing any symptoms or think you’re having a heart attack to seek medical assistance as soon as possible.

Although these problems can be signs of a heart attack, they can also be associated with other health conditions. Tell your doctor about any health concerns you have.

If you or someone you know might be having a heart attack, call 911 right away. Also call 911 if you are taking prescription drugs for angina (chest pain) and the pain doesn’t go away after you take the medication. You need to take an ambulance to the hospital as soon as possible. Do not try to drive yourself, and do not have someone else drive you unless there is no ambulance service where you live. The sooner you get to a hospital, the more emergency medical professionals can do to stop any heart damage and prevent deadly heart rhythm problems, heart failure, and death. If blood flow in the blocked artery can be restored quickly, it may prevent permanent damage to the heart.

The good news is that excellent treatments are available for heart attacks. These treatments — which work best when given right after symptoms begin — can save lives and help prevent disability after a heart attack.

For more information

National Heart, Lung, and Blood Institute
301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

American Heart Association
800-242-8721 
inquiries@heart.org
www.heart.org

Parkinson’s disease is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination.

Symptoms usually begin gradually and worsen over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.

While virtually anyone could be at risk for developing Parkinson’s, some research studies suggest this disease affects more men than women. It’s unclear why, but studies are underway to understand factors that may increase a person’s risk. One clear risk is age: Although most people with Parkinson’s first develop the disease after age 60, about 5% to 10% experience onset before the age of 50. Early-onset forms of Parkinson’s are often, but not always, inherited, and some forms have been linked to specific alterations in genes.

What causes Parkinson’s disease?

The most prominent signs and symptoms of Parkinson’s disease occur when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems associated with the disease. Scientists still do not know what causes the neurons to die.

People with Parkinson’s disease also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying position.

Many brain cells of people with Parkinson’s disease contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic variants that impact Parkinson’s and Lewy body dementia.

Some cases of Parkinson’s disease appear to be hereditary, and a few cases can be traced to specific genetic variants. While genetics is thought to play a role in Parkinson’s, in most cases the disease does not seem to run in families. Many researchers now believe that Parkinson’s results from a combination of genetic and environmental factors, such as exposure to toxins.

Symptoms of Parkinson’s disease

Parkinson’s has four main symptoms:

• Tremor in hands, arms, legs, jaw, or head
• Muscle stiffness, where muscle remains contracted for a long time
• Slowness of movement
• Impaired balance and coordination, sometimes leading to falls

Other symptoms may include:

• Depression and other emotional changes
• Difficulty swallowing, chewing, and speaking
• Urinary problems or constipation
• Skin problems

The symptoms of Parkinson’s and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.

People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward; take small, quick steps; and reduce swinging their arms. They also may have trouble initiating or continuing movement.

Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.

Many people with Parkinson’s disease note that prior to experiencing stiffness and tremor, they had sleep problems, constipation, loss of smell, and restless legs. While some of these symptoms may also occur with normal aging, talk with your doctor if these symptoms worsen or begin to interfere with daily living.

Diagnosis of Parkinson’s disease

There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinson’s. Doctors usually diagnose the disease by taking a person’s medical history and performing a neurological examination. If symptoms improve after starting to take medication, it’s another indicator that the person has Parkinson’s.

A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to better evaluate the cause. Many other diseases have similar features but require different treatments, so it is important to get an accurate diagnosis as soon as possible.

Treatments for Parkinson’s disease

Although there is no cure for Parkinson’s disease, medicines, surgical treatment, and other therapies can often relieve some symptoms.

Medicines for Parkinson’s disease

Medicines can help treat the symptoms of Parkinson’s by:

• Increasing the level of dopamine in the brain
• Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
• Helping control non-movement symptoms

The main therapy for Parkinson’s is levodopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy — such as nausea, vomiting, low blood pressure, and restlessness — and reduces the amount of levodopa needed to improve symptoms.

People living with Parkinson’s disease should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, like being unable to move or having difficulty breathing.

The doctor may prescribe other medicines to treat Parkinson’s symptoms, including:

• Dopamine agonists to stimulate the production of dopamine in the brain
• Enzyme inhibitors (e.g., MAO-B inhibitors, COMT inhibitors) to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
• Amantadine to help reduce involuntary movements
• Anticholinergic drugs to reduce tremors and muscle rigidity

Deep brain stimulation

For people with Parkinson’s disease who do not respond well to medications, the doctor may recommend deep brain stimulation. During a surgical procedure, a doctor implants electrodes into part of the brain and connects them to a small electrical device implanted in the chest. The device and electrodes painlessly stimulate specific areas in the brain that control movement in a way that may help stop many of the movement-related symptoms of Parkinson’s, such as tremor, slowness of movement, and rigidity.

Other therapies

Other therapies that may help manage Parkinson’s symptoms include:

• Physical, occupational, and speech therapies, which may help with gait and voice disorders, tremors and rigidity, and decline in mental functions
• A healthy diet to support overall wellness
• Exercises to strengthen muscles and improve balance, flexibility, and coordination
• Massage therapy to reduce tension
• Yoga and tai chi to increase stretching and flexibility

Support for people living with Parkinson’s disease

While the progression of Parkinson’s is usually slow, eventually a person’s daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinson’s disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.

To learn more, please visit https://www.nia.nih.gov/health/parkinsons-disease/parkinsons-disease-causes-symptoms-and-treatments.

Alzheimer’s disease changes the brain in ways that can affect how a person acts. Some days, the person might seem like themselves, and other days they might act in unusual ways. This variation from one day to the next is common for people with Alzheimer’s. On this page, learn about some of the common behavior changes that affect people with Alzheimer’s and how to manage these changes.

How does Alzheimer’s affect behavior?

In addition to thinking and memory problems, people with Alzheimer’s may experience symptoms such as agitation, trouble sleeping, and hallucinations. They may wander, pace, and behave in unusual ways. These problems can make your job as a caregiver harder. It’s important to remember that the disease, not the person with Alzheimer’s, causes these changes.

Common behavior changes in Alzheimer’s include:

• Showing signs of anxiety or fear
• Getting upset, worried, and angry more easily
• Acting depressed or not interested in things
• Hiding things or believing other people are hiding things
• Imagining things that aren’t there
• Feeling suspicious of or threatened by others, for little or no reason
• Pacing a lot of the time
• Showing unusual sexual behavior
• Wandering away from home
• Hitting other people
• Misunderstanding what they see or hear
• Having difficulty sleeping through the night

Other reasons for changes in behavior

In addition to changes in the brain, other things may affect how people with Alzheimer’s behave. The following are factors that may cause distressing behaviors in people with Alzheimer’s:

• Emotions such as sadness, fear, stress, confusion, or anxiety
• Health-related problems, such as pain, lack of sleep, and problems seeing or hearing
• Other physical issues, such as constipation, hunger, or thirst
• Side effects of new medications
• A noisy or stressful environment (for example, many conversations at once or a loud TV or radio)

Sudden or rapidly fluctuating changes in behavior, especially if the person has had an infection or recent medication changes, should be immediately brought to a doctor’s attention.

Caregivers may find it helpful to consider whether changes in behavior are caused by the disease itself or something else, such as the environment. But figuring out the cause of a behavior change is not always an easy task. Keeping track of common behavioral changes can help caregivers and health care providers recognize a pattern and determine the cause of the behavioral change.

Tips to manage behavior changes

Learning ways to manage behavior changes can make everyday life less stressful for a person with Alzheimer’s, their caregivers, and their loved ones. Here are some tips:

• Be patient, try not to show frustration, and avoid arguing.
• Reassure the person that you are there to help.
• Learn how to communicate with a person with Alzheimer’s.
• Redirect their attention to a new object or activity, such as listening to music, reading a book, or going for a walk.
• Create a comforting home setting by reducing noise and clutter and keeping well-loved objects (such as photos) around the home.
• Try to keep the person to a routine by bathing, dressing, and eating at the same time each day.
• Find ways for the person to be physically active, which can improve mood and sleep.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/alzheimers-caregiving-managing-personality-and.

Have you, or has someone you love, recently been diagnosed with mild cognitive impairment, early-stage Alzheimer’s disease, vascular dementia, Lewy body dementia, or a frontotemporal disorder? Do you worry about how to manage if you live alone? If so, these tips offer ways to help cope with changes in memory and thinking, prepare for the future, and stay active and engaged.

Make Everyday Tasks Easier

Many people with early-stage dementia continue to manage their everyday activities. But it’s important to look ahead to a time when performing daily tasks will be harder. The sooner you adopt new strategies to help you cope with changes, the more time you will have to adjust to them. Here are some tips:

• Organizing your days. Write down to-do lists, appointments, and events in a notebook or calendar. You can also keep track of activities with computer software or a smartphone app. Some people have an area in their home, such as an entryway table or bench, where they store important items or organize the things they need each day. You may also want to consider using a digital clock that displays the day of the week and date, in addition to the time.
• Paying bills. Setting up automated payments is an easy way to pay your bills correctly and on time without having to write checks. Many companies and banks offer this service at no extra charge. You can set up automatic payments with your utility providers, insurance companies, bank, and mortgage company or leasing office. Also consider asking someone you trust to help you pay bills. That person could review your financial statements and ask you about anything unusual.
• Shopping for meals. Many stores offer grocery delivery services, usually for a small fee. You can also order fresh or frozen meals online or by phone. Meals on Wheels America (888-998-6325) can deliver free or low-cost meals to your home, too, and this service sometimes includes a short visit and safety check. Other possible sources of meals include religious communities and senior centers. If you make your own meals at home, consider easy-to-prepare items, such as foods that you can heat in the microwave.
• Taking medications. Several products can help you manage medications. You can try a weekly pillbox, a pillbox that gives you a notification (such as an alarm or vibration) when it’s time to take medicine, or an automatic medication dispenser. You can buy these items at a drugstore or online, but you may need someone to help you set these up. Or try an electronic reminder system, such as a smartphone app or an alarm you set on your phone or computer.
• Using transportation. If you drive, you may find that you become confused, get lost, or need help with directions more often than before. Talk with your doctor about these changes. If family or friends express concerns about your driving, take their concerns seriously. Some people decide to give up driving and learn how to use public transportation or ride sharing. Neighbors, volunteers, or ride services for older adults may also be able to help with transportation.

For more suggestions on living independently, see Aging in Place: Growing Older at Home.

Scan Your Home for Safety

Making minor changes in your home can create a safer environment. For example:

• Get rid of unused items and extra furniture. If there are things you no longer use (such as clothing, appliances, decorations, and furniture), now is the time to remove them. Consider giving items to family and friends or donating items in good condition to a charity. Some organizations will pick items up from your home.
• Remove items that you may trip over. Move electrical cords, pick up throw rugs, and look for other things you might trip over. Falls can cause injury and disability that may make it difficult to live alone. Read more about fall prevention.
• Install an automatic shut-off switch on the stove. This switch can help prevent a fire from starting if the stove is left on accidentally. If necessary, have your stove disabled. Consider using a microwave or cooking device with an automatic shut-off, such as a slow cooker or rice cooker, to heat up food.
• Set the water heater at 120 °F. This setting will help you to avoid burns from scalding tap water and may help save money, too!
• Improve bathroom safety. Add nonskid mats to showers and tubs. Also consider installing grab bars in the tub or shower. Add a nightlight in the bathroom or hallway and keep a flashlight near your bed for trips to the bathroom at night.
• Carry identification with you. Medical ID bracelets and necklaces are helpful in case you get lost or need help. In an emergency, an ID can also let emergency responders know if you have allergies or special medical needs.
• Consider getting safety devices to alert others in an emergency. Personal safety devices you may want to consider include fall monitors, emergency call buttons, and GPS tracking systems. Talk to your doctor or social worker about finding an alert system to notify family and friends if you fall, become ill, or get lost.
• Make sure smoke and carbon monoxide detectors are installed and working throughout your home. These detectors should be installed in or near the kitchen and all bedrooms. Set reminders to check the batteries every six months.
• Get help with home maintenance and organization. Ask a family member or hire a professional service to help with tasks like managing clutter and making home repairs. Add labels to cabinets and drawers to make it easier to find flashlights, fire extinguishers, and other safety items quickly.

Prepare for the Future

Preparing for the future may be difficult to think about. But by starting discussions with family and friends early, everyone can help make decisions together. Talk about health and finances now, rather than later, to make sure you have a say in future decisions.

Discuss decisions about health and finances as soon as possible to ensure that others, including your doctor and family, understand your preferences for your late-stage or end-of-life decisions. Other ways to prepare for the future include:

• Get legal and financial matters in order as soon as possible. Prepare or update your will, living will, and durable powers of attorney for health care and finances. If you need legal advice, call your lawyer, or contact the National Academy of Elder Law Attorneys (703-942-5711) to find an attorney. Be sure to let someone you trust know where your documents are kept or give them a copy. Read to learn more about advance care planning.
• Understand your options for in-home care. Family members and friends may be able to help with everyday activities. If you need more help, look into options for a personal care assistant or home health care aide. Consider the costs of these services and whether any of the costs are covered by insurance. Check with your insurance provider(s) and resources like the USA.gov Benefit Finder Tool and BenefitsCheckUp to find out about benefits you may qualify for. Learn more about long-term care and how to pay for it.
• Plan for care when you can no longer live alone. There will likely come a time when you need more day-to-day care and support. Could a family member or caregiver move in with you? Or could you move in with them? Professional home care, assisted living communities, and nursing homes are other options.
• If you work, consider your options. You could share your diagnosis with your employer and discuss how to adjust your work. Under the Americans With Disabilities Act, employers with more than 15 employees are required to provide reasonable accommodations for people with disabilities. This might include changing your hours, getting reminders, or splitting up large tasks. Learn more about Alzheimer’s and employment.
• Find out about potential disability benefits if you are no longer able to work. People with dementia may be eligible for disability income through private disability insurance (if you purchased this previously), Social Security, or veterans’ benefits. A Social Security program called Compassionate Allowances ensures quick review of disability benefit claims for people with conditions including early-onset Alzheimer’s and several other types of dementia.

Strengthen Your Support System

Family members, friends, or other caregivers may be able to help in different ways. Here are some suggestions:

• Identify family and friends who can help. Talk to them about your diagnosis and ask if they can visit you regularly and be an emergency contact. Write down and save their phone numbers and other contact information in an obvious place, such as on your refrigerator door or in your wallet or mobile phone. Even family members who live far away can help. Read about long-distance caregiving.
• Consider sharing your diagnosis with neighbors you trust. Neighbors are often the first people to notice if someone is wandering or looks lost and they may be able to get help. Get tips for helping family and friends understand Alzheimer’s.
• Visit a health care provider. Your primary care doctor, neurologist, or other specialist can track changes in your memory, thinking, and ability to complete everyday tasks. Ask the doctor to provide you with a care plan and write down directions (or have a family member or friend take notes during the visit). If getting to the doctor’s office is difficult, ask your doctor about home visits or telehealth appointments. The office may also be able to recommend home health care services or a geriatric care manager, a person who helps older people find services they need.
• Learn about home- and community-based support and services. Social service agencies, local nonprofits, and Area Agencies on Aging can provide or refer you to in-home help, transportation, and meals to help you live at home. Call the Eldercare Locator (800-677-1116) to learn about services in your area. Learn more about getting help with Alzheimer’s caregiving.
• Stay connected with technology. Smartphones, computers, and tablets can connect you with family and friends through video calls, email, and social media. You may want to get products that are easy to use, such as a telephone with pictures for dialing. Whatever technology you choose, start early so you can learn the system and establish a routine. Are you unfamiliar with technology? Ask your local library or community center about classes.
• Talk with others who share your condition. Ask your doctor’s office or a social worker about support groups in your community or hosted by nonprofit organizations. For example, the Alzheimer’s Association has both online and in-person support groups and a 24-hour helpline (800-272-3900). Many NIA-supported Alzheimer’s Disease Research Centers offer programs and events for people with Alzheimer’s or a related dementia and their caregivers. Your community may also have a memory café — a place for people with dementia and their caregivers to enjoy activities and socialize.
• Get urgent help if you need it. If you are experiencing depression or have thoughts of harming yourself, immediate help is available. Call or text the 24-hour 988 Suicide & Crisis Lifeline at 988 or 800-273-TALK (800-273-8255). For TTY, use your preferred relay service or dial 711 then 988.

Take care of your physical and mental health

Eating a healthy diet, getting regular exercise, and staying connected with others offer proven benefits for well-being. Here are some tips for taking care of your mind and body if you have early-stage dementia:

• Exercise. You don’t have to join a gym or spend a lot of money to be physically active. Even light housework, gardening, and walking around the neighborhood can have benefits. Experts recommend both aerobic exercise (such as walking) and strength training (such as lifting weights). Learn more about physical activity for people with dementia.
• Eat right. Eating healthy foods helps everyone stay well, and it’s particularly important for people with dementia. Learn more about healthy eating.
• Make sleep a priority. Dementia often changes a person’s sleeping habits. But there are steps you can take to help you get a good night’s sleep, including following a regular sleep schedule.
• Be mindful. One way to help manage stress and reduce anxiety is a technique called mindfulness, which involves focusing awareness on the present moment without judgment. Learn more about the health benefits of mindfulness in daily living.
• Stay social. Spending meaningful time with others can help you cope with challenges and improve your quality of life. Join a support group, chat with family and friends regularly, or share activities you enjoy with your spouse or partner. Learn more about how to continue to participate in activities you enjoy.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-and-dementia/tips-living-alone-early-stage-dementia.

