AgePage

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Exercise and Physical Activity:

Getting Fit for Life

“After walking on a treadmill at the local community center, I knew I’d be happier outside. So, I got a step counter and started walking in my neighborhood. Since then,

I’ve seen yellow tulips bloom in spring and red dogwood leaves drop in fall. I always come home with more energy and happy to go on with the rest of the day.” Marian (age 81)

“Both my wife and I have heart problems. About 2 years ago, we joined our local health club, where we do both endurance and strength training exercises. On the off days, we walk near our house. It’s been lifesaving for us.” (Bob age 69)

These older adults are living proof that exercise and physical activity are good for you, no matter how old you are. In fact, staying active can help you:

• Keep and improve your strength so you can stay independent
• Have more energy to do the things you want to do
• Improve your balance
• Prevent or delay some diseases like heart disease, diabetes, and osteoporosis
• Perk up your mood and reduce depression

You don’t need to buy special clothes or belong to a gym to become more active. Physical activity can and should be part of your everyday life. Find things you like to do. Go for brisk walks. Ride a bike. Dance. Work around the house. Garden. Climb stairs. Swim. Rake leaves. Try different kinds of activities that keep you moving. Look for new ways to build physical activity into your daily routine.

Four Ways to Be Active

To get all of the benefits of physical activity, try all four types of exercise: 1) endurance, 2) strength, 3) balance, and 4) flexibility.

• Try to build up to at least 30 minutes of activity that makes you breathe hard on most or all days of the week. Every day is best. That’s called an endurance activity because it builds your energy or “staying power.” You don’t have to be active for 30 minutes all at once. Ten minutes at a time is fine.
  How hard do you need to push yourself? If you can talk without any trouble at all, you are not working hard enough. If you can’t talk at all, it’s too hard.
• Keep using your muscles. Strength exercises build muscles. When you have strong muscles, you can get up from a chair by yourself, you can lift your grandchildren, and you can walk through the park.
  Keeping your muscles in shape helps prevent falls that cause problems like broken hips. You are less likely to fall when your leg and hip muscles are strong.
• Do things to help your balance. Try standing on one foot, then the other. If you can, don’t hold on to anything for support. Get up from a chair without using your hands or arms. Every now and then walk heel-to-toe. As you walk, put the heel of one foot just in front of the toes of your other foot. Your heel and toes should touch or almost touch.
• 4. Stretching can improve your flexibility. Moving more freely will make it easier for you to reach down to tie your shoes or look over your shoulder when you back the car out of your driveway. Stretch when your muscles are warmed up. Don’t stretch so far that it hurts.

Who Should Exercise?

Almost anyone, at any age, can do some type of physical activity. You can still exercise even if you have a health condition like heart disease or diabetes. In fact, physical activity may help. For most older adults, brisk walking, riding a bike, swimming, weight lifting, and gardening are safe, especially if you build up slowly. But, check with your doctor if you are over 50 and you aren’t used to energetic activity. Other reasons to check with your doctor before you exercise include:

• Any new symptom you haven’t discussed with your doctor
• Dizziness or shortness of breath
• Chest pain or pressure or the feeling that your heart is skipping, racing, or fluttering
• Blood clots
• An infection or fever with muscle aches
• Unplanned weight loss
• Foot or ankle sores that won’t heal
• Joint swelling
• A bleeding or detached retina, eye surgery, or laser treatment
• A hernia
• Recent hip or back surgery

Here are some things you can do to make sure you are exercising safely:

• Start slowly, especially if you haven’t been active for a long time.
• Little by little build up your activities and how hard you work at them.
• Don’t hold your breath during strength exercises. That could cause changes in your blood pressure. It may seem strange at first, but you should breathe out as you lift something, and breathe in as you relax.
• Use safety equipment. For example, wear a helmet for bike riding or the right shoes for walking or jogging.
• Unless your doctor has asked you to limit fluids, be sure to drink plenty when you are doing activities. Many older adults don’t feel thirsty even if their body needs fluids.
• Always bend forward from the hips, not the waist. If you keep your back straight, you’re probably bending the right way. If your back “humps,” that’s probably wrong.
• Warm up your muscles before you stretch. Try walking and light arm pumping first.
  Exercise should not hurt or make you feel really tired. You might feel some soreness, a little discomfort, or a bit weary, but you should not feel pain. In fact, in many ways, being active will probably make you feel better.

For More Information

Local fitness centers or hospitals might be able to help you find a physical activity program that works for you. You also can check with nearby religious groups, senior and civic centers, parks, recreation associations, YMCAs, YWCAs, or even area shopping malls for exercise, wellness, or walking programs.

Looking for more information on how to exercise safely? Check out Go4Life®, at www.nia.nih.gov/Go4Life. This exercise and physical activity campaign from the National Institute on Aging has exercises, success stories, and free video and print materials. Many groups have information about physical activity and exercise for older adults. The following list of resources will help you get started:

American College of Sports
Medicine
401 West Michigan Street
Indianapolis, IN 46202-3233
1-317-637-9200
www.acsm.org

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-800-232-4636 (toll-free)
1-888-232-6348 (TTY/toll-free)
www.cdc.gov

National Library of Medicine
Medline Plus
“Exercise for Seniors”
“Exercise and Physical Fitness”
www.medlineplus.gov

President’s Council on Fitness, Sports, and Nutrition
1101 Wootton Parkway, Suite 560
Rockville, MD 20852
1-240-276-9567
www.fitness.gov

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Falls and Fractures

A simple thing can change your life—like tripping on a rug or slipping on a wet floor. If you fall, you could break a bone, like thousands of older men and women do each year. A broken bone might not sound awful. But, for older people, a break can be the start of more serious problems.

Many things can cause a fall. Your eyesight, hearing, and reflexes might not be as sharp as they were when you were younger. Diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can affect your balance. Some medicines can cause you to feel dizzy or sleepy, making you more likely to fall.

But don’t let a fear of falling keep you from being active. Doing things like getting together with friends, gardening, walking, or going to the local senior center helps you stay healthy. The good news is that there are simple ways you can prevent most falls.