Asking questions is key to good communication with your doctor. If you don’t ask questions, he or she may assume you already know the answer or that you don’t want more information. Don’t wait for the doctor to raise a specific question or subject; he or she may not know it’s important to you. Be proactive. Ask questions when you don’t know the meaning of a word (like aneurysm, hypertension, or infarct) or when instructions aren’t clear (for example, does taking medicine with food mean before, during, or after a meal?).

Learn about medical tests

Sometimes, doctors need to do blood tests, X-rays, or other procedures to find out what is wrong or to learn more about your medical condition. Some tests, such as Pap tests, mammograms, glaucoma tests, and screenings for prostate and colorectal cancer, are done regularly to check for hidden medical problems.

Before having a medical test, ask your doctor to explain why it is important, what it will show, and what it will cost. Ask what kind of things you need to do to prepare for the test. For example, you may need to have an empty stomach, or you may have to provide a urine sample. Ask how you will be notified of the test results and how long they will take to come in.

Questions to ask your doctor before a medical test

• Why is the test being done?
• What steps does the test involve? How should I get ready?
• Are there any dangers or side effects?
• How will I find out the results? How long will it take to get the results?
• What will we know after the test?

When the results are ready, make sure the doctor tells you what they are and explains what they mean. You may want to ask your doctor for a written copy of the test results. If the test is done by a specialist, ask to have the results sent to your primary doctor.

Discuss your diagnosis and what to expect

A diagnosis identifies your disease or physical problem. The doctor makes a diagnosis based on the symptoms you are experiencing and the results of the physical exam, laboratory work, and other tests.

If you understand your medical condition, you can help make better decisions about treatment. If you know what to expect, it may be easier for you to deal with the condition.

Ask the doctor to tell you the name of the condition and why he or she thinks you have it. Ask how it may affect you and how long it might last. Some medical problems never go away completely. They can’t be cured, but they can be treated or managed.

Questions to ask your doctor about your diagnosis

• What may have caused this condition? Will it be permanent?
• How is this condition treated or managed? What will be the long-term effects on my life?
• How can I learn more about my condition?

Understand your medications

Your doctor may prescribe a drug for your condition. Make sure you know the name of the drug and understand why it has been prescribed for you. Ask the doctor to write down how often and for how long you should take it.

Make notes about any other special instructions. If you are taking other medications, make sure your doctor knows what they are, so he or she can prevent harmful drug interactions. Check with your doctor’s office before taking any over-the-counter medications.

Let the doctor know if your medicine doesn’t seem to be working or if it is causing problems. If you want to stop taking your medicine, check with your doctor first.

You may find it helpful to keep a chart of all the medicines you take and when you take them. Download, print, and copy the Medications worksheet.

Paying for medications

Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. You can ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”

Get answers to commonly asked questions about medicines, including how to save money on medications.

For more information about questions to ask the doctor

Centers for Disease Control and Prevention
800-232-4636
cdcinfo@cdc.gov
www.cdc.gov

Medicare
800-633-4227
877-486-2048 (TTY)
www.cms.gov
www.medicare.gov

MedlinePlus
National Library of Medicine
www.medlineplus.gov

Agency for Healthcare Research and Quality
301-427-1364
info@ahrq.hhs.gov
www.ahrq.gov

Healthy Eating As You Age: Know Your Food Groups

Making smart food choices is an important part of healthy aging. Understanding the different food groups — and how much of each should make up your diet — can help you form a healthy eating pattern over time. This article describes the main food groups and other important nutrients recommended for older adults in the Dietary Guidelines for Americans (PDF, 30.6M). We also provide suggestions for how to fit occasional treats into your healthy eating pattern.

It is important to get the recommended amount of each food group without going over your daily recommended calories. Keep in mind that the amount you should eat to maintain your weight depends on your age, sex, and level of physical activity.

Main food groups

Vegetables

Vegetables come in a wide variety of colors, flavors, and textures. They contain vitamins and minerals, carbohydrates, and are an important source of fiber. The vegetable food group includes dark green vegetables, red and orange vegetables, starchy vegetables, and legumes (beans and peas).

Dark green vegetables include broccoli, collard greens, spinach, and kale. Red and orange vegetables include acorn squash, carrots, pumpkin, tomato, and sweet potato. Starchy vegetables include corn, green peas, and white potatoes. Other vegetables include eggplant, beets, cauliflower, Brussels sprouts, celery, artichokes, green beans, and onions. Legumes include black beans, garbanzo beans (chickpeas), kidney beans, soybeans, and tofu. Legumes can also be counted in the protein foods group.

1/2 cup-equivalent of vegetables equals:

• 
  1 cup uncooked spinach
• 
  6 baby carrots
• 
  1/2 cup cooked kidney beans
• 
  1/2 cup broccoli florets
• 
  1/2 large (3-inch diameter, 3-3/4 inch long) red pepper
• 
  1/2 cup cooked green beans

See more foods in the vegetable group.

Fruits

Fruits bring color, flavor, and important nutrients to your diet. There are so many choices — citrus fruits like oranges and grapefruits; different kinds of berries; fruits that grow on trees, such as apricots, cherries, peaches, and mangoes; and others like figs, grapes, and pineapples.

According to the Dietary Guidelines (PDF, 30.6M), older Americans generally do not eat enough fruit. Adding more fruit to your diet can have significant benefits for overall health. Fruits, like vegetables, contain carbohydrates and provide extra fiber that helps keep your digestive system moving. For even more fiber, eat fruits with the skin on — just make sure you wash all fruits thoroughly before eating. Although 100% fruit juice also counts toward this category, at least half of the fruits you eat should be whole fruits. When purchasing frozen, canned, or dried fruit, choose options that are lowest in added sugars.

1/2 cup-equivalent of fruit equals:

• 
  1 small piece fruit, such as a 2-inch peach or large plum
• 
  1/4 cup dried fruit
• 
  1/8 medium cantaloupe
• 
  1/2 cup 100% orange juice
• 
  1/2 medium grapefruit
• 
  1/2 cup grapes

See more foods in the fruit group.

Grains

Any food made from wheat, rye, rice, oats, cornmeal, barley, or other cereal grain is a grain product. This includes bread and pasta, breakfast cereal, grits, tortillas, and even popcorn. Grains — along with fruits, vegetables, and dairy — contain carbohydrates, the body’s main source of energy.

Read food labels to find grain choices that are low in saturated fat and added sugar. Be especially wary of options labeled “low-fat,” which can be high in added sugar.

At least half the grain foods you eat should be whole grains. Whole grains provide iron and many B vitamins, and they have fiber, too. Examples of whole grains include whole wheat, whole oats, whole bulgur (also known as cracked wheat), and whole cornmeal.

Some grain products are refined, which gives them a finer texture and a longer shelf life but removes fiber and nutrients. Most refined grains are enriched, which means that some nutrients are added back after processing. Examples of refined grain products include white flour, degermed cornmeal, white bread, and white rice.

1 ounce-equivalent of grain equals:

• 
  1 slice bread
• 
  1 small (2-1/2-inch diameter) muffin
• 
  1 cup breakfast cereal (flakes, rounds, or puffed)
• 
  1/2 cup cooked cereal, rice, or pasta
• 
  3 cups popcorn
• 
  1 small (6-inch diameter) corn or flour tortilla

See more foods in the grain group.

Protein foods

Proteins are often called the body’s building blocks. They are used to build and repair tissues, and also help your body fight infection. Your body uses extra protein for energy. Older adults should try to eat a variety of nutrient-dense proteins. Choose lean (low-fat) meats and poultry. Keep in mind that you can also get protein from seafood, eggs, beans, nuts, seeds, and soy products. Protein from plant sources tends to be lower in saturated fat, contains no cholesterol, and provides fiber and other health-promoting nutrients. Plant sources of protein, such as nuts and seeds, have different nutritional value than plant-based meat alternatives, which can be heavily processed and high in sodium.

The Dietary Guidelines (PDF, 30.6M) recommend that you eat 8 to 10 ounces per week of a variety of seafood, not only for the protein but also because seafood contains omega-3 fatty acids, such as EPA and DHA, which are good for your heart. Seafoods that are higher in EPA and DHA include salmon, anchovies, and trout. These seafoods are also lower in mercury, which can be harmful, than other types of seafood.

1 ounce-equivalent equals:

• 
  1/2 ounce nuts (12 almonds, 24 pistachios, or 7 walnut halves)
• 
  1 tablespoon peanut butter
• 
  1/2 cup split pea, lentil, or other bean soup
• 
  1/4 cup tofu
• 
  1 egg
• 
  2 tablespoons hummus

See more foods in the protein group.

Dairy

Consuming dairy helps older adults maintain strong bones and provides several vital nutrients, including calcium, potassium, and vitamin D. For your heart health, pick from the many low-fat or fat-free choices in the dairy group. These give you important vitamins and minerals, with less fat. Certain fortified dairy alternatives can provide similar nutritional content to dairy.

1 cup-equivalent of dairy equals:

• 
  1 cup yogurt
• 
  1-1/2 ounces hard cheese, such as cheddar, mozzarella, Swiss, or Parmesan
• 
  1/3 cup shredded cheese
• 
  1 cup milk or calcium-fortified soy beverage
• 
  2 cups cottage cheese
• 
  1 cup pudding made with milk

See more foods in the dairy group.

Other foods

Some foods are not in any of the main food groups. These include oils, which can be eaten regularly as part of a healthy diet, as well as unhealthy fats, sugars, and calories from drinks, which should only be consumed occasionally. There is no recommended daily intake amount in cups or ounces for these products. Limiting the calories you consume from this category can help keep your healthy eating habits on track.

Oils & solid fats

Oils are high in calories, but they are also an important source of nutrients like vitamin E. For older adults, the daily allowance of oils ranges from 5 to 8 teaspoons, depending on activity level. Oils contain monounsaturated and polyunsaturated fats, which are healthy fats that give you energy and help the body absorb certain vitamins.

Measuring your daily oils can be tricky — knowing what you add while cooking or baking is one thing, but oil is naturally a part of some foods.

Teaspoons of oil:

• 
  1/2 medium avocado has 3 teaspoons of oil
• 
  4 large ripe olives have 1/2 teaspoon of oil
• 
  1 tablespoon of peanut butter has 2 teaspoons of oil

See more oil equivalents.

In general, try to use oils instead of solid fats, such as butter or lard, which are high in saturated fat. Saturated fats occur naturally in some foods, but they are also added to foods such as baked goods and potato chips. To lower the saturated fat in your diet, eat low-fat or fat-free dairy products, choose cuts of meat with less fat, and remove the skin from chicken. Reading the Nutrition Facts label can help you keep track of how much saturated fat you consume.

Limit the consumption of foods high in added sugar, which include sweetened cereals, highly processed snack foods such as cookies and cakes, dairy desserts, and many items marketed as low-fat. Read the ingredient list to see if the food you are eating has added sugar. Some key words to look for: brown sugar, corn sweetener, corn syrup, dextrose, fructose, and high-fructose corn syrup.

Beverages

Although many beverages can be part of a healthy eating pattern, some add calories without adding nutritional value and you should avoid them. Beverages that are calorie-free — especially water — or that contribute beneficial nutrients, such as fat-free and low-fat milk and 100% juice, should be the primary beverages you consume.

Coffee and tea. Drinking coffee or tea barely provides any calories unless you add sugar or cream, which are not nutrient-dense and should be consumed in moderation. Be cautious when ordering drinks from coffee shops because these are often loaded with extra sugars and fats.

Sweetened beverages. Examples of beverages that often have added sugars are soda, fruit drinks, sports drinks, energy drinks, and sweetened waters. Most sweetened beverages do not contribute to meeting food group goals and often contain a high number of calories.

Alcohol. Alcohol is not nutrient-dense and is not part of the healthy eating patterns recommended in the Dietary Guidelines. If you consume alcohol, do so in moderation, defined as one drink or less per day for women and two drinks or less per day for men.

Calories from sugars, saturated fats, and drinks can add up quickly. As these foods provide no nutritional benefit, they should only be consumed on occasion and in limited amounts.

To learn more, please visit https://www.nia.nih.gov/health/healthy-eating-nutrition-and-diet/healthy-eating-you-age-know-your-food-groups.

No one ever plans to be sick or disabled. Yet, planning for the future can make all the difference in an emergency and at the end-of-life. Being prepared and having important documents in a single place can give you peace of mind, help ensure your wishes are honored, and ease the burden on your loved ones.

Checklist for getting your affairs in order

This list provides common steps to consider when getting your affairs in order.

1. Plan for your estate and finances. Depending on your situation, you may choose to prepare different types of legal documents to outline how your estate and finances will be handled in the future. Common documents include a will, durable power of attorney for finances, and a living trust.

• A will specifies how your estate — your property, money, and other assets — will be distributed and managed when you die. A will can also address care for children under age 18, adult dependents, and pets, as well as gifts and end-of-life arrangements, such as a funeral or memorial service and burial or cremation. If you do not have a will, your estate will be distributed according to the laws in your state.
• A durable power of attorney for finances names someone who will make financial decisions for you when you are unable to.
• A living trust names and instructs a person, called the trustee, to hold and distribute property and funds on your behalf when you are no longer able to manage your affairs.

2. Plan for your future health care. Many people choose to prepare advance directives, which are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes due to disease or severe injury. The most common advance directives include a living will and a durable power of attorney for health care.

• A living will tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment. You can say which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies. Learn how to prepare a living will.
• A durable power of attorney for health care names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself. Your proxy — also known as a representative, surrogate, or agent — should be familiar with your values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, such as a serious auto accident or stroke. Learn how to choose a health care proxy.

These documents are part of advance care planning, which involves preparing for future decisions about your medical care and discussing your wishes with your loved ones.

3. Put your important papers and copies of legal documents in one place. You can set up a file, put everything in a desk or dresser drawer, or list the information and location of papers in a notebook. For added security, you might consider getting a fireproof and waterproof safe to store your documents. If your papers are in a bank safe deposit box, keep copies in a file at home. View a list of important papers.

4. Tell someone you know and trust or a lawyer where to find your important papers. You don’t need to discuss your personal affairs, but someone you trust should know where to find your papers in case of an emergency. If you don’t have a relative or friend you trust, ask a lawyer to help.

5. Talk to your loved ones and a doctor about advance care planning. A doctor can help you understand future health decisions you may face and plan the kinds of care or treatment you may want. Discussing advance care planning with your doctor is free through Medicare during your annual wellness visit. Private health insurance may also cover these discussions. Share your decisions with your loved ones to help avoid any surprises or misunderstandings about your wishes.

6. Give permission in advance for a doctor or lawyer to talk with your caregiver as needed. If you need help managing your care, you can give your caregiver permission to talk with your doctors, your lawyer, your insurance provider, a credit card company, or your bank. You may need to sign and return a form. Giving permission for your doctor or lawyer to talk with your caregiver is different from naming a health care proxy. A health care proxy can only make decisions if you are unable to communicate them yourself.

7. Review your plans regularly. It’s important to review your plans at least once each year and when any major life event occurs, like a divorce, move, or major change in your health.

Which documents do you need to have in place?

When you’re getting your affairs in order, it’s important to prepare and organize important records and files all in one place. Typically, you will want to include personal, financial, and health information. Remember, this is a starting place. You may have other information to add. For example, if you have a pet, you will want to include the name and address of your veterinarian.

Personal information

• Full legal name
• Social Security number
• Legal residence
• Date and place of birth
• Names and addresses of spouse and children
• Location of birth and death certificates and certificates of marriage, divorce, citizenship, and adoption
• Employers and dates of employment
• Education and military records
• Names and phone numbers of religious contacts
• Memberships in groups and awards received
• Names and phone numbers of close friends, relatives, doctors, lawyers, and financial advisors

Financial information

• Sources of income and assets (pension from your employer, IRAs, 401(k)s, interest, etc.)
• Social Security information
• Insurance information (life, long-term care, home, car) with policy numbers and agents’ names and phone numbers
• Names of your banks and account numbers (checking, savings, credit union)
• Investment income (stocks, bonds, property) and stockbrokers’ names and phone numbers
• Copy of most recent income tax return
• Location of most up-to-date will with an original signature
• Liabilities, including property tax — what is owed, to whom, and when payments are due
• Mortgages and debts — how and when they are paid
• Location of original deed of trust for home
• Car title and registration
• Credit and debit card names and numbers
• Location of safe deposit box and key

Health information

• Current prescriptions (be sure to update this regularly)
• Living will
• Durable power of attorney for health care
• Copies of any medical orders or forms you have (for example, a do-not-resuscitate order)
• Health insurance information with policy and phone numbers

Who can help with getting your affairs in order?

You may want to talk with a lawyer about setting up a general power of attorney, durable power of attorney, joint account, or trust. Be sure to ask about the lawyer’s fees before you make an appointment.