If you take care of your overall health, you may be able to lower your chances of falling. Most of the time, falls and accidents don’t “just happen.” Here are a few hints that will help you avoid falls and broken bones:

• Stay physically active. Plan an exercise program that is right for you. Regular exercise improves muscles and makes you stronger. It 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.
• Have your eyes and hearing tested. Even small changes in sight and hearing may cause you to fall. When you get new eyeglasses, take time to get used to them. Always wear your glasses when you need them. If you have a hearing aid, be sure it fits well, and wear it.
• Find out about the side effects of any medicine you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
• Get enough sleep. If you are sleepy, you are more likely to fall.
• Limit the amount of alcohol you drink. Even a small amount of alcohol can affect your balance and reflexes.
• Stand up slowly. Getting up too quickly can cause your blood pressure to drop. That can make you feel wobbly.
• Use a walking stick if you need help feeling steady when you walk. If your doctor tells you to use a cane or walker, make sure it is the right size for you and the wheels roll smoothly. This is very important when you’re walking in areas you don’t know well or in places where the walkways are uneven.
• Be very careful when walking on wet or icy surfaces. They can be very slippery! Try to have sand or salt spread on icy areas by your front or back door.
• Wear non-skid, rubber-soled, low-heeled shoes, or lace-up shoes with non-skid soles that fully support your feet. It is important that the soles are not too thin or too thick. Don’t walk around on stairs or floors in socks or in shoes and slippers with smooth soles.

Always tell your doctor if you have fallen since your last checkup—even if you aren’t hurt when you fall.

Weak Bones: Osteoporosis is a disease that makes bones weak and more likely to break. Many people think osteoporosis is only a problem for women, but it can also affect older men. For people with osteoporosis, even a minor fall may be dangerous. Talk to your doctor about whether you have osteoporosis

Your Own Medical Alarm: Think about getting a home-monitoring system. Usually, you wear a button on a chain around your neck. If you fall or need emergency help, you push the button to alert the service. You can find local “medical alarm” services in your yellow pages. Most medical insurance companies and Medicare do not cover home-monitoring systems. Be sure to ask about costs.

Make Your Home Safe

There are many changes you can make to your home that will help you avoid falls and ensure your safety.

In Stairways, Hallways, and Pathways

• Have handrails on both sides of the stairs, and make sure they are tightly fastened. Hold the handrails when you use the stairs, going up or down. If you must carry something while you’re on the stairs, hold it in one hand and use the handrail with the other. Don’t let what you’re carrying block your view of the steps.
• Make sure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Remember to use the lights!
• Keep areas where you walk tidy. Don’t leave books, papers, clothes, and shoes on the floor or stairs.
• Check that all carpets are fixed firmly to the floor so they won’t slip. Put no-slip strips on tile and wooden floors. You can buy these strips at the hardware store.
• Don’t use throw rugs or small area rugs.

In Bathrooms and Powder Rooms

• Mount grab bars near toilets and on both the inside and outside of your tub and shower.
• Place non-skid mats, strips, or carpet on all surfaces that may get wet.
• Remember to turn on night lights.

In Your Bedroom

• Put night lights and light switches close to your bed.
• Keep your telephone near your bed.

In Other Living Areas

• Keep electric cords and telephone wires near walls and away from walking paths.
• Tack down all carpets and large area rugs firmly to the floor.
• Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
• Make sure your sofas and chairs are the right height for you to get in and out of them easily.
• Don’t walk on newly washed floors—they are slippery.
• Keep items you use often within easy reach.
• Don’t stand on a chair or table to reach something that’s too high—use a “reach stick” instead or ask for help. Reach sticks are special grabbing tools that you can buy at many hardware or medical-supply stores. If you use a step stool, make sure it is steady and has a handrail on top. Have someone stand next to you.
• Don’t let your cat or dog trip you. Know where your pet is whenever you’re standing or walking.
• Keep emergency numbers in large print near each telephone.

Home Improvements Prevent Falls

Many State and local governments have education and/or home modification programs to help older people prevent falls. Check with your local health department, senior affairs office, or area agency on aging to see if there is a program near you.

Here are some helpful resources:

Eldercare Locator
1-800-677-1116 (toll-free)
www.eldercare.gov

National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-800-232-4636 (toll-free)
1-888-232-6348 (TTY/toll-free)
www.cdc.gov/ncipc

National Resource Center on
Supportive Housing and Home
Modification
University of Southern California
Fall Prevention Center of Excellence
3715 McClintock Avenue, Room 228
Los Angeles, CA 90089-0191
1-213-740-1364
www.homemods.org

Rebuilding Together
1899 L Street, NW, Suite 1000
Washington, DC 20036
1-800-473-4229 (toll-free)
www.rebuildingtogether.org

Looking for more information about exercise? Check out Go4Life® at www.nia.nih.gov/Go4Life. This exercise and physical activity campaign from the National Institute on Aging has exercises, success stories, and free video and print materials.

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Flu-Get the Shot

Each winter, millions of people suffer from seasonal flu. Flu—the short name for influenza—is caused by viruses. Viruses are very small germs. Some viruses can spread easily from one person to another. They cause illnesses or infections like the flu.

Flu is a mild illness for some people. For older people, especially those who have health problems like diabetes or heart disease, the flu can be very serious, even life threatening.

How Serious Is Flu?

Most people who get the flu feel much better in a week or two. But, some people can get very sick. For example, because your body is busy fighting off the flu, you might pick up a second infection. Older people are at great risk of these secondary infections, such as pneumonia.

How Does Flu Spread?

It was mid-November, and Ellen had not gotten a flu shot. One day she was out having lunch with a friend and noticed people sneezing and coughing at the next table. Two days later, Ellen woke up feeling achy and had a fever. She had the flu. Her husband Jack took care of her and was careful to wash his hands after touching Ellen’s dishes. But, a few days later he too was sick. Maybe he used the phone just after Ellen finished talking with their son. Or maybe he touched a doorknob Ellen used after sneezing. Flu spreads easily from one person to another.

The flu is contagious—that means it spreads from person to person, often through the air. You can pass on the infection before you feel sick. You are contagious for several days after you get sick. You can catch the flu when someone near you coughs or sneezes. Or if you touch something the virus is on, like Ellen and Jack’s phone or doorknob, and then touch your nose or mouth, you could catch the flu. The flu virus can live on a surface like a book or doorknob for a number of hours. Remember to wash your hands often when you are around someone who is sick. Make a point of washing them before eating and touching your eyes, nose, or mouth. If you can, stay away from sick people. That will help stop the flu from spreading.

Is It the Flu or a Cold?

It’s easy to confuse a common cold with seasonal flu. A cold is milder than the flu, but since the flu can make older people very sick, you should know the difference. That way you will know when to call the doctor, who might want to give you a prescription for medicines that can help you get over the flu. People with the flu can have fever, chills, dry cough, general aches and pains, and a headache. They feel very tired. Sore throat, sneezing, stuffy nose, or stomach problems are less common. What some people call “stomach flu” is not influenza.