You do not have to involve a lawyer in creating your advance directives for health care. Most states provide the forms for free, and you can complete them yourself. Learn more about completing an advance directive.

You should be able to find a directory of local lawyers on the internet or contact your local library, your local bar association for lawyers, or the Eldercare Locator. Your local bar association can also help you find what free legal aid options your state has to offer. An informed family member may be able to help you manage some of these issues.

What other decisions can you prepare for in advance?

Getting your affairs in order can also mean making decisions about organ donation and funeral arrangements, or what you want to happen to your body after you die. Deciding and sharing your decisions can help your loved ones during a stressful time and best ensure your wishes are understood and respected.

Organ donation and brain donation. When someone dies, their healthy organs and tissues may be donated to help someone else. You can register to be an organ donor when you renew your driver’s license or state ID at your local department of motor vehicles. You can also register online. Some people also choose to donate their brain to advance scientific research. It may be possible to donate organs for transplant as well as the brain for scientific research. Learn more about organ donation and brain donation.

Funeral arrangements. You can decide ahead of time what kind of funeral or memorial service you would like and where it will be held. You can also decide whether you would like to be buried or cremated and whether you want your body’s ashes kept by loved ones or scattered in a favorite place. Be sure and specify certain religious, spiritual, or cultural traditions that you would like to have during your visitation, funeral, or memorial service. You can make arrangements directly with a funeral home or crematory. Read these tips on planning a funeral. If you choose not to be embalmed or cremated, most states allow families to take care of transportation, preparation of the body, and other needed arrangements. Learn more about the burial options available in your state. Put your preferences in writing and give copies to your loved ones and, if you have one, your lawyer.

To learn more, please visit https://www.nia.nih.gov/health/advance-care-planning/getting-your-affairs-order-checklist-documents-prepare-future.

Phyllis’s Story

Phyllis loves playing with her grandchildren, working in the garden, and going to bingo games. But, at age 76, the constant knee pain from osteoarthritis is taking a toll. It keeps her awake at night and stops her from doing activities she enjoys. The pain’s getting to be too much to handle, but she doesn’t know what to do about it.

You’ve probably been in pain at one time or another. Maybe you’ve had a headache or bruise—pain that doesn’t last too long. But, many older people have ongoing pain from health problems like arthritis, diabetes, shingles, or cancer.

Pain can be your body’s way of warning you that something is wrong. Always tell the doctor where you hurt and exactly how it feels.

Acute Pain and Chronic Pain

There are two kinds of pain. Acute pain begins suddenly, lasts for a short time, and goes away as your body heals. You might feel acute pain after surgery or if you have a broken bone, infected tooth, or kidney stone.

Pain that lasts for 3 months or longer is called chronic pain. This pain often affects older people. For some people, chronic pain is caused by a health condition such as arthritis. It may also follow acute pain from an injury, surgery, or other health issue that has been treated, like post-herpetic neuralgia after shingles.

Living with any type of pain can be hard. It can cause many other problems. For instance, pain can:

• Get in the way of your daily activities
• Disturb your sleep and eating habits
• Make it difficult to continue working
• Be related to depression or anxiety
• Keep you from spending time with friends and family

Describing Pain

Many people have a hard time describing pain. Think about these questions when you explain how the pain feels:

• Where does it hurt?
• When did the pain start? Does it come and go?
• What does it feel like? Is the pain sharp, dull, or burning? Would you use some other word to describe it?
• Do you have other symptoms?
• When do you feel the pain? In the morning? In the evening? After eating?
• Is there anything you do that makes the pain feel better or worse? For example, does using a heating pad or ice pack help? Does changing your position from lying down to sitting up make it better?
• What medicines, including over-the-counter medications and non-medicine therapies have you tried, and what was their effect?

Your doctor or nurse may ask you to rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine. Or, your doctor may ask if the pain is mild, moderate, or severe. Some doctors or nurses have pictures of faces that show different expressions of pain and ask you to point to the face that shows how you feel. Your doctor may ask you to keep a diary of when and what kind of pain you feel every day.

Attitudes About Pain

Everyone reacts to pain differently. Some people feel they should be brave and not complain when they hurt. Other people are quick to report pain and ask for help.

Worrying about pain is common. This worry can make you afraid to stay active, and it can separate you from your friends and family. Working with your doctor, you can find ways to continue to take part in physical and social activities despite having pain.

Some people put off going to the doctor because they think pain is part of aging and nothing can help. This is not true!

It is important to see a doctor if you have a new pain. Finding a way to manage pain is often easier if it is addressed early.

Treating Pain

Treating, or managing, chronic pain is important. Some treatments involve medications, and some do not. Your treatment plan should be specific to your needs.

Most treatment plans focus on both reducing pain and increasing ways to support daily function while living with pain.

Talk with your doctor about how long it may take before you feel better. Often, you have to stick with a treatment plan before you get relief. It’s important to stay on a schedule. Sometimes this is called “staying ahead” or “keeping on top” of your pain. Be sure to tell your doctor about any side effects. You might have to try different treatments until you find a plan that works for you. As your pain lessens, you can likely become more active and will see your mood lift and sleep improve.

Pain Specialist

Some doctors receive extra training in pain management. If you find that your regular doctor can’t help you, ask him or her for the name of a pain medicine specialist. A pain specialist may be a doctor, nurse, or anesthesiologist.

If you or a loved one is managing pain from cancer or other serious illness, ask to be seen by a palliative care specialist. These specialists are trained to manage pain and other symptoms for people with serious illnesses.

Medicines to Treat Pain

Your doctor may prescribe one or more of the following pain medications. Talk with your doctor about their safety and the right dose to take.

• Acetaminophen may help all types of pain, especially mild to moderate pain. Acetaminophen is found in over-the-counter and prescription medicines. People who have more than three drinks per day or who have liver disease should not take acetaminophen.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, naproxen, and ibuprofen. Long-term use of some NSAIDs can cause side effects, like internal bleeding or kidney problems, which make them unsafe for many older adults. You may not be able to take ibuprofen if you have high blood pressure.
• Narcotics (also called opioids) are used for moderate to severe pain and require a doctor’s prescription. They may be habit-forming. They can also be dangerous when taken with alcohol or certain other drugs. Examples of narcotics are codeine, morphine, and oxycodone.
• Other medications are sometimes used to treat pain. These include antidepressants, anticonvulsive medicines, local painkillers like nerve blocks or patches, and ointments and creams.

As people age, they are at risk for developing more side effects from medications. It’s important to take exactly the amount of pain medicine your doctor prescribes. Don’t chew or crush your pills if they are supposed to be swallowed whole. Talk with your doctor or pharmacist if you’re having trouble swallowing your pills.

Mixing any pain medication with alcohol or other drugs can be dangerous. Make sure your doctor knows all the medicines you take, including over-the-counter drugs and dietary supplements, as well as the amount of alcohol you drink.

Remember: If you think the medicine is not working, don’t change it on your own. Talk to your doctor or nurse.

Can I Get Addicted to Pain Medicine?

Sometimes, strong medications called opioids are needed to control pain. Opioid pain relievers are generally safe when taken for a short time as prescribed by your doctor, but they can become addictive, especially if they are misused. Regular use can lead to dependence. Never take opioids in greater amounts or more often than prescribed.

Using opioids can also increase risk for falls, dizziness, and other ailments in older adults.

Becoming addicted to prescription pain medicine can happen to anyone, including older adults. Sometimes, these treatments are the only ones available that can help. But, sometimes other treatments can and should be tried first or can be used intermittently or simultaneously. So, ask your doctor if there is another medicine or a non-medicine alternative you can try. Tell your doctor if you or a family member has a history of alcohol or drug abuse.

For more information about opioid use, visit the Centers for Disease Control and Prevention’s website.

Opioid addiction can be treated. If you or someone close to you needs help for a substance use disorder, talk with your doctor, or contact the Substance Abuse and Mental Health Services Administration at 1-800-662-4357.

What Other Treatments Help with Pain?

In addition to drugs, there are a variety of complementary and alternative approaches that may provide relief. Talk to your doctor about these treatments. It may take both medicine and other treatments to feel better.

• Acupuncture uses hair-thin needles to stimulate specific points on the body to relieve pain.
• Biofeedback helps you learn to control your heart rate, blood pressure, muscle tension, and other body functions. This may help reduce your pain and stress level.
• Cognitive behavioral therapy is a form of short-term counseling that may help reduce your reaction to pain.
• Distraction can help you cope with acute pain, taking your mind off your discomfort.
• Electrical nerve stimulation uses electrical impulses to relieve pain.
• Guided imagery uses directed thoughts to create mental pictures that may help you relax, manage anxiety, sleep better, and have less pain.
• Hypnosis uses focused attention to help manage pain.
• Massage therapy can release tension in tight muscles.
• Mind-body stress reduction combines mindfulness meditation, body awareness, and yoga to increase relaxation and reduce pain.
• Physical therapy uses a variety of techniques to help manage everyday activities with less pain and teaches you ways to improve flexibility and strength.

Helping Yourself

There are things you can do yourself that might help you feel better. Try to:

• Keep a healthy weight. Putting on extra pounds can slow healing and make some pain worse. A healthy weight might help with pain in the knees, back, hips, or feet.
• Be physically active. Pain might make you inactive, which can lead to more pain and loss of function. Activity can help.
• Get enough sleep. It can reduce pain sensitivity, help healing, and improve your mood.
• Avoid tobacco, caffeine, and alcohol. They can get in the way of treatment and increase pain.
• Join a pain support group. Sometimes, it can help to talk to other people about how they deal with pain. You can share your thoughts while learning from others.

Cancer Pain

Some people with cancer are more afraid of the pain than of the cancer. But most pain from cancer or cancer treatments can be controlled. As with all pain, it’s best to start managing cancer pain early. It might take a while to find the best approach.

One special concern in managing cancer pain is “breakthrough pain.” This is pain that comes on quickly and can take you by surprise. It can be very upsetting. After one attack, many people worry it will happen again. This is another reason to talk with your doctor about having a pain management plan in place.

Alzheimer’s Disease and Pain

People who have Alzheimer’s disease may not be able to tell you when they’re in pain. When you’re caring for someone with Alzheimer’s, watch for clues. A person’s face may show signs of being in pain or feeling ill. You may see a person frequently changing position or having trouble sleeping. You may also notice sudden changes in behavior such as increased agitation, crying, or moaning. Refusing to eat may be a sign that the person has tooth pain or other oral health issues. It’s important to find out if there is something wrong. If you’re not sure what to do, call the doctor for help.

Pain at the End of Life

Not everyone who is dying is in pain. But, if a person has pain at the end of life, there are ways to help. Experts believe it’s best to focus on making the person comfortable, without worrying about possible addiction or drug dependence. For more information, read Providing Comfort at the End of Life.

Caring for Someone in Pain

It’s hard to see a loved one hurting. Caring for a person in pain can leave you feeling tired and discouraged. To keep from feeling overwhelmed, you might consider asking other family members and friends for help. Or, some community service organizations might offer short-term, or respite, care. The Eldercare Locator might help you find a local group that offers this service.

Some Facts About Pain

• Most people don’t have to live with pain. There are pain treatments. While not all pain can be cured, most pain can be managed. If your doctor has not been able to help you, ask to see a pain specialist.
• The side effects from pain medicine are often manageable. Side effects from pain medicine like constipation, dry mouth, and drowsiness may be a problem when you first begin taking the medicine. These problems can often be treated and may go away as your body gets used to the medicine.
• Your doctor will not think you’re weak if you talk about your pain. If you’re in pain, tell your doctor so you can get help.
• If you use pain medicine now, it will still work when you need it later. Using medicine at the first sign of pain may help control your pain later.
• Pain is not “all in your head.” No one but you knows how your pain feels. If you’re in pain, talk with your doctor.

To learn more, please visit https://www.nia.nih.gov/health/pain/pain-you-can-get-help.

Ask About Different Treatment Options

You will benefit most from a treatment when you know what is happening and are involved in making decisions. Make sure you understand what your treatment involves and what it will or will not do. Have the doctor give you directions in writing and feel free to ask questions. For example: “What are the pros and cons of having surgery at this stage?” or “Do I have any other choices?”

If your doctor suggests a treatment that makes you uncomfortable, ask if there are other treatments that might work. If cost is a concern, ask the doctor if less expensive choices are available. The doctor can work with you to develop a treatment plan that meets your needs.

Here are some things to remember when deciding on a treatment:

• Discuss different treatment choices. There are different ways to manage many health conditions, especially chronic conditions like high blood pressure and cholesterol. Ask what your options are.
• Discuss risks and benefits of treatment options. Once you know your options, ask about the pros and cons of each one. Find out what side effects might occur, how long the treatment would continue, and how likely it is that the treatment will work for you.
• Consider how a treatment may affect your life. When thinking about the pros and cons of a treatment, don’t forget to consider its impact on your overall life. For instance, will one of the side effects interfere with a regular activity that means a lot to you? Is one treatment choice expensive and not covered by your insurance? Doctors need to know about these practical matters so they can work with you to develop a treatment plan that meets your needs.

Questions to Ask About Treatment Options

• Are there any risks associated with the treatment?
• How soon should treatment start? How long will it last?
• Are there other treatments available?
• How much will the treatment cost? Will my insurance cover it?

Talking with Medical Specialists

Your doctor may send you to a specialist for further evaluation, or you may request to see a specialist yourself. Your insurance plan may require you to have a referral from your primary doctor. A visit to the specialist may be short. Often, the specialist already has seen your medical records or test results and is familiar with your case. If you are unclear about what the specialist tells you, ask questions.

For example, if the specialist says you have a medical condition that you aren’t familiar with, you may want to say something like: “I don’t know much about that condition. Could you explain what it is and how it might affect me?” or “I’ve heard that is a painful problem. What can be done to prevent or manage the pain?”

You also may ask for written materials to read, or you can call your primary doctor to clarify anything you haven’t understood.

Ask the specialist to send information about any diagnosis or treatment to your primary doctor. This allows your primary doctor to keep track of your medical care. You also should let your primary doctor know at your next visit how well any treatments or medications the specialist recommended are working.

Questions to Ask Your Specialist

• What is my diagnosis?
• What treatment do you recommend? How soon do I need to begin the new treatment?
• Will you discuss my care with my primary doctor?

If You Need Surgery

In some cases, surgery may be the best treatment for your condition. If so, your doctor will refer you to a surgeon. Knowing more about the operation will help you make an informed decision about how to proceed. It also will help you get ready for the surgery, which makes for a better recovery.

Ask the surgeon to explain what will be done during the operation and what reading material, videos, or websites you can look at before the operation.

Find out if you will have to stay overnight in the hospital or if the surgery can be done on an outpatient basis. Will you need someone to drive you home? Minor surgeries that don’t require an overnight stay can sometimes be done at medical centers called ambulatory surgical centers.

Questions to Ask Your Surgeon

• What is the success rate of the operation? How many of these operations have you done successfully?
• What problems occur with this surgery? What kind of pain or discomfort can I expect?
• What kind of anesthesia will I have? Are there any risks associated with its use in older people?
• Will I have to stay in the hospital overnight? How long is recovery expected to take? What does it involve? When can I get back to my normal routine?

Do you have questions about palliative care and hospice? Read about how to care for the seriously ill.

Discuss How Prevention Can Improve Your Health

Doctors and other health professionals may suggest you change your diet, activity level, or other aspects of your life to help you deal with medical conditions. Research has shown that these changes, particularly an increase in exercise, have positive effects on overall health.

Until recently, preventing disease in older people received little attention. But, things are changing. We now know that it’s never too late to stop smoking, improve your diet, or start exercising. Getting regular checkups and seeing other health professionals, such as dentists and eye specialists, helps promote good health. Even people who have chronic diseases, like arthritis or diabetes, can prevent further disability and, in some cases, control the progress of the disease.

If a certain disease or health condition runs in your family, ask your doctor if there are steps you can take to help prevent it. If you have a chronic condition, ask how you can manage it and if there are things you can do to keep it from getting worse. If you want to discuss health and disease prevention with your doctor, say so when you make your next appointment. This lets the doctor plan to spend more time with you.

It is just as important to talk with your doctor about lifestyle changes as it is to talk about treatment. For example: “I know that you’ve told me to eat more dairy products, but they really disagree with me. Is there something else I could eat instead?” or “Maybe an exercise class would help, but I have no way to get to the senior center. Is there something else you could suggest?”

As with treatments, consider all the alternatives, look at pros and cons, and remember to take into account your own point of view. Tell your doctor if you feel his or her suggestions won’t work for you and explain why. Keep talking with your doctor to come up with a plan that works.

Many doctors now recommend that older people try to make physical activity a part of everyday life. When you are making your list of things to talk about with your doctor, add exercise. Ask how exercise would benefit you, if there are any activities you should avoid, and whether your doctor can recommend any specific kinds of exercise.

Start exercising with the links and free videos from NIA, developed specifically for older people.