Can Flu Be Prevented?

Getting a flu shot every year can help you stay healthy. A flu shot contains the flu vaccine, which could keep you from getting the flu. Medicare will pay for the shot, and so will many private health insurance plans. You can get a flu shot at your doctor’s office or from your local health department. Sometimes grocery or drug stores offer flu shots. The vaccine is the same wherever you receive it. A flu shot won’t keep everyone healthy. But, getting the flu shot every year can mean that if you do get the flu, you might have only a mild case.

Who Should Get a Flu Shot?

The Centers for Disease Control and Prevention, part of the Federal Government, says that people age 50 and older should get a flu shot every year. Anyone who lives with or takes care of people age 50 or older should also have a flu shot every year.

When Should I Get My Flu Shot?

Most people get the flu between November and April. That’s why that time is called the flu season. It takes at least 2 weeks for your shot to start working, so try to get your flu shot in October or early November. Don’t worry if you can’t get your flu shot before the flu season starts. The shot can help keep you healthy no matter when you get it.

Why Do You Need a Flu Shot Every Year?

You need a flu shot every year for two reasons. First, flu viruses change. Each year’s virus may be just a little different. If the virus changes, the vaccine used in the flu shot is changed. Second, the protection you get from a flu shot lessens with time, especially in older people. So, you should get the shot every fall to do your best to stay protected from the flu.

Are There Side Effects?

Most people have no problem with a flu shot. In fact, for most people, the flu is far more dangerous than the flu shot.

When you get the flu shot, your arm might be sore, red, or a bit swollen. These side effects may start shortly after getting the shot and can last up to 2 days. They should not get in the way of your daily activities. A few people do have a headache or a low-grade fever for about a day after they get the shot. The flu shot cannot cause you to get the flu.

If you are allergic to eggs, you should not get the flu shot. Because eggs are used to make the flu vaccine, people who are allergic to eggs could have a serious reaction to the shot.

What Can I Do if I Get the Flu?

If you get the flu, there are things you can do to feel better. First, call your doctor to see if there are medicines that can help. Remind him or her if you are taking drugs to fight cancer or other medicines that make it hard for your body to fight illness. There are prescription drugs, called antivirals that are used to treat people with the flu. If you take them within 48 hours after the flu begins, these drugs can make you feel better more quickly. Antibiotics do not help you get over the flu. They are sometimes prescribed to help you get over a secondary infection if it is caused by bacteria. Bacteria are a different type of germ than viruses.

Antivirals can also be used to prevent flu. If you hear that there is a flu outbreak in your area, check with your doctor. He or she could prescribe an antiviral that might protect you. Prevention is the key. The first choice for preventing the flu is a flu shot.

If you are sick, try to rest in bed and drink plenty of fluids, like juice and water but not alcohol. Medicine such as aspirin or acetaminophen can bring down your fever, which might help with the aches and pains. It is important not to smoke if you are sick with the flu. It is a respiratory illness that can infect your lungs, as well as your nasal passages. These same areas are also bothered by smoking. Take it easy as much as you can until you are well.

What about the “Bird Flu”?

Sometimes a new, different kind of flu virus appears. You may have heard about the avian or bird flu. This flu is an example of how changes in a flu virus might lead to serious illness. However, there is some good news about bird flu. It is rare in people. In most cases, the bird flu has not passed from one person to another, and so, it might not become widespread in humans. But this could change over time. Scientists are working on new vaccines that can help protect people from bird flu. Right now, having seasonal flu does not build your body’s protection against bird flu.

Things to Remember About the Flu

• The flu can be dangerous for older people.
• The flu can be prevented.
• Older people need the flu shot every year.
• Medicare pays for the flu shot.
• The flu shot is safe.

For More Information

National Institute of Allergy and
Infectious Diseases
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612
1-301-496-5717
1-866-284-4107 (toll-free)
1-800-877-8339 (TDD/toll-free)
www.niaid.nih.gov

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-800-232-4636 (toll-free)
1-888-232-6348 (TTY/toll-free)
www.cdc.gov
www.flu.gov

Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857
1-888-463-6332 (toll-free)
www.fda.gov

American Lung Association
1301 Pennsylvania Avenue, NW
Suite 800
Washington, DC 20004
1-800-586-4872 (toll-free)
www.lungusa.org

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Healthy Eating After 50

“Food just doesn’t taste the same anymore.”

“I can’t get out to go shopping.”

“I’m just not that hungry.”

Sound familiar? These are a few common reasons some older people don’t eat healthy meals. But, choosing healthy foods is a smart thing to do—no matter how old you are!

Here are some tips to get you started:

• Eat many different colors and types of vegetables and fruits.
• Make sure at least half of your grains are whole grains.
• Eat only small amounts of solid fats and foods with added sugars.
• Limit saturated fat (found mostly in foods that come from animals) and trans fats (found in foods like store-bought baked goods and some margarines).
• Eat seafood twice a week.

Two Plans for Smart Food Choices

The Dietary Guidelines for Americans, 2010 from the U.S. Department of Agriculture (USDA) and Department of Health and Human Services (HHS) describes two eating plans. Eating a variety of foods from each food group in either plan will help you get the nutrients you need.

One plan is called the USDA Food Patterns. It suggests that people 50 or older choose healthy foods every day from the following:

Fruits—1-½ to 2-½ cups
What is the same as ½ cup of cut-up fruit?

• A 2-inch peach or
• 1/4 cup of dried fruit

Vegetables—2 to 3-½ cups
What is the same as a cup of cut-up vegetables?

• Two cups of uncooked leafy vegetable

Grains—5 to 10 ounces
What is the same as an ounce of grains?

• A small muffin
• A slice of bread
• A cup of flaked, ready-to-eat cereal or
• 1/2 cup of cooked rice or pasta

Protein foods—5 to 7 ounces
What is the same as an ounce of meat, fish, or poultry?

• One egg
• 1.4 cup of cooked beans or tofu
• 1/2 ounce of nuts or seeds, or 1 tablespoon of peanut butter

Dairy foods—3 cups of fat-free or low-fat milk
What is the same as 1 cup of milk?

• One cup of yogurt
• 1-1/2 to 2 ounces of cheese
• One cup of cottage cheese is the same as 1/2 cup of milk.

Oils—5 to 8 teaspoons
What is the same as oil added during cooking?

• Foods like olives, nuts, and avocado have a lot of oil in them.

Solid fats and added sugars (SoFAS) — keep the amount of SoFAS small

If you eat too many foods containing SoFAS, you will not have enough calories for the nutritious foods you should be eating.

Your doctor may want you to follow a certain diet because you have a health problem like heart disease or diabetes. Or, you might have been told to avoid eating certain foods because they can change how well your medicines work. Talk to your doctor or a registered dietitian about foods you can eat instead.

Here’s a tip: Stay away from “empty calories.” These are foods and drinks with a lot of calories but not many nutrients—for example, chips, cookies, soda, and alcohol.

The second eating plan is called the DASH Eating Plan. DASH stands for Dietary Approaches to Stop Hypertension. DASH is a lot like the Food

Patterns, but following this plan can help you lower your blood pressure.

See “For More Information” at the end of this AgePage to find out more about DASH.

How Much Should I Eat?

How much you should eat depends on how active you are. If you eat more calories than your body uses, you gain weight. What are calories? Calories are a way to count how much energy is in food. The energy you get from food helps you do the things you need to do each day. Try to choose foods that have a lot of the nutrients you need, but not many calories.

Just counting calories is not enough for making smart choices. Think about this: a medium banana, 1 cup of flaked cereal, 1-1/2 cups of cooked spinach, 1 tablespoon of peanut butter, or 1 cup of 1% milk all have roughly the samen number of calories. But the foods are different in many ways. Some have more of the nutrients you might need than others do. For example, milk gives you more calcium than a banana, and peanut butter gives you more protein than cereal. Some foods can make you feel fuller than others.

Here’s a tip: In the USDA Food Patterns, eating the smallest amount suggested for each food group gives you about 1,600 calories. The largest amount has 2,800 calories.

How Much Is On My Plate?

How does the food on your plate compare to how much you should be eating? Here are some ways to see how the food on your plate measures up:

• deck of cards = 3 ounces of meat or poultry
• ½ baseball = ½ cup of fruit, rice, pasta, or ice cream
• baseball = 1 cup of salad greens
• 4 dice = 1-. ounces of cheese
• tip of your first finger = 1 teaspoon of butter or margarine
• ping pong ball = 2 tablespoons of peanut butter
• fist = 1 cup of flaked cereal or a baked potato
• compact disc or DVD = 1 pancake or tortilla

How Many Calories do people over age 50 need each day?

A woman:

• who is not physically active needs about 1,600 calories
• who is somewhat active needs about 1,800 calories
• who has an active lifestyle needs about 2000–2,200 calories

A man:

• who is not physically active needs about 2,000 calories
• who has an active lifestyle needs about 2,400-2,800 calories
• who has an active lifestyle needs about 2,400-2,800 calories

Here’s a tip: Aim for at least 150 minutes of physical activity each week. Ten-minute sessions several times a day on most days are fine.

Having Problems with Food?

Does your favorite chicken dish taste different? As you grow older, your sense of taste and smell may change. Foods may seem to have lost flavor. Also, medicines may change how food tastes. They can also make you feel less hungry. Talk to your doctor about whether there is a different medicine you could use. Try extra spices or herbs on your foods to add flavor. Maybe some of the foods you used to eat no longer agree with you. For example, some people become lactose intolerant. They have stomach pain, gas, or diarrhea after eating or drinking something with milk in it, like ice cream. Most can eat small amounts of such food or can try yogurt, buttermilk, or hard cheese. Lactose-free foods are available now also. Your doctor can test to see if you are lactose intolerant. Is it harder to chew your food? Maybe your dentures need to fit better, or your gums are sore. If so, a dentist can help you. Until then, you might want to eat softer foods that are easier to chew.

Read The Label

At first, reading labels on food packages may take some time. The facts there can help you make better food choices. Labels have a Nutrition Facts panel. It tells how much protein, carbohydrates, fats, sodium, key vitamins and minerals, and calories are in a serving. The panel also shows how many servings are in the package— sometimes what looks like one serving is really more.Each label also has an ingredients list. Items are listed from largest amount to smallest.

Do I Need To Drink Water?

With age, you may lose some of your sense of thirst. Drink plenty of liquids like water, juice, milk, and soup. Don’t wait until you feel thirsty. Try to add liquids throughout the day. You could try soup for a snack, or drink a glass of water before exercising or working in the yard. Don’t forget to take sips of water, milk, or juice during a meal.

What about Fiber?

Fiber is found in foods from plants— fruits, vegetables, beans, nuts, seeds, and whole grains. Eating more fiber might prevent stomach or intestine problems, like constipation. It might also help lower cholesterol, as well as blood sugar. It is better to get fiber from food than dietary supplements. Start adding fiber slowly. That will help avoid unwanted gas.

Here are some tips for adding fiber:

• Eat cooked dry beans, peas, and lentils often.
• Leave skins on your fruit and vegetables if possible.
• Choose whole fruit over fruit juice.
• Eat whole-grain breads and cereals.
• Drink plenty of liquids to help fiber move through your intestines.

Should I Cut Back On Salt?

The usual way people get sodium is by eating salt. The body needs sodium, but too much can make blood pressure go up in some people. Most fresh foods contain some sodium, especially those high in protein. Salt is added to many canned and prepared foods.

People tend to eat more salt than they need. If you are 51 or older, about 2⁄3 of a teaspoon of table salt—1,500 milligrams (mg) sodium—is all you need each day. That includes all the sodium in your food and drink, not just the salt you add. Try to avoid adding salt during cooking or at the table. Talk to your doctor before using salt substitutes. Some contain sodium. And most have potassium which some people also need to limit. Eat fewer salty snacks and processed foods. Look for the word sodium, not salt, on the Nutrition Facts panel. Choose foods labeled “low-sodium.”

Often, the amount of sodium in the same kind of food can vary greatly between brands.

Here’s a tip: Spices, herbs, and lemon juice can add flavor to your food, so you won’t miss the salt.

What about Fat?

Fat in your diet comes from two places—the fat already in food and the fat added when you cook. Fat gives you energy and helps your body use certain vitamins, but it is high in calories. To lower the fat in your diet:

• Choose cuts of meat, fish, or poultry (with the skin removed) with less fat.
• Trim off any extra fat before cooking.
• Use low-fat dairy products and salad dressings.
• Use non-stick pots and pans, and cook without added fat.
• Choose an unsaturated or monosaturated vegetable oil for cooking—check the label.
• Don’t fry foods. Instead, broil, roast, bake, stir-fry, steam, microwave, or boil them.