Questions to Ask Your Doctor About Prevention

• Is there any way to prevent a condition that runs in my family—before it affects me?
• Are there ways to keep my condition from getting worse?
• How will making a change in my habits help me?
• Are there any risks in making this change?
• Are there support groups or community services that might help me?
• How to Evaluate Health Information Online
• Many people search online to find information about medical problems and health issues. However, not all health information on the web is of equal quality. Read about how to find websites that are accurate and reliable. Don’t forget to talk with your doctor about what you’ve learned online.

To learn more, please visit https://www.nia.nih.gov/health/medical-care-and-appointments/discussing-health-decisions-your-doctor.

A simple accident like tripping on a rug or slipping on a wet floor can change your life. If you fall, you could break a bone, which thousands of older adults experience each year. For older people, a broken bone can also be the start of more serious health problems and can lead to long-term disability.

If you or an older adult in your life has fallen, you’re not alone. More than one in four people age 65 years or older fall each year. The risk of falling — and fall-related problems — rises with age. However, many falls can be prevented. For example, exercising, managing your medications, having your vision checked, and making your home safer are all steps you can take to prevent a fall.

Many older adults fear falling, even if they haven’t fallen before. This fear may lead them to avoid activities such as walking, shopping, or taking part in social activities. But staying active is important to keeping your body healthy and actually helps to prevent falls. So don’t let a fear of falling keep you from being active! Learn about what causes falls and how to lower your risk of falling so you can feel more comfortable with staying active.

What causes falls in older adults?

Many things can cause a fall.

• Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger.
• Certain conditions, such as diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance and lead to a fall.
• Conditions that cause rushed movement to the bathroom, such as incontinence, may also increase the chance of falling.
• Older adults with mild cognitive impairment or certain types of dementia are at higher risk of falling.
• Age-related loss of muscle mass (known as sarcopenia), problems with balance and gait, and blood pressure that drops too much when you get up from lying down or sitting (called postural hypotension) are all risk factors for falling.
• Foot problems that cause pain, and unsafe footwear such as backless shoes or high heels, can also increase your risk of falling.
• Some medications can increase a person’s risk of falling because they cause side effects such as dizziness or confusion. The more medications you take, the more likely you are to fall.
• Safety hazards in the home or community environment can also cause falls.

Steps to take to prevent falls

If you take care of your overall health, you may have a lower chance of falling. Most of the time, falls and accidents don’t just happen for no reason. Here are a few tips to help lessen your risk of falls and broken bones, also known as fractures:

• Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. Exercise also helps keep your joints, tendons, and ligaments flexible. Mild weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis, a disease that makes bones weak and more likely to break
• Try balance and strength training exercises. Yoga, Pilates, and tai chi can all improve balance and muscle strength. You can also try lifting weights or using resistance bands to build strength. Learn more about different types of exercises to improve balance and strength.
• Fall-proof your home. Check out these tips for changes you can make to your home that will help you avoid falls and ensure your safety.
• Have your eyes and hearing tested. Even small changes in sight and hearing are linked to an increased risk for falls. When you get new eyeglasses or contact lenses, take time to get used to them. Wear your glasses or contacts as your eye doctor advises. If you have a hearing aid, be sure it fits well and wear it.
• Find out about the side effects of any medicines you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
• Get enough sleep. If you are tired, you are more likely to fall.
• Avoid or limit alcohol. Too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries.
• Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly. Get your blood pressure checked when lying and standing.
• Use an assistive device if you need help feeling steady when you walk. Using canes and walkers correctly can help prevent falls. If your doctor tells you to use a cane or walker, make sure it’s the right size for you. Walker wheels should roll smoothly. If you borrow walking support equipment from a friend, ask your health care provider to make sure the equipment is the correct size and is safe to use. This is exceptionally important when you’re walking in areas you don’t know well or where the walkways are uneven. A physical or occupational therapist can help you decide which devices might be helpful and teach you how to use them safely.
• Take extra caution when walking on wet or icy surfaces. These can be very slippery! Use an ice melt product or sand to clear icy areas by your doors and walkways.
• Keep your hands free. Use a shoulder bag, fanny pack, or backpack to leave your hands free to hold on to railings.
• Choose the right footwear. To fully support your feet, wear nonskid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles.
• Consider staying inside when the weather is bad. Some community services provide 24-hour delivery of prescriptions and groceries, and many take orders over the phone.
• Always tell your doctor if you have fallen since your last check-up, even if you did not feel pain when you fell. A fall can alert your doctor to a new medical problem or issues with your medications or eyesight that can be corrected. Your doctor may suggest physical therapy, a walking aid, or other steps to help prevent future falls.

What to do if you fall

Whether you are at home or somewhere else, a sudden fall can be startling and upsetting. If you do fall, stay as calm as possible and take the following steps:

• Breathe. Take several deep breaths to try to relax. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.
• Decide if you are hurt. Getting up too quickly or in the wrong way could make an injury worse.
• Crawl to a sturdy chair. If you think you can get up safely without help, roll over onto your side. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.
• Slowly sit down in the chair. Put your hands on the chair seat and slide one foot forward so that it’s flat on the floor. Keep the other leg bent so the knee is on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair.
• Get help. If you are hurt or cannot get up on your own, ask someone for help or call 911. If you are alone, try to get into a comfortable position and wait for help to arrive. Prepare for a fall by keeping a well-charged cordless or mobile phone with you at all times and arrange for daily contact with a family member or friend. Emergency response systems are another option: These systems enable you to push a button on a special necklace or bracelet to call for help. Some smartwatches also have this feature.

Keep your bones strong to prevent fall-related fractures

Having healthy bones won’t necessarily prevent a fall, but if you do fall, healthy bones may help prevent serious injury, such as breaking a hip or other bone. Bone breaks and fracture can lead to a hospital or nursing home stay, long-term disability, or even death. Getting enough calcium and vitamin D can help keep your bones strong. So can staying active. Try to get at least 150 minutes per week of physical activity.

Other ways to maintain bone health include quitting smoking and avoiding or limiting alcohol use. Tobacco and alcohol use may decrease your bone mass and increase your chance of fractures. Additionally, try to maintain a healthy weight. Being underweight increases the risk of bone loss and broken bones.

Osteoporosis is a disease that weakens bones, making them thin and brittle. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about osteoporosis.

Falls are a common reason for trips to the emergency room and for hospital stays among older adults. Many of these hospital visits are for fall-related fractures. You can help lower your risk of fractures by keeping your bones strong and following the tips above to avoid falls.

To learn more, please visit https://www.nia.nih.gov/health/falls-and-falls-prevention/falls-and-fractures-older-adults-causes-and-prevention.

Figuring out how much to eat while achieving or maintaining a healthy weight can be difficult. Getting the proper nutrients and eating the right amount for your weight and activity level can contribute to healthy aging. This article provides suggestions for how older adults can get the nutrients they need within a recommended daily number of calories.

How many calories do you need?

A calorie is a unit of measurement that describes how much energy is released when your body breaks down food. Although calorie count alone does not dictate whether a food is nutritious, thinking about how many calories you need can guide healthy eating habits. If you are over age 60 and you want to maintain your current weight, how many calories do you need to eat each day? The Dietary Guidelines suggest:

For a Woman	Calories
Not physically active	1,600
Moderately active	1,800
Active lifestyle	2,000-2,200

For a Man	Calories
Not physically active	2,000-2,200
Moderately active	2,200-2,400
Active lifestyle	2,400-2,600

Unsure which activity category you’re in? Consult the Dietary Guidelines for definitions of each level. You can increase your physical activity level by adding walking, jogging, dancing, recreational sports, and other similar approaches to your day.

Serving and portion sizes

A “serving size” is a standard amount of a food, such as a cup or an ounce. Serving sizes can help you when choosing foods and when comparing similar items while shopping, but they are not recommendations for how much of a certain food to eat.

The term “portion” means how much of a food you are served or how much you eat. A portion size can vary from meal to meal. For example, at home you may serve yourself two small pancakes in one portion, but at a restaurant, you may get a stack of four pancakes as one portion. A portion size may also be bigger than a serving size. For example, the serving size on the nutrition label for your favorite cereal may be 1 cup, but you may actually pour yourself 1½ cups in a bowl.

Portion size can be a problem when eating out. To keep your portion sizes under control, try ordering smaller appetizers instead of an entrée as your meal, or share an entrée with a friend. Or eat just one-half of an entrée and take the rest home to enjoy as a meal the next day.

Healthy food shifts

Eating the right amount is important, but so is making sure you’re getting all the nutrients you need. Older adults often need fewer calories, but more nutrients, which makes it essential to eat nutrient-dense foods. To eat nutrient-dense foods across all the food groups, you may need to make some changes in your food and beverage choices. You can move toward a healthier eating pattern by making shifts in food choices over time. Here are some ideas:

Check out these tips for planning healthy meals as you get older.

Healthy beverage shifts

It’s easy to forget about calories you consume from beverages. If you drink sodas, creamy and sweet coffee drinks, or alcohol, swapping them out for healthier options can make a huge difference. There are plenty of beverage options that are low in added sugars, saturated fats, and sodium. Here are some options:

100-calorie snacks

Another way to think about the idea of nutrient-dense and calorie-dense foods is to look at a variety of foods that all provide the same calories. Let’s say that you wanted to have a small snack. You might choose:

• A 7- or 8-inch banana
• 20 peanuts
• 3 cups low-fat popcorn
• Two regular chocolate-sandwich cookies
• 1/2 cup low-fat ice cream
• One scrambled large egg cooked with oil
• 2 ounces baked chicken breast with no skin

These choices all have about 100 calories but provide different amounts of nutrients. The right choice for you may depend on what else you’re eating throughout the day.

Eating healthy is not just about how much you eat, it’s also about what you eat. Older adults should try to eat foods that are packed with nutrients while limiting foods that are high in calories but provide few nutrients. Swapping out snacks and beverages with nutrient-dense alternatives can help you get the nutrients you need while staying within your recommended number of calories.

To learn more, please visit https://www.nia.nih.gov/health/healthy-eating-nutrition-and-diet/how-much-should-i-eat-quantity-and-quality.

Fatigue is a feeling of weariness, tiredness, or lack of energy. It can be a normal response to physical activity, emotional stress, boredom, or lack of sleep, but it can also signal a more serious mental or physical condition.

Everyone feels tired now and then. If you feel tired continuously for multiple weeks, you may want to see your doctor, who can help discover what’s causing your fatigue and identify ways to relieve it.

What causes fatigue?

Sometimes, fatigue can be the first sign that something is wrong in your body. For example, people with rheumatoid arthritis, a painful condition that affects the joints, often complain of fatigue. People with cancer may feel fatigued from the disease, treatments, or both.

Many medical problems and treatments can add to fatigue. These include:

• Having medical treatments, like chemotherapy and radiation, or recovering from major surgery
• Infections
• Chronic diseases like diabetes, heart disease, kidney disease, liver disease, thyroid disease, and chronic obstructive pulmonary disease
• Untreated pain and diseases like fibromyalgia
• Anemia
• Sleep apnea and other sleep disorders
• Recent stroke
• Parkinson’s disease
• Taking certain medications, such as antidepressants, antihistamines, and medicines for nausea and pain

Talk with your doctor about any concerns you may have about fatigue and your health condition. Treating an underlying or known health problem may help reduce fatigue.

Emotional exhaustion: Can emotions cause fatigue?

Do you worry about your health and who will take care of you? Have you recently lost a loved one? Or have you lost your mobility and independence? Emotional stresses like these can take a toll on your energy. Fatigue can be linked to many conditions, including:

• Anxiety
• Depression
• Grief from loss of family or friends
• Stress from financial or personal problems
• Feeling that you no longer have control over your life

Not getting enough sleep can also contribute to fatigue. Regular physical activity can improve your sleep, help reduce feelings of depression and stress, and boost your mood and overall well-being. Yoga, meditation, deep breathing, and stretching may help reduce stress and anxiety and help you get more rest. Therapy or certain medications may also help relieve anxiety and depression that may be contributing to fatigue.

Talk with your doctor if your mental health seems to be affecting your sleep or making you tired.

Lifestyle habits and fatigue

Some lifestyle habits can make you feel tired, such as:

• Staying up too late. A good night’s sleep is important to feeling refreshed and energetic. Try going to bed and waking up at the same time every day.
• Having too much caffeine. Drinking caffeinated soda, tea, or coffee, or even eating chocolate, can keep you from getting a good night’s sleep. Limit the amount of caffeine you have during the day and avoid it in the evening.
• Drinking too much alcohol. Alcohol is a central nervous system depressant that changes the way you think and act. It may also interact negatively with certain medicines.
• Getting too little or too much exercise. Regular exercise can help boost your energy levels. Overdoing it without proper rest can cause stress and lead to fatigue.
• Boredom. If you were busy during your working years, you may feel lost about how to spend your time when you retire. Engaging in social and productive activities that you enjoy, such as volunteering in your community, can help maintain your well-being.

Tips to feel less tired

Making changes to your lifestyle may help you feel less tired, for example:

• Exercise regularly. Almost anyone, at any age, can do some type of physical activity. If you have concerns about starting an exercise program, ask your doctor if there are any activities you should avoid. Moderate exercise may improve your appetite, energy, and outlook. Some people find that exercises combining balance and breathing (for example, tai chi or yoga) improve their energy.
• Try to avoid long naps (over 30 minutes) late in the day. Long naps can leave you feeling groggy and may make it harder to fall asleep at night. Read A Good Night’s Sleep for tips on getting better rest at night.
• Stop smoking. Smoking is linked to many diseases and disorders, such as cancer, heart disease, and breathing problems, all of which are associated with fatigue.
• Ask for help if you feel swamped. Some people have so much to do that just thinking about their schedules can make them feel tired. Working with others may help a job go faster and be more fun.
• Participate in activities you enjoy. Socializing with friends and family or volunteering in your community can help you feel more engaged and productive throughout the day.
• Eat well and avoid alcohol. Eating nutritious foods can give you energy throughout the day. Staying away from alcoholic drinks can help you avoid negative interactions with medications.
• Keep a fatigue diary. This can help you find patterns throughout the day when you feel more or less tired. It can also help you plan out activities that may give you more energy.

When should I see a doctor for fatigue?

If you’ve been tired or been experiencing low energy for several weeks with no relief, call your health care provider. They will ask questions about your sleep, daily activities, appetite, and exercise, and likely provide a physical examination and order lab tests.

Your treatment will be based on your history and the results of your exam and lab tests. You may be prescribed medications to target underlying health problems, such as anemia or abnormal thyroid function. Health care providers also may suggest therapy or certain medications to help reduce depression, anxiety, or other emotional contributors that are associated with fatigue. They may also advise that you eat a well-balanced diet and begin an exercise program.

To learn more, please visit https://www.nia.nih.gov/health/fatigue/fatigue-older-adults.

Taking care of yourself is one of the most important things you can do as a caregiver. Caregiving is not easy — not for the caregiver and not for the person receiving care. It requires sacrifices and adjustments for everyone. Often, family caregivers must juggle work and family life to make time for these new responsibilities.

Caring for an older adult can also be rewarding. Many people find that caregiving provides a sense of fulfillment and that they like feeling useful and needed. But the ongoing demands of taking care of someone else can strain even the most resilient person. That’s why it’s so important for you to take care of yourself. This article can help you find ways to look out for your own well-being so you can be there for others.

How do you know if you need help?

Caregivers do a lot for others. Because there is so much on their plate, many caregivers don’t spend time taking care of themselves. For example, they are less likely than others to get preventive health services, like annual checkups, and to practice regular self-care. As a result, they tend to have a higher risk of physical and mental health issues, sleep problems, and chronic conditions such as high blood pressure. They are even at an increased risk of premature death.

It’s not always obvious when a person needs help. Watch out for these signs of caregiver stress:

• Feeling exhausted, overwhelmed, or anxious
• Becoming easily angered or impatient
• Feeling lonely or disconnected from others
• Having trouble sleeping or not getting enough sleep
• Feeling sad or hopeless, or losing interest in activities you used to enjoy
• Having frequent headaches, pain, or other physical problems
• Not having enough time to exercise or prepare healthy food for yourself
• Skipping showers or other personal care tasks such as brushing your teeth
• Misusing alcohol or drugs, including prescription medications

Don’t wait until you are completely overwhelmed. Learn what your own warning signs are and take steps to minimize sources of stress where possible.

How can you ask others to help?

When people have asked you if they can lend a hand, have you told them, “Thanks, but I’m fine”? Accepting help from others isn’t always easy. You may worry about being a burden, or you may feel uncomfortable admitting that you can’t do it all yourself. But many caregivers later say they did too much on their own, and they wished they had asked for more support from family and friends.

Understand that many people want to help, and it makes them feel good to contribute. If asking for help is hard for you, here are some tips that may help:

• Ask for small things at first, if that makes it easier for you. Many large jobs can be broken down into simpler tasks.
• If you aren’t comfortable asking face-to-face, send a text or email with your request.
• Consider a person’s skills and interests when thinking about how they could help.
• Be prepared with a list of things that need to be done, and let the other person choose what they’d like to do.
• If someone offers to help, practice saying, “Thanks for asking. Here’s what you can do.”
• Be honest about what you need and what you don’t need. Not every offer is going to be helpful.
• Be prepared for some people to say “no,” and don’t take it personally.