Keeping Food Safe

Older people must take extra care to keep their food safe to eat. You are less able to fight off infections, and some foods could make you very sick. Talk to your doctor or a registered dietitian, a nutrition specialist, about foods to avoid.

Handle raw food with care. Keep it apart from foods that won’t be cooked or are already cooked. Use hot soapy water to wash your hands, tools, and work surfaces as you cook.

Don’t depend on sniffing or tasting food to tell what is bad. Try putting dates on foods in your fridge. Check the “use by” date on foods. If in doubt, toss it out.

Here’s a tip: Make sure food gets into the refrigerator no more than 2 hours after it is cooked.

Can I Afford To Eat Right?

If your budget is limited, it might take some planning to be able to pay for the foods you should eat. Here are some suggestions. First, buy only the foods you need. A shopping list will help with that. Buy only as much food as you will use. Here are some other ways to keep your food costs down:

• Plain (generic) labels or store brand
• Plan your meals around food that is on sale.
• Divide leftovers into small servings, label and date, and freeze to use within a few months.

Federal Government programs are available to help people with low incomes buy groceries. To learn more about these programs, contact the Eldercare Locator listed under For More Information to find your local Area Agency on Aging.

For More Information

To learn more about the DASH diet:

National Heart, Lung, and Blood Institute
Box 30105
Bethesda, MD 20824-0105
1-301-592-8573
1-240-629-3255 (TTY)
www.nhlbi.nih.gov

To find out about nutrition, meal programs, or getting help with shopping:

Eldercare Locator
1-800-677-1116 (toll-free)
www.eldercare.gov

Federal Government
Nutrition Websites:
www.nutrition.gov—Learn more about healthy eating, food shopping, assistance programs, and nutrition-related health subjects.
www.healthfinder.gov—Get tips for following a healthier lifestyle.
www.choosemyplate.gov—USDA Food Patterns
www.foodsafety.gov—Learn how to cook and eat safely.

National Library of Medicine MedlinePlus
www.medlineplus.gov

USDA Food and Nutrition Information Center
10301 Baltimore Avenue
Room 105
Beltsville, MD 20705
1-301-504-5414
www.nal.usda.gov/fnic

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Hearing Loss

Hearing loss can affect your life in many ways. It can range from missing certain sounds to total loss of hearing. Hearing loss can be serious. You may not hear the sound of your smoke detector alerting you to a fire. You may miss out on talks with friends or family.

Hearing problems can make you feel anxious, upset, and left out. It’s easy to withdraw from people when you can’t follow what is being said at the dinner table or in a restaurant. Friends and family may think you’re confused, uncaring, or difficult when you’re really having trouble hearing.

If you have a problem hearing, there is help. There are many treatments—hearing aids, certain medicines, or surgery.

How Do I Know if I Have a Hearing Loss?

See your doctor if you:

• Have trouble hearing over the telephone
• Find it hard to follow conversations when two or more people are talking
• Often ask people to repeat what they are saying
• Need to turn up the TV volume so loud that others complain
• Have a problem hearing because of background noise
• Think that others seem to mumble
• Can’t understand when women and children speak to you

Types of Hearing Loss

Hearing loss can have many different causes. Here are two kinds of hearing loss common in older people.

Presbycusis (prez-bee-KYOO-sis) is a common type of hearing loss that comes on slowly as a person ages. It seems to run in families and affects hearing in both ears. The degree of hearing loss varies from person to person. A common sign of early hearing loss is not being able to hear a phone ringing.

Tinnitus (TIH-nih-tuhs or tih-NIEtuhs) causes a ringing, roaring, or hissing noise in your ear. Tinnitus can go hand-in-hand with many types of hearing loss. It can also be a sign of other health problems, such as high blood pressure or allergies. Often it is unclear what causes tinnitus, which may be permanent, come and go, or go away quickly.

Other Hearing Loss Problems

Loud noise is one of the most common causes of hearing loss. Noise from lawn mowers, snow blowers, motorcycles, firecrackers, or loud music can damage the inner ear. This can result in permanent hearing loss. You can prevent most noise-related hearing loss. Protect yourself by turning down the sound on your stereo, television, or headphones; move away from loud noise; or use earplugs or other ear protection.

Ear wax or fluid build-up can block sounds that are carried from the eardrum to the inner ear. If wax blockage is a problem, try using mild treatments, such as mineral oil, baby oil, glycerin, or commercial ear drops, to soften ear wax. A punctured eardrum can also cause hearing loss. The eardrum can be damaged by infection, pressure, or putting objects in the ear, including cotton-tipped swabs. See your doctor if you have pain or fluid draining from the ear.

Viruses and bacteria, heart condition, stroke, brain injuries, or tumors may affect your hearing. If you have hearing problems caused by a new medication, check with your doctor to see if another medicine can be used.

Sudden deafness is a medical emergency that may be curable if treated in time. See a doctor right away.

Talk To Your Doctor

Your family doctor may be able to diagnose and treat your hearing problem. Or, your doctor may refer you to other clinicians such as an otolaryngologist (oh-toh-layr-ehn-GOL-luh-jist), a doctor who specializes in medical problems of the ear, nose, and throat (also called an ENT doctor), or an audiologist (aw-dee-AH-luh-jist), who is trained to measure hearing and provide services to improve hearing. Audiologists can help select the best hearing aid for you and teach you how to use it.

What Devices Can Help?

There are many hearing devices that can help such as:

Hearing aids. Hearing aids are electronic, battery-run devices that make sounds louder. There are many types of hearing aids available. Before buying a hearing aid, check to find out if your insurance will cover the cost. Ask if you can have a trial period so that you can make sure the device is right for you. An audiologist will teach you how to use your hearing aid.

Words to Know When Looking For Hearing Aids

• Analog hearing aids make certain sounds louder, and lower other sounds so that it’s easier to follow conversations.
• Digital hearing aids give you some choice over what sounds are louder or softer. By controlling some background noise, you may hear conversations more easily.
• Telecoil refers to a magnetic coil in a hearing aid that helps you to hear when talking on the telephone or in buildings that have special sound systems.
• Induction loop systems can help you hear better in some public places such as auditoriums, movie theaters, churches, synagogues, and meeting places where microphones are used. Ask if the place you’re visiting has one.

Hearing aids should fit comfortably in your ear. You may need several visits with the audiologist to get it right. Hearing aids may need repairs, and batteries will have to be changed on a regular basis. Remember, when you buy a hearing aid, you are buying both a product and a service.

Assistive devices. There are many products that can help you hear better. For example:

• Telephone amplifying devices can make it easier to use the phone.
• TV and radio listening systems can let you hear the TV or radio without being bothered by background noise or needing to turn up the volume.
• Alert systems can work with doorbells, smoke detectors, and alarm clocks to send you visual signals or vibrations. For example, a flashing light could let you know someone is at the door or the phone is ringing, or a vibrating alarm clock under your pillow could wake you in the morning.

Cochlear implants. These electronic devices are for people with severe hearing loss. Part of the device is surgically implanted under the skin. Another part is visible. You need special training to adjust to an implant. They don’t work for all types of hearing loss.

What Can I Do If I Have Trouble Hearing?

• Let people know that you have trouble hearing.
• Ask people to face you and to speak more slowly and clearly. Also, ask them to speak without shouting.
• Pay attention to what is being said and to facial expressions or gestures.
• Let the person talking know if you do not understand.
• Ask the person speaking to reword a sentence and try again.

How Can I Help A Person With Hearing Loss?

Here are some tips you can use when talking with someone who has a hearing problem:

• Include people with hearing loss in the conversation.
• Find a quiet place to talk to help reduce background noise, especially in restaurants and social gatherings.
• Stand in good lighting and use facial expressions or gestures to give clues.
• Face the person and talk clearly.
• Speak a little more loudly than normal, but don’t shout.
• Speak at a reasonable speed; do not hide your mouth, eat, or chew gum.
• Repeat yourself if necessary, using different words.
• Try to make sure only one person talks at a time.
• Be patient. Stay positive and relaxed.
• Ask how you can help.

Many people develop hearing problems as they grow older. Today, there are many ways to improve your hearing. Asking for professional help as soon as you notice a problem is the best way to handle the problem.

For More Information

American Academy of Audiology
11730 Plaza America Drive, Suite 300
Reston, VA 20190
1-800-222-2336 (toll-free)
www.audiology.org

American Academy of Otolaryngology—
Head and Neck Surgery
1650 Diagonal Road
Alexandria, VA 22314-2857
1-703-836-4444
1-703-519-1585
(TTY) www.entnet.org

American Speech-Language-Hearing
Association
2200 Research Boulevard
Rockville, MD 20850-3289
1-800-638-8255 (toll-free)
1-301-296-5650 (TTY)
www.asha.org

American Tinnitus Association
P.O. Box 5
Portland, OR 97207-0005
1-800-634-8978 (toll-free)
www.ata.org

Hearing Loss Association of America
7910 Woodmont Avenue, Suite 1200
Bethesda, MD 20814
1-301-657-2248
1-301-657-2249 (TTY)
www.hearingloss.org

National Institute on Deafness and
Other Communication Disorders
NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
1-800-241-1044 (toll-free)
1-800-241-1055 (TTY/toll-free)
www.nidcd.nih.gov

National Library of Medicine
Medline Plus
www.medlineplus.gov

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Heart Health

Elena keeps an eye on her husband Frank to make sure he is taking care of his heart. But she was surprised at a recent medical appointment when Dr. Reyes asked about her family’s history of heart disease. When Dr. Reyes heard that Elena’s mother had died after a heart attack, he told Elena that she too should be following a heart healthy lifestyle. He said older women, as well as older men, can have heart problems. So now, Elena and Frank are both taking steps toward heart health.

Your Heart

Your heart is a strong muscle about the size of the palm of your hand. Just like an engine makes a car go, the heart keeps your body running. The heart pumps oxygen-rich blood through a network of blood vessels called arteries (taking blood away from the heart) and veins (bringing blood back to the heart).

An Aging Heart

Some changes in the heart and blood vessels are normal as you grow older. But over time, disease can damage your blood vessels and your heart.

A common problem for older people is arteriosclerosis (ahr-teer-ee-o-skluhroh- sis). This is a stiffening of the arteries that happens, in part, because of growing older. Atherosclerosis (ath-uhroh- skluh-roh-sis), the buildup of fatty deposits as plaques, is another cause. When plaque builds up along the walls of arteries, there is less space for blood to flow. This makes it harder for blood to get to all the parts of the body that need it, including the heart itself.

Other changes to the heart happen as you age. For example, to help the heart pump blood through stiffer blood vessels, some parts of the heart wall thicken. The size of the four sections of the heart also changes. So do the valves (door-like parts that open and close to control the flow of blood between those sections). The number of heart beats each minute when you are resting (the heart rate) does not change as you age, but the heart can’t beat as fast when you are physically active or stressed as it did when you were younger.

Heart Disease

There are many different kinds of heart disease. Plaque buildup is often to blame. But there are other causes too. For example, choices you might make every day can lead to damage to artery walls. Do you smoke? Do you drink a lot of alcohol? Are you overweight? Do you spend the day sitting at a desk or in front of the television? Do you avoid doing exercise? Do you have diabetes or high blood pressure that is not under control? Are you under a lot of stress? If you answered yes to one or more of these questions, making changes might help you prevent or delay heart disease. Things you can’t control, like your family history, might also increase your risk of heart disease. But even so, leading a heart healthy lifestyle might help you avoid or delay serious illness.

One sign that you are at risk for heart disease is your waist measurement. Extra fat around the middle of your body increases risk. A good way to check that is simply to measure your waist. A man’s risk of heart disease is increased if his waist measures more than 40 inches. A woman’s risk is increased at 35 inches.

Signs of Heart Disease

Early heart disease often doesn’t have symptoms; that’s why regular checkups with a healthcare provider are important. Your doctor will check things like cholesterol, a fat that can add to plaques in your arteries, and your blood pressure. He might also do a blood test for CRP (c-reactive protein). You might also have an ECG or EKG, an electrocardiogram. This is a test that looks at electrical activity in your heart.

Everyone should know the outward warning signs of heart disease. Chest pain should be taken seriously. Pain in the chest, shoulders, arms, neck, jaw, or back can be a symptom of heart disease. If you have heart disease, you might feel chest pain during physical activity. But, it can have other causes too, so it is important to check with your doctor to learn what is triggering yours.

Heart Attack? Call 9-1-1

Act in time: Learn the warning sings of a heart attack. If you or someone you know might be having a heart attack, call 9-1-1 right away. Tou 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.

These warning signs can include crushing chest pain and/or discomfort or pain elsewhere in the upper body, nausea, a cold swear, fainting or lightheadedness, or shortness of breath.

Other signs of heart disease include a weak or numb feeling on one side of the face or body, dizziness, headache, shortness of breath, tiredness, and swelling in the ankles, feet, legs, stomach, and neck. Some people who have a problem with their heartbeat may report a fluttering in their chest or the feeling that their heart is skipping a beat or beating too hard.