What else can a caregiver do if they’re feeling overwhelmed?

If you’re feeling overwhelmed by caregiving, tending to your own needs may be the last thing on your mind. But taking time for yourself can actually make you a better caregiver. If you can find small ways to lower your stress and boost your mood, you’ll have more strength and stamina to take care of someone else.

Below are some suggestions that may help when you’re feeling overwhelmed. Remember that you don’t have to do everything all at once, especially if the thought of self-care just makes you feel more exhausted.

• Be active. Find something active that you enjoy. That might be walking, dancing, gardening, or playing with a pet. Even short periods of exercise can be beneficial.
• Eat well. Work on having a well-balanced diet that includes a variety of healthy foods. Drink plenty of water every day.
• Prioritize sleep. Aim to get seven to nine hours of sleep each night. Develop a relaxing bedtime routine to make it easier to fall asleep. Try to go to sleep and get up at the same time each day.
• Reduce stress. Experiment with relaxation techniques like meditation, tai chi, or yoga. Download a smartphone app with guided meditations or relaxing music. Many of these apps are free.
• Make time to relax. Carve out time each week to do something you enjoy that has nothing to do with caregiving. It can be as simple as watching a favorite TV show, reading a magazine, or working on a hobby.
• Keep up with your own health. Make that doctor’s appointment you’ve been putting off. Tell your doctor that you’re a caregiver: They may be able to suggest resources online or in your community.
• Reach out for support. Talk to a trusted family member or friend or seek counseling from a mental health professional. Join an online or in-person support group for caregivers. These are people who will know what you’re going through and may have suggestions or advice.
• Take a break if you need it. Ask another family member or friend to step in, hire an aide to come for a few hours a week, or sign up the older person for an adult day care program.
• Be kind to yourself. You don’t have to pretend to be cheerful all the time. Feelings of sadness, frustration, and guilt are normal and understandable. Express your feelings by writing in a journal or talking with a friend.

Remember that you are doing the best you can and that you are not alone. Many caregivers have trouble tending to their own health and well-being. But give yourself credit for everything you’re doing. Your caregiving makes a big difference in someone else’s life.

If you’re not the primary caregiver, how can you support that person?

In many cases, one person takes on most of the everyday responsibilities of caring for an older person. It tends to be a spouse or the child or sibling who lives closest. If you are not the primary caregiver, you can still play an important role in supporting that person.

Be sure to acknowledge how important the primary caregiver is in the older person’s life. Also, discuss the physical and emotional effects caregiving can have on people. Although caregiving can be satisfying, it also can be very hard work.

You can lighten the primary caregiver’s load by providing emotional support, taking on specific tasks, and even providing full-time care for a short period of time to give the primary caregiver a break. Ask them what you can do that would be most helpful. Staying in contact by phone or email might also take some pressure off the primary caregiver. Just listening may not sound like much, but it can mean a lot.

A primary caregiver — especially a spouse or partner — may be hesitant to ask for a break. Here are some ways you could help them get the rest they need:

• Offer to stay with the older person for one afternoon a week, for example, so the primary caregiver can have some personal time.
• Arrange for regular respite care in the form of a volunteer, an in-home aide, or an adult day care program.
• If you live far away, travel to stay with the older person for a few days so the primary caregiver can take a vacation or just have some time off.

In time, the older person may have to move to a residential (live-in) facility, such as assisted living or a nursing home. If that happens, the primary caregiver will need your support. You can work together to select a facility and coordinate the move. The primary caregiver may need extra support while adjusting to the person’s absence and to living alone at home. To learn more, please visit https://www.nia.nih.gov/health/caregiving/taking-care-yourself-tips-caregivers.

People with Alzheimer’s disease may become agitated or aggressive as the disease gets worse. Agitation means that a person is restless and worried, and they aren’t able to settle down. Agitated people may pace a lot, not be able to sleep, or act aggressively toward others. They may verbally lash out or try to hit or hurt someone. When these problems start to happen or worsen in the late afternoon or early evening, it’s called sundowning. On this page, learn about the causes of agitation, aggression, and sundowning and how to manage them.

Causes of agitation and aggression

Most of the time, agitation and aggression happen for a reason. When they happen, try to find the cause, then talk with a health care provider about possible solutions. Causes of agitation and aggression can include:

• Pain, depression, or stress
• Too little rest or sleep
• Constipation
• Sudden change in a well-known place, routine, or person
• A feeling of loss — for example, the person may miss the freedom to drive
• Too much noise or confusion, or too many people in the room
• Being pushed by others to do something — for example, to bathe or to remember events or people — when Alzheimer’s has made the activity very hard or impossible
• Feeling lonely and not having enough contact with other people
• Certain medications or interactions between two medications

A doctor can give the person with Alzheimer’s a medical exam to look for any physical problems that may cause agitation and aggression, and in certain cases, may prescribe medication to ease the symptoms.

Tips for coping with agitation or aggression

Here are some ways you can help minimize and cope with agitation or aggression:

• Be patient and try not to show frustration. Speak calmly. Listen to the person’s concerns and avoid arguing. Reassure the person that they are safe, and that you are there to help. Use other communication methods besides speaking, such as gentle touching, to help them calm down. Take deep breaths and count to 10 if you get upset.
• Create a comforting home setting. Try to keep to a routine, such as bathing, dressing, and eating at the same times each day. Reduce noise and clutter. Play soothing music and keep well-loved objects and photos around the home. Let in natural light during the day. Slow down and try to relax if you think your own worries may be causing concern.
• Try focusing on an object or activity. Distract the person with a snack, beverage, or activity. You could watch a favorite TV show, listen to music, go for a walk, read a book, or do a household chore, such as folding laundry, together.
• Protect yourself and others if needed. Hide or lock up car keys and items that could be used in a harmful way, such as guns and kitchen knives. If your loved one becomes aggressive, stay at a safe distance until the behavior stops. Talk to a doctor if aggressive behaviors worsen and consider medications that may help. In an emergency, call 911 and explain that your loved one has dementia.
• Sundowning: Avoiding Late-Day Confusion

When restlessness, agitation, irritability, and confusion happen as daylight begins to fade, it’s known as sundowning. Being overly tired can increase late-afternoon and early-evening restlessness. Try taking these steps with the person living with dementia to help prevent sundowning:

• Stick to a schedule.
• Arrange a time to go outside or sit by a window to get sunlight each day.
• Aim to be physically active each day, but don’t plan too many activities.
• Avoid alcoholic drinks and beverages with caffeine, such as coffee or cola, late in the day.
• Discourage long naps and dozing late in the day.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/coping-agitation-aggression-and-sundowning.

The three most common places people at the end-of-life die are at home, in a hospital, or in a care facility. While not everyone has the chance to decide where they will die, people who know the end of life is approaching may be able to plan ahead. Several factors may help with this planning, including knowing the type of care you need and want, where you can receive this level of care, advance care directives, costs, and availability of family and friends to help.

End-of-life care at home

Home is likely the most private setting for someone who needs end-of-life care. It allows for family and friends to come and go freely and may give the person who is dying a sense of comfort. Services such as visiting nurses as well as special equipment, such as a hospital bed or bedside commode, can be arranged to be at the home.

It’s important for a caregiver or family member to work closely with the health care team to decide the type of comfort care needed at home in order to make the dying person as comfortable as possible. This type of care can often be provided by nursing assistants or family and friends without medical training. However, a doctor will continue to oversee the patient’s health care plan. Hospice care is frequently used at home.

Caring for someone who is at home at the end of life can be physically, emotionally, and financially demanding for the people providing the care. Extra support from paid caregivers or home service providers, also known as respite care, can help. If the person who is dying is returning home from the hospital, sometimes a hospital discharge planner, who is often a social worker, will be able to help with the logistics. Your local Area Agency on Aging might be able to recommend other sources of help.

End-of-life care in hospitals

In a hospital setting, you will have access to medical professionals who understand the needs of a dying person. This can be very reassuring to both the person and their family.

In addition to the regular care team, some hospitals have palliative and hospice care teams that can assist with managing uncomfortable symptoms at the end of life, such as digestive issues or pain. These teams can also help with making medical decisions for patients or families.

End-of-life care in nursing homes or other care facilities

Many people are in care facilities, such as nursing homes, at the end of life. In a nursing home, nursing staff are always present. Unlike a hospital, a doctor is not in the facility at all times but is available when needed.

Some people are discharged from a hospital to a care facility, while others may already be living in one. If you have lived in a nursing home or long-term care facility for a while, you may choose to stay and receive end-of-life care there. You and your family may already have a relationship with staff who work there, which can help make the care feel more personalized than in a hospital.

If you are receiving hospice care, the hospice team can assist the care facility staff with end-of-life care.

To learn more, please visit https://www.nia.nih.gov/health/end-life/different-care-settings-end-life.

• Hands have good germs that your body needs to stay healthy. Hands can also have bad germs on them that make you sick.

Alcohol-based hand sanitizer kills most of the bad germs that make you sick.

• Alcohol-based hand sanitizers kill the good and bad germs, but the good germs quickly come back on your hands.

Alcohol-based hand sanitizer does not create antimicrobial-resistant germs.

• Alcohol-based hand sanitizers kill germs quickly and in a different way than antibiotics.
• Using alcohol-based hand sanitizers to clean your hands does not cause antimicrobial resistance.

Steps to Take

When patients and visitors should clean their hands

• Before preparing or eating food.
• Before touching your eyes, nose, or mouth.
• Before and after changing wound dressings or bandages.
• After using the restroom.
• After blowing your nose, coughing, or sneezing.
• After touching hospital surfaces such as bed rails, bedside tables, doorknobs, remote controls, or the phone.

How to clean hands

With an alcohol-based hand sanitizer:

1. Put product on hands and rub hands together.
2. Cover all surfaces until hands feel dry.
3. This should take around 20 seconds.

With soap and water:

1. Wet your hands with warm water. Use liquid soap if possible. Apply a nickel- or quarter-sized amount of soap to your hands.
2. Rub your hands together until the soap forms a lather and then rub all over the top of your hands, in between your fingers and the area around and under the fingernails.
3. Continue rubbing your hands for at least 15 seconds. Need a timer? Imagine singing the “Happy Birthday” song twice.
4. Rinse your hands well under running water.
5. Dry your hands using a paper towel if possible. Then use your paper towel to turn off the faucet and to open the door if needed.

Ask your healthcare provider to clean their hands

• Wearing gloves alone is not enough for your healthcare provider to prevent the spread of infection.
• Ask questions like:
  • “Before you start the exam, would you mind cleaning your hands again?”
  • “Would it be alright if you cleaned your hands before changing my bandages?”
  • “I didn’t see you clean your hands when you came in, would you mind cleaning them again before you examine me?”
  • “I’m worried about germs spreading in the hospital. Will you please clean your hands once more before you start my treatment?”

Speak up for clean hands in healthcare settings

• Clean your own hands and ask those around you to do the same.
• Don’t be afraid to use your voice: it’s okay to ask your healthcare provider to clean their hands.
• Ask your loved ones and visitors to clean their hands, too, using questions like:
  • “I saw you clean your hands when you arrived some time ago, but would you mind cleaning them again?”

Is there such a thing as too clean?

• Germs are everywhere. They are within and on our bodies and on every surface you touch. But not all germs are bad. We need some of these germs to keep us healthy and our immune system strong.
• Your hands have good germs on them that your body needs to stay healthy. These germs live under the deeper layers of the skin.
• Your hands can also have bad germs on them that make you sick. These germs live on the surface and are easily killed/wiped away by the alcohol-based hand sanitizer.
• Using an alcohol-based hand sanitizer is the preferred way for to keep your hands clean.
• Alcohol-based hand sanitizers kill the good and bad germs, but the good germs quickly come back on your hands.

Washing with soap and water: 15 versus 20 seconds

• Wash your hands for more than 15 seconds, not exactly 15 seconds.
• The time it takes is less important than making sure you clean all areas of your hands.
• Alcohol-based hand sanitizers are the preferred way to clean your hands in healthcare facilities.

Which one? Soap and water versus alcohol-based hand sanitizer

An alcohol-based hand sanitizer is the preferred method for cleaning your hands when they are not visibly dirty because it:

• Is more effective at killing potentially deadly germs on hands than soap.
• Is easier to use during the course of care, especially:
  • when moving from soiled to clean activities with the same patient or resident.
  • when moving between patients or residents in shared rooms or common areas.
• Improves skin condition with less irritation and dryness than soap and water.

To learn more, please visit https://www.cdc.gov/clean-hands/about/hand-hygiene-for-healthcare.html.

Knowing what matters most to your loved one can help you honor their wishes and give you peace of mind if they become too sick to make decisions. Unfortunately, only one in three people in the United States has a plan for their future health care in place. There are steps you can take to help your friend or family member navigate future medical decisions — and to be prepared to make decisions for them, if needed. This is part of advance care planning, which involves preparing for decisions about future medical care and discussing those wishes with loved ones.

How to start the conversation about advance care planning

One of the best things you can do as a caregiver is to discuss your loved one’s care and treatment preferences in advance. Starting the conversation early is especially important if the person has been diagnosed with a condition that affects their cognitive health, such as Alzheimer’s disease or another form of dementia. Here are some ways you might start the conversation:

• Start simple. Talking about specific medical treatments or decisions can be scary and overwhelming. Instead, try asking about any concerns they may have, what decisions they may need to make, and who they might trust to make decisions for them.
• Share what’s important to you. Your loved one may feel more comfortable discussing their preferences if you talk about what matters to you, as well.
• Remind them why it’s important. Talk about the benefits of having these conversations and creating an advance care plan. By documenting their wishes, they are more likely to get the care they want, and it can also help loved ones feel less burden, guilt, and depression.
• Try to be understanding. After a recent diagnosis or health change, it can be overwhelming and difficult to discuss future health care needs. The person may feel more comfortable talking with someone else such as a doctor or someone in their spiritual community. You can also encourage the person to think about their potential needs and plan to discuss them another time.
• Keep the conversation going. Listen carefully to what the person says and encourage them to continue sharing.

If the person is open to creating an advance care plan, you can provide them information on how to get started. It’s possible your loved one may not want to put a plan in place. Still, talking to them about their preferences can help you prepare for future decisions. You may also be able to help prepare in other ways, for example by getting important papers in order.

How to serve as a health care proxy

Most people ask a close friend or family member to be their health care proxy. A health care proxy is typically responsible for talking with doctors and making decisions about tests, procedures, and treatments if a person is unable to speak for themself. The types of decisions a proxy can make should be outlined clearly in the durable power of attorney for health care, a legal document that names the proxy.

If someone has asked you to be their health care proxy, it’s important to consider whether the role is right for you. You may have to discuss sensitive topics, make difficult decisions, and advocate on the person’s behalf. Ask yourself:

• Can I honor this person’s wishes and values about life, health, health care, and dying? Sometimes this can be challenging if your values are not the same.
• Am I comfortable speaking up on the person’s behalf? It’s okay if you don’t know a lot about health care, but it’s important that you are willing to ask questions and stand up for the person.
• Are you comfortable dealing with conflict? A proxy may need to uphold the person’s wishes even if other family members, friends, or loved ones don’t agree.

If you have agreed to be someone’s health care proxy, consider these tips:

• Talk to the person about their values. Learn what matters most to them when it comes to life, health care, and dying.
• Learn about their current and future health concerns. The more you understand their wishes, the more prepared you will be to make decisions for them when the time comes. Ask if they have any plans in place, like a living will, and walk through it together.
• Ask for a copy of their advance directives. This often includes a living will and durable power of attorney for health care forms.
• Keep a copy of important information. Make sure to have contact information for the person’s health care providers and family members.
• Ask about other considerations. For example, is there anyone other than the medical team that you should talk with when making decisions? Are there spiritual, cultural, or religious traditions the person wants you to consider?
• Continue the conversation. Have conversations each year and as major life changes happen, such as a divorce, death, or change in their health.

Even when you have a person’s decisions in writing and have talked about their wishes, you may still face difficult choices or not be able to follow the person’s wishes exactly. Try to reflect on your discussions and do your best to honor the person’s wishes to the extent possible.

Learn more about the role of a health care proxy.

Tips for navigating the health care system

When a person becomes too sick to make decisions for themselves, family members and caregivers may need to navigate the health care system and find ways to advocate for their loved one’s care — especially if a proxy was not named. Use these tips:

• Ask questions. If you are unclear about something you are told, don’t be afraid to ask the doctor or nurse to repeat it or to say it another way.
• Make the person’s wishes clear. Share copies of the person’s advance directives and the proxy’s contact information with the health care team, nursing home staff, or others caring for the person. If the person is still living at home, you can put this information in a colorful envelope near their bed or on the fridge for emergency responders.
• Write down contact information. Ask for a specific person on the medical team that you can contact for questions or if the person needs something.
• Choose one person to make health care choices. Deciding on a main point of contact for the medical team can help everyone stay more organized, coordinate upcoming appointments, and manage medications or changing medical needs.
• Keep family members looped in. Even with one person named as the decision-maker, it is a good idea to have your family agree on the care plan, if possible. If you can’t agree, you might consider working with a mediator, a person trained to bring people with different opinions to a common decision.
• Try to decide on an end-of-life approach. When it becomes clear the person is nearing the end of life, the family should try to discuss the desired end-of-life care approach with the health care team. This might include hospice care. Discussing the options and making decisions as early as possible can help with planning.
• Remind the health care team who the person is. Remind them that the person is not just a patient. Tell them about the person. Share what they were like, discuss the things they enjoyed most, and post pictures in their room.