Talk to your doctor if you have any of these signs. Your healthcare provider may want you to see someone who specializes in heart disease. This doctor is called a cardiologist.

Heart Disease?

There are a lot of steps you can take to keep your heart healthy.

Try to be more physically active. Talk to your doctor about the type of activities that would be best for you. If possible, aim to get at least 30 minutes of moderate-intensity activity on most or all days of the week. Every day is best. It doesn’t have to be done all at once—10-minute periods will do. Start by doing activities you enjoy—brisk walking, dancing, bowling, bicycling, or gardening, for example. You might want to join an exercise group or even a gym. See “For More Information” to learn how to get your free copy of Exercise and Physical Activity: Your Everyday Guide from the National Institute on Aging, written especially for older people.

If you smoke, quit. Smoking adds to the damage to artery walls. It’s never too late to get some benefit from quitting smoking.

Follow a heart healthy diet. Choose low-fat foods and those that are low in salt. Eat plenty of fruits, vegetables, and foods high in fiber like those made from whole grains. And if you drink alcohol, men should not have more than two drinks a day and women only one.

The National Heart, Lung, and Blood Institute (NHLBI) has information on two eating plans—Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH). See For More Information to learn how to contact NHLBI.

Cholesterol

Cholesterol is a type of fat in some foods. Eating fatty foods can raise the cholesterol in your blood. High blood cholesterol levels could add to the plaque in your arteries. Your doctor can check the cholesterol in your blood with a blood test. This will tell you your overall or total cholesterol level as well as the LDLs (“bad” cholesterol), HDLs (“healthy” cholesterol), and triglycerides (another type of fat in the blood that puts you at risk for heart problems).

Keep a healthy weight. Your healthcare provider will probably check your weight and height to learn your BMI (body mass index). A BMI of 25 or higher means you are at greater risk for heart disease as well as diabetes (high blood sugar) and other health conditions. Following a healthy eating plan and being physically active might help you.

The National Heart, Lung, and Blood Institute suggests you ask your doctor the following questions to learn more about your risk for heart disease and what to do about it. Be sure to ask what you can do if you are told you are at increased risk or already have a heart problem.

1. What is my risk for heart disease?
2. What is my blood pressure?
3. What are my cholesterol numbers? (These include total cholesterol, LDL, HDL, and triglycerides.)
4. What are my body mass index (BMI) and waist measurement? Do they mean that I need to lose weight for my health? What is my blood sugar level, and does it mean that I’m at risk for diabetes?
5. What other screening tests do I need to help protect my heart?
6. What can you do to help me quit smoking?
7. How much physical activity do I need to help protect my heart?
8. What’s a heart healthy eating plan for me?
9. How can I tell if I’m having a heart attack? If I think I’m having one, what should I do?

For More Information

American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
1-800-242-8721 (toll-free)
www.heart.org

National Heart, Lung, and Blood
Institute
Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
1-301-592-8573
1-240-629-3255 (TTY)
www.nhlbi.nih.gov

National Library of Medicine MedlinePlus
www.medlineplus.gov

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

High Blood Pressure

You can have high blood pressure, or hypertension, and still feel just fine. That’s because high blood pressure does not cause signs of illness that you can see or feel. But, high blood pressure, sometimes called “the silent killer,” is a major health problem. If high blood pressure isn’t controlled with lifestyle changes and medicine, it can lead to stroke, heart disease, eye problems, or kidney failure.

What Is Blood Pressure?

Blood pressure is the force of blood pushing against the walls of arteries. When the doctor measures your blood pressure, the results are given in two numbers. The first number, called systolic pressure, measures the pressure when your heart beats. The second number, called diastolic pressure, measures the pressure while your heart relaxes between beats. Normal blood pressure is a systolic pressure of less than 120 and a diastolic pressure of less than 80.

Do You Have High Blood Pressure?

One reason to have regular visits to the doctor is to have your blood pressure checked. The doctor will say your blood pressure is high when it measures 140/90 or higher at two or more checkups. He or she may ask you to check your blood pressure at home at different times of the day. If the pressure stays high, the doctor may suggest medicine, changes in your diet, and exercise.

You could have prehypertension if your blood pressure is only slightly higher than normal—for example, the first number (systolic) is between 120 and 139, or the second number (diastolic) is between 80 and 89.
Prehypertension can put you at risk for developing high blood pressure. Your doctor will probably want you to make changes in your day-to-day habits to try to lower your blood pressure.

What If Just The First Number Is High?

For older people, the first number (systolic) often is 140 or greater, but the second number (diastolic) is less than 90. This problem is called isolated systolic hypertension. Isolated systolic hypertension is the most common form of high blood pressure in older people, and it can lead to serious health problems. It is treated in the same way as regular high blood pressure. If your systolic pressure is 140 or higher, ask your doctor how you can lower it.

What Do The Numbers Mean?

	Systolic	Diastolic
Nornal Plood Pressure	Less than 120	Less than 80
Prehypertension	Between 120-139	Between 80-89
High Blood Pressure	140 or more	90 or more
Isonlated Systolic Hypertension	140 or more	Less than 90

Some Risks You Can’t Change

Anyone can get high blood pressure. But, some people have a greater chance of having it because of things they can’t change. These are:

• Age. The chance of having high blood pressure increases as you get older.
• Gender. Before age 55, men have a greater chance of having high blood pressure. Women are more likely to have high blood pressure after menopause.
• Family history. High blood pressure tends to run in some families.
• Race. African-Americans are at increased risk for high blood pressure.

How Can I Control My Blood Pressure?

More than half of Americans over age 60 and about three-fourths of those 70 years of age and older have high blood pressure. The good news is that blood pressure can be controlled in most people. To start, there are many lifestyle changes you can make to lower your risk of high blood pressure, including:

• Keep a healthy weight. Being overweight adds to your risk of high blood pressure. Ask your doctor if you need to lose weight.
• Exercise every day. Moderate exercise can lower your risk of high blood pressure. Try to exercise at least 30 minutes a day most days of the week. Check with your doctor before starting an exercise plan if you have a long-term health problem or are over 50 and have been inactive.
• Eat a healthy diet. A diet rich in fruits, vegetables, whole grains, and low-fat dairy products may help to lower blood pressure. Ask your doctor about following a healthy diet.
• Cut down on salt. Many Americans eat more salt (sodium) than they need.
  Most of the salt comes from processed food (for example, soup and baked goods). A low-salt diet might help lower your blood pressure. Talk with your doctor about eating less salt.
• Drink less alcohol. Drinking alcohol can affect your blood pressure. Most men should not have more than two drinks a day; most women should not have more than one drink a day.
• Don’t smoke. Smoking increases your risk for high blood pressure and heart disease. If you smoke, quit.
• Manage stress. People react to stress in different ways. For some, stress can cause their blood pressure to go up. Talk to your doctor about how you can lower stress. Exercise and getting a good night’s sleep can help.