There may also be people in your community who can help you navigate the health care system. Some hospitals have a patient advocate or care navigator, or you may consider working with a geriatric care manager.

To learn more, please visit https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-and-health-care-decisions-tips-caregivers-and

Physical activity is essential for healthy aging, and it can be beneficial at any stage of life. Some potential benefits are immediate, such as reduced feelings of anxiety, reduced blood pressure, and improved sleep. Others are long term and require consistent physical activity over time, such as reduced risk of cardiovascular disease, type 2 diabetes, and some cancers.

Importance of an active lifestyle for older adults

It’s never too late to start being physically active and to achieve the benefits of an active lifestyle. Older adults can benefit from all three types of exercise: aerobic, muscle-strengthening, and balance. Many activities, from exercise programs to household tasks, can count towards the 150 minutes of moderate-intensity aerobic activity and two days of muscle-strengthening activities recommended each week.

Physical activity can be an opportunity to participate in activities you enjoy, spend time with friends and family, get outdoors, improve fitness, and maintain a healthy weight. Additionally, being physically active as an older adult may improve your health and health-related quality of life. Active older adults also tend to live longer!

Functional ability and fall prevention

Physical activity improves physical function, making it easier to perform tasks of daily living — including household chores, getting into or out of a bed or chair, and moving around the neighborhood. This increased functional ability can help maintain independence and support independent living for older adults.

Movement and exercise may offer protection against osteoporosis and age-related loss of muscle mass, strength, and function, also known as sarcopenia. The health and functional ability of bones and muscles are especially important for older adults, who are at higher risk for falls and fall-related injuries. Improved physical function can reduce the risk of falls and likelihood of serious injury if there is a fall.

Disease risk and chronic health conditions

Physical activity helps to prevent certain diseases and chronic health conditions that are common among older adults. Older adults who are physically active have a lower risk of:

• Cardiovascular disease (including heart disease and stroke) and death caused by it
• High blood pressure
• Type 2 diabetes
• High cholesterol
• Obesity
• Cancers of the bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach
• Dementia (including Alzheimer’s disease)
• Depression

Being active can also help to slow or manage chronic disease and to delay death. For older adults who are managing a diagnosis, exercising with chronic conditions can improve quality of life and reduce the risk of developing new health conditions.

Mental and emotional health

Physical activity supports emotional and mental health in addition to physical health. Physical activity can help reduce feelings of depression and anxiety, improve sleep, and benefit overall emotional well-being. It may also improve or maintain some aspects of cognitive function, such as your ability to shift quickly between tasks, plan an activity, and ignore irrelevant information. Older adults who exercise with others get the added benefit of social connection as well.

Try these exercise ideas and see how you feel!

• Walking, bicycling, or dancing. Endurance activities increase your breathing, get your heart pumping, and boost chemicals in your body that may improve mood.
• Yoga. This mind and body practice typically combines physical postures, breathing exercises, and relaxation.
• Tai Chi. This “moving meditation” involves shifting the body slowly, gently, and precisely, while breathing deeply.
• An activity you enjoy. Whether it’s gardening, playing tennis, kicking around a soccer ball with your grandchildren, or something else, choose an activity that you want to do, not have to do.

To learn more, please visit https://www.nia.nih.gov/health/exercise-and-physical-activity/health-benefits-exercise-and-physical-activity.

As a primary care practitioner, you likely have long-established relationships with some of your patients and are in an ideal position to observe potential signs of a cognitive problem. You and your staff are often the first to address a patient’s or family’s concerns about cognitive as well as behavioral and functional changes that may have already affected their lives and resulted in, for example, a motor vehicle accident or being the victim of identity theft or financial fraud.^(1, 2) It’s important to take concerns seriously and to assess the person as early as possible to determine the potential cause of impairment. This quick guide features information about assessing cognitive, behavioral, and functional changes in older adults.

Why is it important to assess cognitive impairment in older adults?

It’s important to address any changes in an older person’s memory, language abilities, or personality as these may reflect a neurodegenerative disease process that may either be due to a reversible cause or become more serious. Whether memory or other cognition concerns are reported by the patient or a family member, or directly observed by you, the issues should be noted in the patient’s chart and followed up with a cognitive, behavioral and/or functional assessment.

Cognitive impairment in older adults has a variety of possible causes, including medication side effects; metabolic and/or endocrine dysfunction; delirium due to illness (such as a urinary tract or COVID-19 infection); depression; and dementia, including Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal disorders. Some causes, like medication side effects and depression, can be reversed or improved with treatment. Others, such as Alzheimer’s, cannot be reversed, but symptoms may be treatable for a period of time. It is important to help prepare patients and their families for additional changes that come as cognitive impairment progresses.

Many people who are developing dementia or already have it do not receive a diagnosis. One study found that more than 50% of patients with dementia had not received a clinical cognitive evaluation by a physician.⁽³⁾ Another study showed that physicians were unaware of cognitive impairment in more than 40% of their cognitively impaired patients.⁽⁴⁾ Yet another analysis looking at undetected dementia globally found the U.S. rate to be 61%.⁽⁵⁾ The problem of underdiagnosis is even more pronounced in underserved populations and in those with lower educational attainment.^(6, 7) The failure to evaluate memory or cognitive complaints is likely to hinder treatment of underlying disease and comorbid conditions, and may present safety issues for the patient and others.^(8, 9) In many cases, the cognitive problem will worsen over time and may lead to preventable hospitalizations.^{(2, 8, 10, 11)}

Some older people have mild cognitive impairment (MCI). People living with MCI have more memory problems than is normal for their age, but their symptoms do not interfere significantly with their everyday lives. Older people with MCI are at greater risk for developing Alzheimer’s, but not all of them do. Some may even go back to normal cognition. It is important to determine the cause of the impairment to anticipate future needs, address any reversible causes, and try to mediate modifiable risk factors.

Most people with memory, other cognitive, or behavioral complaints want a diagnosis to understand the nature of their problem and to know what to expect.^{(10, 12, 13, 14, 15)} In a survey conducted by the Alzheimer’s Association of 2,434 U.S. adults age 18 and older, 85% of respondents said they would want to know early if they had Alzheimer’s. Reasons for wanting to know included planning for the future, allowing for earlier treatment of symptoms, taking steps to preserve existing cognitive function, and being able to understand what is happening.⁽¹⁶⁾

Some people are reluctant to mention concerns about memory or other cognitive or behavioral issues because they fear a diagnosis of dementia and how the disease will impact their lives in the future. In these cases, a primary care provider can explain the benefits of finding out what may be causing the person’s health concerns.

While pharmacological treatment options for Alzheimer’s-related memory loss and other cognitive symptoms are limited, there are medicines approved by the U.S. Food and Drug Administration to help manage symptoms, as well as newer medicines granted Accelerated Approval to treat Alzheimer’s. Learn more about these medications in NIA’s How Is Alzheimer’s Disease Treated?

In addition, there are non-drug strategies that can promote physical and emotional comfort. Assessing cognitive impairment and identifying its cause, particularly at an early stage, is beneficial so patients and families can learn about these strategies and develop a care plan in concert with their health care providers.

Clinical trials or other research studies are also an option for people with cognitive impairment. Patients may be interested in participating in clinical trials not only for themselves but also because of the potential to help future generations. Visit the Alzheimers.gov Clinical Trials Finder for more information.

Benefits of early assessment

If assessment is negative, meaning there is no evidence of cognitive impairment: Concerns may be alleviated, at least at that point in time, and it is useful for both the person with concerns as well as the clinician to have a baseline for future assessments.

If assessment is positive and further evaluation is warranted: The patient and physician can take the next step of identifying the cause of impairment because medical conditions such as tumors, vitamin deficiencies, or medication side effects can also cause serious memory problems that resemble dementia. The results of an evaluation may lead to:

• Treating the underlying disease or health condition
• Managing comorbid conditions and medications more effectively and appropriately for the diagnosis
• Averting or addressing potential safety issues
• Allowing the patient to create or update advance directives and plan long-term care
• Ensuring the patient has support services and a care network to help with medical, legal, and financial concerns
• Working with the patient and their caregiver to develop strategies to improve quality of life, modify the patient’s lifestyle, make home safety modifications, and manage emotions related to the dementia diagnosis
• Referring the patient to a geriatrician, neurologist, geriatric psychiatrist, neuropsychologist, geriatric social worker, geriatric counselor, mental health counselor, or substance abuse professional for a more specific diagnosis or help with care management
• Ensuring the caregiver receives appropriate information, referrals, and support for coping with a dementia diagnosis, managing stress, and preparing for expected changes as well as making the best use of intact abilities
• Encouraging participation in clinical research, including clinical trials and studies

Learn more at Alzheimers.gov/clinical-trials and Talking With Your Patients About Alzheimer’s and Related Dementias Clinical Trials.

When is assessment indicated?

In its 2020 review and recommendation regarding routine screening for cognitive impairment in adults 65 years old and older, the U.S. Preventive Services Task Force noted that “although there is insufficient evidence to recommend for or against screening for cognitive impairment, there may be important reasons to identify cognitive impairment early. Clinicians should remain alert to early signs or symptoms of cognitive impairment (e.g., problems with memory or language) and evaluate the individual as appropriate.”⁽¹⁷⁾

Other risk factors that could indicate the need for dementia screening include: history of type 2 diabetes, stroke, depression, trouble managing money or medications, and being older than 80.⁽¹⁸⁾ Tools such as the Dementia Screening Indicator can help guide clinician decisions about when it may be appropriate to screen for cognitive impairment in the primary care setting.⁽¹⁸⁾

How can physicians and staff find time for assessment?

Trained staff need only 10 minutes or less to initially assess a patient for cognitive impairment. While results alone are insufficient to diagnose dementia, they are an important first step. The AD8, QDRS, and Mini-Cog are among many possible tools and some can be filled out by the person or the caregiver while in the waiting room.

Disclaimer: NIA does not endorse any specific cognitive assessment tools. The selection of an assessment tool depends on a variety of factors, including the setting, target population age and demographics, language, and expertise of the administrator. Research is underway to create and validate new tools for cognitive assessment in primary care settings. For more information, visit Cognitive Assessment Considerations: Understanding the Evidence.

How to assess for cognitive impairment

Assessment for cognitive impairment can be performed at any visit but is a required component of the Medicare Annual Wellness Visit.^(8, 19) Coverage for yearly wellness visits, and importantly, for follow-up visits for cognitive assessment and care plan services, is available to patients with Medicare Part B coverage.

Visit the Centers for Medicare & Medicaid Services (CMS) for more information on cognitive assessment and care plan services (code 99483), including what it covers and how to bill for it. CMS also created a related educational video for health care providers. The Alzheimer’s Association also offers information on cognitive assessment and care planning services.

Positive results from a brief assessment warrant further evaluation. A combination of neuropsychological evaluation, including self- and informant-reports from a person who has frequent contact with the person being evaluated, such as a spouse or other care provider, is the best way to assess cognitive impairment more fully.⁽²⁰⁾

A primary care provider may conduct an evaluation or refer to a specialist, such as a geriatrician, neurologist, geriatric psychiatrist, or neuropsychologist. If available, a local memory disorders clinic or an NIA-funded Alzheimer’s Disease Research Center may also accept referrals.

Genetic testing, neuroimaging, and biomarker testing have been recommended for limited clinical uses.^(2, 21) These tests are primarily conducted in research settings and may require consultation with the medical provider, a counselor, and the family and caregivers as there are complex ethical, legal, and social implications that should be considered. In addition, some new Alzheimer’s medications may require or warrant the confirmation of beta-amyloid plaques before prescribing, as well as brain imaging during treatment to evaluate for amyloid-related imaging abnormalities (ARIA).

Interviews to assess memory, behavior, mood, and functional status of the patient are best conducted without family members or companions present who may prompt the person’s responses. However, family members or close companions can also be good sources of information. It can be beneficial to speak with them while the patient is in the room, as well as privately to allow for a more candid discussion. Per HIPAA regulations, the patient should give permission in advance. Brief, easy-to-administer tools, such as the Short IQCODE (PDF, 1.9M), the AD8, or the QDRS for the caregiver are available.

Note that people who are only mildly impaired may be adept at covering up their cognitive decline and reluctant to address the problem. In some cases, patients may not have insight into their cognitive and functional problems due to the nature of their illness.

Additional resources are available to help health care teams in their detection of cognitive impairment and support of patients. For example, the American Academy of Family Physicians developed a Cognitive Care Kit, and the Gerontological Society of America developed the GSA KAER Toolkit for Primary Care Teams.

For more information on cognitive assessment tools, and other resources for health professionals, visit Alzheimer’s and Related Dementias Resources for Professionals.

What to do after assessment

After assessment for cognitive impairment is complete, take time to reflect on your relationship with the person to determine the best way to deliver the results.

Some people may prefer a cautious, reserved explanation. Other patients may prefer more precise language and appreciate when specific words, such as “Alzheimer’s disease,” are referenced.

The American College of Physicians Foundation and Alzheimer’s Association have produced an 11-minute video, Disclosing an Alzheimer’s Diagnosis, that may be helpful. Written materials can also be helpful: NIA’s Alzheimer’s and related Dementias Education and Referral Center has free tools and publications you can give to your patients, including Next Steps After an Alzheimer’s Diagnosis. Local resources can also be found using the Eldercare Locator.

Communicating with older patients

If possible, schedule additional time for the appointment or a follow-up, so that you can listen and respond to the patient’s and caregiver’s concerns. Ask the patient if there is a family member or friend who can help with medical, legal, and financial concerns going forward. Suggest making these arrangements as early as possible and ensure that the patient has given you formal authorization to include the caregiver in the conversation about your patient’s care. Keep that person’s name and contact information in your notes for future reference.

Informing family members or others that the patient may have Alzheimer’s, or any cognitive impairment, may be done in a telephone conference or group meeting, which should be arranged with the consent of the patient. It is the patient’s choice on how, whether, and with whom they want to share this information. Let everyone know that you will continue to be available for care, information, guidance, and support. And provide them with resources, such as the 24/7 helpline, in writing. Make them aware that there are support groups and other ways to get help.

Consider how your practice can coordinate and integrate care for the patient and caregiver across the many specialists and services that will be involved. Nonprofit support and community organizations can provide information about planning, social services, and care.

Learn more in Caring for Older Patients With Cognitive Impairment.

Communicating with caregivers

All caregivers face challenges, but these challenges are compounded for people caring for patients with Alzheimer’s or other forms of cognitive impairment. Here are some approaches that can be especially useful when communicating with caregivers:

• Explain that much can be done to improve the patient’s quality of life. Measures such as modifications in daily routine and medications may help. If the patient is in the later stages of dementia, consider bringing in a palliative care consultant to help with symptom management.
• Provide information about the consumer resources and services available from local organizations, as well as support groups.
• Encourage caregivers to get regular respite, especially when patients require constant attention. Ask if the caregiver, who is at considerable risk for stress-related disorders, is receiving adequate support. Encourage the caregiver to speak with their own health care provider. They may have trouble recognizing their own needs when they are so focused on their loved one; assure them that it is crucial to take care of themselves in order to best support their loved one.

Points to remember

• People should be assessed for cognitive impairment if:
  • The individual, family members, or others express concerns about changes in the person’s memory, thinking, or behavior
  • As the health care provider, you observe problems/changes in the patient’s memory, thinking, or behavior
• Brief assessments are available and can be used in an office visit.
• Assessment for cognitive impairment is a required component of the Medicare Annual Wellness Visit.
• People, particularly those who express a concern, likely want to know what the underlying problem is. It is important to emphasize that, no matter what the diagnosis is, there are options for support and care for the person and their caregivers.
• It’s important to talk with the patient and caregiver about potential challenges and how to cope with their results.

To learn more, please visit https://www.nia.nih.gov/health/health-care-professionals-information/assessing-cognitive-impairment-older-patients.

Dietary supplements can be beneficial at any age, but they can also have unwanted side effects, such as unsafe prescription drug interactions. They could also not work at all.

It’s important to understand the supplements you are taking and why you are taking them. Talk with your doctor if you are considering taking a supplement.

What is a dietary supplement?

Dietary supplements are substances you might use to add nutrients to your diet or to lower your risk of health problems such as osteoporosis or arthritis. Dietary supplements come in the form of pills, capsules, powders, gel capsules and tablets, extracts, or liquids. They might contain vitamins, minerals, fiber, amino acids, herbs or other plants, or enzymes. Sometimes, the ingredients in dietary supplements are added to foods and drinks. A doctor’s prescription is not needed to buy dietary supplements.

Should I take a dietary supplement?

Eating a variety of healthy foods is the best way to get the nutrients you need. However, some people may not get enough vitamins and minerals from their daily diet. When that’s the case, their doctors may recommend a dietary supplement to provide missing nutrients.

If you are thinking about using dietary supplements:

• Learn. Find out as much as you can about any dietary supplement you might take. Talk with your doctor, pharmacist, or a registered dietitian. A supplement that seemed to help your neighbor might not work for you. If you are reading fact sheets or checking websites, be aware of the source of the information. Could the writer or group profit from the sale of a particular supplement? Read more about choosing reliable health information websites.
• Remember. Just because something is said to be “natural” doesn’t mean it is safe or good for you. It could have side effects. It might make a medicine your doctor prescribed for you either weaker or stronger. It could also be harmful to you if you have certain medical conditions.
• Tell your doctor. Before deciding to start taking a dietary supplement to treat any health condition, check with your doctor. Do not take a supplement to try to diagnose or treat any health condition without first checking with your doctor. Learn how medications can interact with dietary supplements. For more information, visit the National Center for Complementary and Integrative Health.
• Buy wisely. Choose brands that your doctor, dietitian, or pharmacist recommend. Don’t buy dietary supplements with ingredients you don’t need. Don’t assume that more is better — it can actually be harmful to take too many supplements or those with a very high concentration of a nutrient. It is possible to waste money on unneeded supplements.
• Check the science. Make sure any claim about a dietary supplement is based on scientific proof. Look for the United States Pharmacopeia (USP) verified mark. USP verifies the identity, quality, strength, and purity of supplements. Information on some dietary supplements is available on MedlinePlus, but it’s important to note that most supplements listed have limited evidence of any benefit. If something sounds too good to be true, it probably is.
• Be a savvy consumer. Some advertisements for dietary supplements in magazines, online, or on TV promise that some of these products will make you feel better, keep you from getting sick, or even help you live longer. It’s important to know that often, there is little, if any, science supporting these claims.

Dietary supplements for older adults

People over age 50 may need more of some vitamins and minerals than younger adults do. Your doctor or a dietitian can tell you whether you need to change your diet or take a vitamin or mineral supplement to get enough of these:

• Calcium: Calcium works with vitamin D to keep bones strong at all ages. Bone loss can lead to fractures in both older women and men. Calcium is found in milk and milk products (fat-free or low-fat is best), canned fish with soft bones, dark-green leafy vegetables like kale, and foods with calcium added, such as breakfast cereals.
• Vitamin D: Most people in the United States consume less than recommended amounts of vitamin D. Talk with your doctor about adding vitamin D-fortified milk and milk products, vitamin D-fortified cereals, and fatty fish to your diet, or using a vitamin D supplement.
• Vitamin B6: This vitamin is needed to form red blood cells. It is found in potatoes, bananas, chicken breasts, and fortified cereals.
• Vitamin B12: This helps keep your red blood cells and nerves healthy. While older adults need just as much vitamin B12 as other adults, some have trouble absorbing the vitamin naturally found in food. If you have this problem, your doctor may recommend that you eat foods like fortified cereals with this vitamin added, or take a B12 supplement. Strict vegetarians and vegans are at greater risk of developing vitamin B12 deficiency because natural food sources of vitamin B12 are limited to animal foods. Talk with your doctor about whether taking a B12 supplement is right for you.

What are antioxidants?

You might hear about antioxidants in the news. These are natural substances in food that might help protect you from some diseases. Here are some common antioxidants that you should be sure to include in your diet:

• Beta-carotene: Found in fruits and vegetables that are either dark green or dark orange
• Selenium: Found in seafood, liver, meat, and grains
• Vitamin C: Found in citrus fruits, peppers, tomatoes, and berries
• Vitamin E: Found in wheat germ, nuts, and sesame seeds; and canola, olive, and peanut oils

Currently, research results suggest that large doses of supplements with antioxidants will not prevent chronic diseases such as heart disease or diabetes. In fact, some studies have shown that taking large doses of some antioxidants could be harmful. Again, it is best to check with your doctor before taking a dietary supplement.

Herbal supplements and older adults

Herbal supplements are dietary supplements that come from plants. These types of supplements are taken by mouth, whether it’s by a capsule, tablet, powder, or liquid.

A few that you may have heard of are ginkgo biloba, ginseng, echinacea, and black cohosh. Researchers are looking at using herbal supplements to prevent or treat some health problems, but it’s too early to know if these are both safe and useful. Previous studies of certain herbal supplements have not shown any benefits.

It’s important to know that just because a supplement is natural, or comes from plants, that doesn’t necessarily mean it’s safe.

Are dietary supplements safe?

The U.S. Food and Drug Administration (FDA) checks prescription medicines, such as antibiotics or blood pressure drugs, to make sure they are safe and do what they promise. The same is true for over-the-counter drugs such as pain and cold medicines. However, the FDA does not have authority over dietary supplements, which do not have to be approved by this agency for safety or efficacy before being sold to the public.

The federal government does not regularly test what is in dietary supplements, and companies are not required to share information about the safety of these products with the FDA before they sell them. So, just because a dietary supplement is on a store shelf, that does not mean it is safe, does what the label says it will, or contains what the label states.

If the FDA receives reports of possible problems with a supplement, it will issue warnings about the product. The FDA may also take supplements that are found to be unsafe off the market.

The Federal Trade Commission investigates reports of ads that might misrepresent what dietary supplements do. A few private groups, such as the U.S. Pharmacopeia, NSF International, ConsumerLab.com, and the Natural Products Association, have their own “seals of approval” for dietary supplements. To earn such a seal, products must be made by following good manufacturing procedures, must contain what is listed on the label, and must not have harmful levels of ingredients that don’t belong there, such as lead.

Whether you take dietary supplements or not, it’s still important to follow a healthy lifestyle. Try sticking to a healthy diet, being physically active, keeping your mind active, not smoking, and seeing your doctor regularly.

To learn more, please visit https://www.nia.nih.gov/health/vitamins-and-supplements/dietary-supplements-older-adults.

Alzheimer’s disease often affects a person’s sleeping habits. People with Alzheimer’s may experience the following sleep problems:

• Sleeping a lot or not enough
• Waking up many times during the night
• Napping a lot during the day
• Restlessness, agitation, irritability, and confusion as daylight begins to fade, known as sundowning

Here are some tips that may help caregivers ease sleep problems in people with Alzheimer’s: 

• Help the person get exercise each day.
• Limit naps and dozing late in the day.
• Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest meal in the middle of the day.
• Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce noise levels, and play soothing music if the person enjoys it.
• Follow a regular schedule by going to sleep and getting up at the same time each day, even on weekends or when traveling.
• Develop a relaxing bedtime routine with lowered lights, cool temperature, and no electronic screens.
• Avoid alcohol and caffeine.
• Use nightlights in the bedroom, hall, and bathroom.

Getting Help with Sleep Problems

If sleep problems continue to be a challenge, talk with a health care provider. They may be able to identify possible causes and suggest solutions. For example, a person with Alzheimer’s may have a medical condition or take a medication that causes sleep problems. In other cases, Alzheimer’s itself may be causing changes to the brain that disrupts sleep. The health care provider may recommend medication or nonmedication strategies to help the person sleep well.

To learn more, please visit https://www.nia.nih.gov/health/sleep/managing-sleep-problems-alzheimers-disease.

Many factors influence healthy aging. Some of these, such as genetics, are not in our control. Others — like exercise, a healthy diet, going to the doctor regularly, and taking care of our mental health — are within our reach. Research supported by NIA and others has identified actions you can take to help manage your health, live as independently as possible, and maintain your quality of life as you age. Read on to learn more about the research and the steps you can take to promote healthy aging.

Taking care of your physical health

While scientists continue to actively research how to slow or prevent age-related declines in physical health, they’ve already discovered multiple ways to improve the chances of maintaining optimal health later in life. Taking care of your physical health involves staying active, making healthy food choices, getting enough sleep, limiting your alcohol intake, and proactively managing your health care. Small changes in each of these areas can go a long way to support healthy aging.

Get moving: Exercise and physical activity

Whether you love it or hate it, physical activity is a cornerstone of healthy aging. Scientific evidence suggests that people who exercise regularly not only live longer, but also may live better — meaning they enjoy more years of life without pain or disability.

A study of adults 40 and older found that taking 8,000 steps or more per day, compared to only taking 4,000 steps, was associated with a 51% lower risk of death from all causes. You can increase the number of steps you get each day by doing activities that keep your body moving, such as gardening, walking the dog, and taking the stairs instead of the elevator.

Although it has many other benefits, exercise is an essential tool for maintaining a healthy weight. Adults with obesity have an increased risk of death, disability, and many diseases such as type 2 diabetes and high blood pressure. However, thinner is not always healthier either. Being or becoming too thin as an older adult can weaken your immune system, increase the risk of bone fracture, and in some cases may be a symptom of disease. Both obesity and underweight conditions can lead to loss of muscle mass, which may cause a person to feel weak and easily worn out.

As people age, muscle function often declines. Older adults may not have the energy to do everyday activities and can lose their independence. However, exercise can help older adults maintain muscle mass as they age. In a 2019 investigation of data from NIA’s Baltimore Longitudinal Study of Aging, researchers found that moderate to vigorous physical activity is strongly associated with muscle function, regardless of age. This suggests that exercise may be able to prevent age-related decline in muscle function.

In addition to helping older adults live better, maintaining muscle mass can help them live longer. In another study, researchers found that in adults older than 55, muscle mass was a better predictor of longevity than was weight or body mass index (BMI).

What can you do?

Although many studies focus on the effects of physical activity on weight and BMI, research has found that even if you’re not losing weight, exercise can still help you live longer and better. There are many ways to get started. Try being physically active in short spurts throughout the day or setting aside specific times each week to exercise. Many activities, such as brisk walking or yoga, are free or low cost and do not require special equipment. As you become more active, you will start feeling energized and refreshed after exercising instead of exhausted. The key is to find ways to get motivated and get moving.

Healthy eating: Make smart food choices

Making smart food choices can help protect you from certain health problems as you age and may even help improve brain function. As with exercise, eating well is not just about your weight. With so many different diets out there, choosing what to eat can be confusing. The 2020-2025 Dietary Guidelines for Americans provide healthy eating recommendations for each stage of life. The Dietary Guidelines suggest an eating pattern with lots of fresh fruits and vegetables, whole grains, healthy fats, and lean proteins.

Much of the research shows that the Mediterranean-style eating pattern, which includes fresh produce, whole grains, and healthy fats, but less dairy and more fish than a traditional American diet, may have a positive impact on health. A 2021 study analyzing the eating patterns of more than 21,000 participants found that people closely following the Mediterranean-style pattern had a significantly lower risk of sudden cardiac death.

A low-salt diet called Dietary Approaches to Stop Hypertension (DASH) has also been shown to deliver significant health benefits. Studies testing the DASH diet found that it lowers blood pressure, helps people lose weight, and reduces the risk of type 2 diabetes and heart disease.

Yet another eating pattern that may support healthy aging is the MIND diet, which combines a Mediterranean-style eating pattern with DASH. Researchers have found that people who closely follow the MIND diet have better overall cognition — the ability to clearly think, learn, and remember — compared to those with other eating styles.

What can you do?

Try starting with small changes by adopting one or two aspects of the Mediterranean-style eating pattern or MIND diet. Several studies have shown that incorporating even a part of these eating patterns, such as more fish or more leafy greens, into your daily eating habits can improve health outcomes. One study of 182 older adults with frequent migraines found that a diet lower in vegetable oil and higher in fatty fish could reduce migraine headaches. Another study that followed almost 1,000 older adults over five years found that consumption of green leafy vegetables was significantly associated with slower cognitive decline.

Even if you haven’t thought much about healthy eating until recently, changing your diet now can still improve your well-being as an older adult. If you are concerned about what you eat, talk with your doctor about ways you can make better food choices.

Getting a good night’s sleep

Getting enough sleep helps you stay healthy and alert. Even though older adults need the same seven to nine hours of sleep as all adults, they often don’t get enough. Feeling sick or being in pain can make it harder to sleep, and some medicines can keep you awake. Not getting enough quality sleep can make a person irritable, depressed, forgetful, and more likely to have falls or other accidents.

Sleep quality matters for memory and mood. In one study of adults older than 65, researchers found that those who had poor sleep quality had a harder time problem-solving and concentrating than those who got good quality sleep. Another study, which looked at data from nearly 8,000 people, showed that those in their 50s and 60s who got six hours of sleep or less a night were at a higher risk of developing dementia later in life. This may be because inadequate sleep is associated with the buildup of beta-amyloid, a protein involved in Alzheimer’s disease. Poor sleep may also worsen depression symptoms in older adults. Emerging evidence suggests that older adults who were diagnosed with depression in the past, and do not get quality sleep, may be more likely to experience their depression symptoms again.

More generally, a 2021 study found that older adults who did not sleep well and napped often were at greater risk of dying within the next five years. Conversely, getting good sleep is associated with lower rates of insulin resistance, heart disease, and obesity. Sleep can also improve your creativity and decision-making skills, and even your blood sugar levels.

What can you do?

There are many things you can do to help you sleep better, such as following a regular sleep schedule. Try to fall asleep and get up at the same time each day. Avoid napping late in the day, as this may keep you awake at night. Exercise can help you sleep better, too, if it isn’t too close to bedtime. Research suggests that behavioral interventions, such as mindfulness meditation, can also improve sleep quality.

Quit smoking

It doesn’t matter how old you are or how long you’ve been smoking, research confirms that even if you’re 60 or older and have been smoking for decades, quitting will improve your health. Quitting smoking at any age will:

• Lower your risk of cancer, heart attack, stroke, and lung disease
• Improve your blood circulation
• Improve your sense of taste and smell
• Increase your ability to exercise
• Set a healthy example for others

One study found that among men 55 to 74 years old and women 60 to 74 years old, current smokers were three times more likely to die within the six-year follow-up period than those who had never smoked.

What can you do?

If you smoke, quit. Quitting smoking is good for your health and may add years to your life. One study of nearly 200,000 people demonstrated that older adults who quit smoking between the ages of 45 and 54 lived about six years longer compared to those who continued to smoke. Adults who quit between the ages of 55 to 64 lived about four years longer. It is never too late to stop smoking and reap the benefits of breathing easier, having more energy, saving money, and improving your health.

Alcohol and other substances

Like all adults, older adults should avoid or limit alcohol consumption. In fact, aging can lead to social and physical changes that make older adults more susceptible to alcohol misuse and abuse and more vulnerable to the consequences of alcohol. Alcohol dependence or heavy drinking affects every organ in the body, including the brain.

A comprehensive study from the National Institute on Alcohol Abuse and Alcoholism shows that alcohol consumption among older adults, especially women, is on the rise. The researchers also found evidence that certain brain regions show signs of premature aging in alcohol-dependent men and women. In addition, heavy drinking for extended periods of time in older adults may contribute to poor heart health, as shown in this 2016 study. These studies suggest that stopping or limiting the use of alcohol could improve heart health and prevent the accelerated aging seen with heavy alcohol use.

In addition to being cautious with alcohol, older adults and their caregivers should be aware of other substances that can be misused or abused. Because older adults are commonly prescribed opioids for pain and benzodiazepines for anxiety or trouble sleeping, they may be at risk for misuse and dependence on these substances. One study of adults age 50 and older showed that misuse of prescription opioids or benzodiazepines is associated with thoughts of suicide.

What can you do?

Learn about the current U.S. guidelines for drinking and when to avoid alcohol altogether. It’s important to be aware of how much you are drinking and the harm that drinking can cause. If you or a loved one needs help with substance abuse or alcohol use, talk with your doctor or a mental health professional. You can also try finding a support group for older adults with substance or alcohol abuse issues.

Learn about substance use in older adults and get tips on how to stop drinking alcohol or drink less alcohol.

Go to the doctor regularly

Going to the doctor for regular health screenings is essential for healthy aging. A 2021 study found that getting regular check-ups helps doctors catch chronic diseases early and can help patients reduce risk factors for disease, such as high blood pressure and cholesterol levels. People who went to the doctor regularly also reported improved quality of life and feelings of wellness.

In recent years, scientists have developed and improved upon laboratory, imaging, and similar biological tests that help uncover and monitor signs of age-related disease. Harmful changes in the cells and molecules of your body may occur years before you start to experience any symptoms of disease. Tests that detect these changes can help medical professionals diagnose and treat disease early, improving health outcomes.

What can you do?

Visit the doctor at least yearly and possibly more depending on your health. You cannot reap the benefits of medical advancements without regular trips to the doctor for physical exams and other tests. Regular screenings can uncover diseases and conditions you may not yet be aware of, such as diabetes, cancer, and cardiovascular disease. If you only seek medical attention when you’re experiencing symptoms, you may lose the chance of having your doctor catch a disease in its earliest stages, when it would be most treatable. Regular check-ups can help ensure you could start treatment months or years earlier than would have been possible otherwise.

Taking care of your mental health

Mental health, or mental wellness, is essential to your overall health and quality of life. It affects how we think, feel, act, make choices, and relate to others. Managing social isolation, loneliness, stress, depression, and mood through medical and self-care is key to healthy aging.

Social isolation and loneliness

As people age, changes such as hearing and vision loss, memory loss, disability, trouble getting around, and the loss of family and friends can make it difficult to maintain social connections. This makes older adults more likely to be socially isolated or to feel lonely. Although they sound similar, social isolation and loneliness are different. Loneliness is the distressing feeling of being alone or separated, while social isolation is the lack of social contacts and having few people to interact with regularly.

Several recent studies show that older adults who are socially isolated or feel lonely are at higher risk for heart disease, depression, and cognitive decline. A 2021 study of more than 11,000 adults older than age 70 found that loneliness was associated with a greater risk of heart disease. Another recent study found that socially isolated older adults experienced more chronic lung conditions and depressive symptoms compared to older adults with social support.

Feeling lonely can also impact memory. A study of more than 8,000 adults older than 65 found that loneliness was linked to faster cognitive decline.

Research also shows that being socially active can benefit older adults. A study of more than 3,000 older adults found that making new social contacts was associated with improved self-reported physical and psychological well-being. Being social may also help you reach your exercise goals. A 2019 study found that older adults who had regular contact with friends and family were more physically active than those who did not.

What can you do?

Staying connected with others may help boost your mood and improve your overall well-being. Stay in touch with family and friends in person or over the phone. Scheduling time each day to connect with others can help you maintain connections. Meet new people by taking a class to learn something new or hone a skill you already have.

Stress

Stress is a natural part of life and comes in many forms. Sometimes stress arises from difficult events or circumstances. Positive changes, like the birth of a grandchild or a promotion, can cause stress too. Research shows that constant stress can change the brain, affect memory, and increase the risk of developing Alzheimer’s or related dementias.

Older adults are at particular risk for stress and stress-related problems. A recent study examined how levels of the stress hormone cortisol change over time. Researchers have found that cortisol levels in a person’s body increase steadily after middle-age, and that this age-related increase in stress may drive changes in the brain. A meta-analysis funded by the National Institute of Mental Health supports the notion that stress and anxiety rewire the brain in ways that can impact memory, decision-making, and mood.

Finding ways to lower stress and increase emotional stability may support healthy aging. In an analysis of data from the Baltimore Longitudinal Study of Aging, scientists followed 2,000 participants for more than five decades, monitoring their mood and health. The data reveal that individuals who were emotionally stable lived on average three years longer than those who had a tendency toward being in a negative or anxious emotional state. Long-term stress also may contribute to or worsen a range of health problems, including digestive disorders, headaches, and sleep disorders.

What can you do?

You can help manage stress with meditation techniques, physical activity, and by participating in activities you enjoy. Keeping a journal may also help you identify and challenge negative and unhelpful thoughts. Reach out to friends and family who can help you cope in a positive way.

Depression and overall mood

Although depression is common in older adults, it can be difficult to recognize. For some older adults with depression, sadness is not their main symptom. Instead, they might feel numb or uninterested in activities and may not be as willing to talk about their feelings. Depression not only affects mental health, but also physical health. A review article funded by the National Heart, Lung, and Blood Institute summarizes hundreds of studies from around the world showing that depression increases risk of heart disease and metabolic disorders. Research has also shown that recurrent depression is a risk factor for dementia. In a study of more than 1,000 older adults, scientists found a relationship between the number of depressive episodes and increased risk of developing Alzheimer’s.

Although different than depression, which is a serious medical disorder, mood changes can also influence aging. A 2020 longitudinal study demonstrated a link between positive mood and better cognitive control. Further studies are necessary to determine whether changes that improve mood could improve cognition. The way you think about aging can also make a difference. Research shows that whether you hold negative or positive views about aging may impact health as you age. Negative beliefs about aging may increase undesirable health outcomes, Alzheimer’s disease biomarkers, and cellular aging. Meanwhile, positive beliefs about aging may decrease the risk of developing dementia and obesity.

What can you do?

Depression, even when severe, can be treated. As soon as you begin noticing signs, it’s important to get evaluated by a health care professional. In addition to deep sadness or numbness, lack of sleep and loss of appetite are also common symptoms of depression in older adults. If you think you or a loved one may have depression, start by making an appointment to see your doctor or health care provider. If you are thinking of harming yourself, get help immediately — call or text the 24-hour 988 Suicide & Crisis Lifeline at 988 or 800-273-TALK (800-273-8255). For TTY, use your preferred relay service or dial 711 then 988.

Leisure activities and hobbies

Your favorite activities are not only fun — they may also be good for your health. Research shows that people who participate in hobbies and social and leisure activities may be at lower risk for some health problems. For example, one study found that participation in a community choir program for older adults reduced loneliness and increased interest in life. Another study showed that older adults who spent at least an hour reading or engaged in other hobbies had a decreased risk of dementia compared to those who spent less than 30 minutes a day on hobbies.

Research on music, theater, dance, creative writing, and other participatory arts shows promise for improving older adults’ quality of life and well-being, from better cognitive function, memory, and self-esteem to reduced stress and increased social interaction. Even hobbies as simple as taking care of a pet can improve your health. According to a 2020 study, pet ownership (or regular contact with pets) was associated with better cognitive function, and in some cases, better physical function.

What can you do?

Look for opportunities to participate in activities. Get out and about by going to a sporting event, trying a new restaurant, or visiting a museum. Learn how to cook or play a musical instrument. Consider volunteering at a school, library, or hospital to become more active in your community.

Taking care of your cognitive health

Cognition — the ability to clearly think, learn, and remember — often changes as we age. Although some people develop Alzheimer’s or other types of dementia, many older adults experience more modest changes in memory and thinking. Research shows that healthy eating, staying active, and learning new skills may help keep older adults cognitively healthy.

How different factors affect cognitive health

If you think your daily choices don’t make a difference, data from an NIH study with 3,000 participants show otherwise. Researchers scored participants on five healthy lifestyle factors, all of which have important health benefits:

• At least 150 minutes per week of moderate- to vigorous-intensity physical activity
• Not smoking
• Not drinking heavily
• A high-quality, Mediterranean-style diet
• Engagement in mentally stimulating activities, such as reading, writing letters, and playing games

The findings show that making these small, daily changes can add up to significant health benefits. Those who followed at least four of these healthy lifestyle behaviors had a 60% lower risk of developing Alzheimer’s. Even practicing just two or three activities lowered the risk by 37%. While results from observational studies such as this one cannot prove cause and effect, they point to how a combination of modifiable behaviors may mitigate Alzheimer’s risk and identify promising avenues to be tested in clinical trials.

New clinical trials are also testing the benefits of tightly controlling blood pressure on healthy aging. These trials are based on a 2019 study, with data supporting the idea that intensive blood pressure control may slow age-related brain damage and even mild cognitive impairment, which can increase the risk for Alzheimer’s or a related dementia.

Researchers continue work to understand how we might prevent Alzheimer’s and other forms of age-related cognitive decline. NIA is currently funding more than 350 active clinical trials on Alzheimer’s and related dementias, 100 of which use nondrug interventions, such as exercise, diet, cognitive training, sleep, or combination therapies.

How cognitive training affects health outcomes

Many brain training programs are marketed to the public to improve cognition. Although some of these computer or smartphone-based interventions show promise, so far there is no conclusive evidence that these applications are beneficial.

But there is some evidence that exercising your brain by learning a new skill can improve memory function. A study of adults 60 and older showed that sustained engagement in cognitively demanding, novel activity enhanced memory function. In particular, the new skills learned in this study were 1) learning how to use computer software to edit photos and 2) learning how to quilt. Learning a new game, instrument, craft, or other skill can be fun and may have the added benefit of staving off memory loss as you age.

Taking care of your physical, mental, and cognitive health is important for healthy aging. Even making small changes in your daily life can help you live longer and better. In general, you can support your physical health by staying active, eating and sleeping well, and going to the doctor regularly. Take care of your mental health by interacting with family and friends, trying to stay positive, and participating in activities you enjoy. Taking steps to achieve better physical and mental health may reduce your risk for Alzheimer’s and related dementias as you age.

Next steps

There is still a lot to learn, though, about how people age and what habits support healthy aging. Scientists are exploring these questions with studies that look at physical, mental, and cognitive health. You can be a part of scientific progress by joining a clinical trial or research study in person or online. All types of volunteers are needed, including caregivers, older adults with medical conditions, and those who are healthy.

To explore all trials funded by NIH, visit ClinicalTrials.gov. To find Alzheimer’s and related dementias research studies, visit the Alzheimers.gov Clinical Trials Finder. Every treatment available today is due to people like you who choose to participate in clinical research.

To learn more, please visit https://www.nia.nih.gov/health/healthy-aging/what-do-we-know-about-healthy-aging.

Bluegrass Consulting Group, a Majestic Management company, is proud to announce the acquisition of Wellington Parc Nursing and Rehabilitation, an 80-bed skilled nursing facility in Owensboro, Kentucky. This acquisition reflects Bluegrass Consulting Group’s continued commitment to strengthening senior care services across the state of Kentucky while upholding the values of compassion, dignity, and excellence in care.

Located in Owensboro, Kentucky, Wellington Parc Nursing and Rehabilitation offers compassionate 24-hour skilled nursing care in its 80-bed facility. The Care Team is specially trained to work with seniors, providing personalized therapy and care programs designed to maximize independence and enhance quality of life. Services include daily living assistance, balance training, medication management, IV therapy, and diabetes management.

“We are thrilled to expand our footprint in the great state of Kentucky with the addition of Wellington Parc Nursing and Rehabilitation in Owensboro,” said Paul Pruitt, Chief Executive Officer of Majestic Management. “At Bluegrass Consulting Group, our mission is clear: Through the hearts of our Care Team members, we provide excellent healthcare to those we serve. This new community reflects that mission and reinforces our Brand Promise of Excellent Healthcare. Our dedicated Care Team will ensure that residents and families in Owensboro receive compassionate, personalized care tailored to their needs. As we grow, our focus remains on innovation, compassion, and excellence—working to provide the best possible experiences for those we serve.” Beyond traditional nursing care, Wellington Parc ensures residents have access to a wide range of supportive services, including memory care, and partnerships for private home and hospice care. This holistic approach provides residents and their families with peace of mind knowing comprehensive care is available in one place.

To learn more about Wellington Parc Nursing and Rehabilitation or to schedule a tour of the facility, please call (270) 685-2374.

Many people want the same things as they get older: to stay in their own homes, to maintain independence for as long as possible, and to turn to family and friends for help when needed. Staying in your own home as you get older is called “aging in place.” But many older adults and their families have concerns about safety, getting around, or other daily activities. Living at home as you age requires careful consideration and planning. This article offers suggestions to help you find the help you need to continue to live independently.

Planning ahead for aging in place

The best time to think about how to age in place is before you need a lot of care. Planning ahead allows you to make important decisions while you are still able.

The first step is to think about the kinds of help you need now and might want in the future. You can learn about home-based care and other services in your community and find out what they cost. Planning ahead also gives you time to set up your home to meet your needs as you age.

Another step is to consider any illnesses, such as diabetes or heart disease, that you or your spouse might have. Find out about how the illness could make it hard for someone to get around or take care of themselves in the future. Your health care provider can help answer your questions.

Talk with your family, friends, and other caregivers about what support is needed for you to stay in your home. Be realistic and plan to revisit the decision as your needs change over time.

Support for aging at home

Home-based care includes health, personal, and other support services to help you stay at home and live as independently as possible. In-home services may be short-term — for someone who is recovering from an operation, for example — or long-term, for people who need ongoing help.

In many cases, home-based support is provided at home by informal caregivers, such as family members, friends, and neighbors. It can also be supplemented by formal caregivers and community services.

Help you can receive at home includes:

• Personal care: Help with everyday activities, also called “activities of daily living,” including bathing, dressing, grooming, using the toilet, eating, and moving around — for example, getting out of bed and into a chair
• Household chores: Housecleaning, yard work, grocery shopping, laundry, and similar chores around the house
• Meals: Shopping for food and preparing nutritious meals
• Money management: Tasks such as paying bills and filling out health insurance forms
• Health care: Help with many aspects of health care, including giving medications, caring for wounds, helping with medical equipment, and providing physical therapy
• Transportation: Assistance getting around, such as rides to the doctor’s office or grocery store
• Safety: Home safety features and help in case of a fall or other emergency

Find detailed information about in-home support services, including suggestions for arranging them, information about costs, and additional resources.

Making your home safe and accessible

There are a variety of ways to make your surroundings safer and easier to manage so they meet your needs as you age. Go through your home room by room to identify potential problems and safety issues. First, correct any immediate dangers, such as loose stair railings and poor lighting, and then work on other ways to ensure you will be as safe as possible at home.

See the Worksheet: Home Safety Checklist (PDF, 251K) for suggestions to help you identify and remove hazards around the house. Keep in mind that it may not be necessary to make all of the suggested changes. It is important, however, to reevaluate home safety every so often as your needs change.

Are you worried that making changes might be expensive? You may be able to get help paying for repairs and safety updates to your home. Check with your state housing finance agency, social services department, community development groups, or the federal government for financial aid programs and discounts. You can also visit the Eldercare Locator or call 800-677-1116 for help finding resources.

Resources for aging in place

If staying in your home is important to you, you may have concerns about getting around, being safe, and staying connected. Some of these activities become more challenging as you age. The resources below can help you find solutions.

Reach out to people you know. Family, friends, and neighbors are the biggest source of help for many older people. They may be able to drive you to doctor’s appointments, help with errands and chores, or just keep you company. Talk with those close to you about the best way to get what you need. If you are physically able, think about trading services with a friend or neighbor. For example, one could do the grocery shopping, and the other could cook dinner.

Learn about community resources. Your local Area Agency on Aging, local and state offices on aging or social services, or your tribal organization may have lists of services. These organizations will be familiar with resources available in your community and may have tips for accessing them. Health care providers and social workers may also have suggestions. If you belong to a religious community, find out whether it offers services for older adults or ask for guidance from your pastor, rabbi, or other religious leader.

Get help during the day. Support is available if your regular caregiver isn’t available during the day (for example, because they go to work). Some organizations have volunteers who regularly pay short visits to older adults. The volunteer can provide support, assistance, and companionship. Or you might consider an adult day care program, which can offer social activities, exercise, meals, and personal care during the day. Additionally, respite services provide short-term care for an older adult at home when a regular caregiver isn’t available.

Be prepared for a medical emergency. If you have a serious allergy or medical need, talk with your doctor about whether you should get a medical alert ID bracelet or necklace. You might also consider an emergency medical alert system, which responds to medical and other emergencies via an electronic monitor that a person wears. The monitor alerts emergency personnel when a person becomes lost, falls, or needs urgent medical assistance.

Talk to a geriatric care manager. These specially trained professionals can help find resources to make your daily life easier. They will work with you to form a care plan and find services you need. Geriatric care managers can be especially helpful when family members live far apart. Your doctor or other health care provider may be able to recommend a geriatric care manager, or you can contact the Aging Life Care Association for a list of these professionals in your area.

Look into government resources. Federal, state, and local governments offer many resources for older adults and their families and caregivers. A good place to start is the Eldercare Locator, which connects older Americans and their caregivers with trustworthy local support resources. Visit the Eldercare Locator or call 800-677-1116.

How much will it cost to age in place?

An important part of planning is thinking about how you are going to pay for the help you need. Home-based services can be expensive, but they may cost less than moving into a residential facility, such as assisted living or a nursing home.

How people pay for care depends on their financial situation, their eligibility for assistance programs, and the kinds of services they use. People often rely on a variety of payment sources, including:

• Personal funds, including savings, a pension or other retirement fund, income from investments, or proceeds from the sale of a home.
• Federal and state government programs, such as Medicare, Medicaid, and the U.S. Department of Veterans Affairs (VA). Visit USA.gov for more information about government programs for health care and financial assistance.
• Private financing, including long-term care insurance, reverse mortgages, certain life insurance policies, annuities, and trusts.

Read more about the options for paying for long-term care.

When it’s time to leave home

Most people prefer to stay in their own home for as long as possible. But there may come a time when it’s no longer safe or comfortable to live alone.

The decision about whether and when an older adult should move from their home is often difficult and emotional. Everyone will have their own reasons for wanting (or not wanting) to take such a step. One person may decide a move is right because they can’t or don’t want to manage the home any longer. For another person, the need for regular, hands-on care motivates a change.

Learn as much as you can about the housing options available as you grow older. Talk with your family about the pros and cons of each option before making a decision.

To learn more, please visit https://www.nia.nih.gov/health/aging-place/aging-place-growing-older-home.

Donald came to Wellington Parc for rehabilitation and, with the added challenge of dementia, his recovery journey required a truly collaborative approach. With the combined efforts of our Nursing, Physical Therapy, Occupational Therapy, and Speech Therapy teams, Donald worked hard to regain strength and independence.

Through determination and compassionate care, Donald achieved his goal—he successfully returned to his memory care unit at Calumet Trace Assisted Living! His daughter Holly was by his side to celebrate this incredible milestone, and we couldn’t be happier for both of them.

Congratulations to Donald and his amazing care team on this wonderful achievement!