If these lifestyle changes don’t control your high blood pressure, your doctor will prescribe medicine. You may try several kinds before finding the one that works best for you. Medicine can control your blood pressure, but it can’t cure it. You may need to take medicine for the rest of your life. You and your doctor can plan together how to manage your blood pressure.

High Blood Pressure Facts

High blood pressure is serious because it can lead to major health problems. If you have high blood pressure, remember:

• High blood pressure may not make you feel sick, but it is serious. See a doctor to treat it.
• You can lower your blood pressure by changing your day-to-day habits and by taking medicine, if needed.
• If you take high blood pressure medicine, making some lifestyle changes may help lower the dose you need.
• If you are already taking blood pressure medicine and your blood pressure is 120 or less, that’s good. It means medicine and lifestyles changes are working. If another doctor asks if you have high blood pressure, the answer is, “Yes, but it is being treated.”
• Tell your doctor about all the drugs you take. Don’t forget to mention over-the-counter drugs, vitamins, and dietary supplements. They may affect your blood pressure. They also can change how well your blood pressure medicine works.
• Blood pressure pills should be taken at the same time each day. For example, take your medicine in the morning with breakfast or in the evening after brushing your teeth. If you miss a dose, do not double the dose the next day.
• Know what your blood pressure should be. Don’t take more of your blood pressure medicine than your doctor prescribes. Very low blood pressure is not good, either. Systolic pressure that is a lot lower than 100 may make you dizzy and faint and may cause you to fall.
• Do not stop taking your high blood pressure medicine unless your doctor tells you to stop. Don’t skip a day or take half a pill. Remember to refill your medicine before you run out of pills.
• If your doctor asks you to take your blood pressure at home, keep in mind:
• There are many blood pressure home monitors for sale. Ask your doctor, nurse, or pharmacist to see which monitor you need and to show you how to use it.
• Avoid smoking, exercise, and caffeine 30 minutes before taking your blood pressure.
• Make sure you are sitting with your feet on the floor and your back is against something.
• Relax quietly for 5 minutes before checking your blood pressure.
• Keep a list of your blood pressure numbers to share with your doctor, physician’s assistant, or nurse. Take your home monitor to the doctor’s office to make sure your monitor is working right.

For More Information

National Heart, Lung, and Blood
Institute
Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
1-301-592-8573
1-240-629-3255 (TTY)
www.nhlbi.nih.gov

National Library of Medicine
MedlinePlus
Search for: “High Blood Pressure”
www.medlineplus.gov

American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
1-800-242-8721 (toll-free)
www.heart.org

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

HIV, AIDS, and Older People

Grace was dating again. George, a close family friend she had known for a long time, was starting to stay overnight more and more often. Because she was past childbearing age,Grace didn’t think about using condoms. And because she had known George for so long, she didn’t think to ask him about his sexual history. So, Grace was shocked when she tested positive for HIV.

What Is HIV? What Is AIDS?

Like most people, you probably have heard a lot about HIV and AIDS. You may have thought that these diseases weren’t your problem and that only younger people have to worry about them. But anyone at any age can get HIV/AIDS. HIV (short for human immunodeficiency virus) is a virus that damages the immune system—the system your body uses to fight off diseases. HIV infection leads to a much more serious disease called AIDS (acquired immunodeficiency syndrome). When the HIV infection gets in your body, your immune system can be made weaker. This puts you in danger of getting other life-threatening diseases, infections, and cancers. When that happens, you have AIDS. AIDS is the last stage of HIV infection. If you think you may have HIV, it is very important to get tested. Today there are drugs that can help your body keep the HIV in check and fight against AIDS.

What Are the Symptoms of HIV/AIDS?

Many people have no symptom when they first become infected with HIV. It can take as little as a few weeks for minor, flu-like symptoms to show up, or more than 10 years for more serious symptoms to appear. Signs of HIV include headache, cough, diarrhea, swollen glands, lack of energy, loss of appetite, weight loss, fevers and sweats, repeated yeast infections, skin rashes, pelvic and abdominal cramps, sores in the mouth or on certain parts of the body, or short-term memory loss.

You can now also test your blood at home. The “Home Access Express HIV-1 Test System” is made by the Home Access Health Corporation. You can buy it at the drug store. It is the only HIV home test system approved by the Food and Drug Administration (FDA) and legally sold in the United States. Other HIV home test systems and kits you might see on the

Internet or in magazines or newspapers have not been approved by FDA and may not always give correct results.

Getting Tested for HIV/AIDS

• It can take as long as 3 to 6 months after the infection for the virus to show up in your blood.
• Your healthcare provider can test your blood for HIV/AIDS. If you don’t have a healthcare provider, check your local phone book for the phone number of a hospital or health center where you can get a list of test sites. Health agencies in most cities offer HIV testing. You can also check www.hivtest.org to find a testing site.
• Many healthcare providers who test for HIV also can provide counseling.
• In most states the tests are private, and you can choose to take the test without giving your name.

How Do People Get HIV and AIDS?

Anyone, at any age, can get HIV and AIDS. HIV usually comes from having unprotected sex or sharing needles with an infected person, or through contact with HIV-infected blood. No matter your age, you may be at risk if:

• You are sexually active and do not use a latex or polyurethane condom. You can get HIV/AIDS from having sex with someone who has HIV. The virus passes from the infected person to his or her partner in blood, semen, and vaginal fluid. During sex, HIV can get into your body through any opening, such as a tear or cut in the lining of the vagina, vulva, penis, rectum, or mouth. Latex condoms can help prevent an infected person from transferring the HIV virus to you. (Natural condoms do not protect against HIV/AIDS as well as the latex and polyurethane types do.)

You do not know your partner’s drug and sexual history. What you don’t know can hurt you. Even though it may be hard to do, it’s very important to ask your partner about his or her sexual history and drug use. Here are some questions to ask: Has your partner been tested for HIV/AIDS? Has he or she had a number of different sex partners? Has your partner ever had unprotected sex with someone who has shared needles? Has he or she injected drugs or shared needles with someone else? Drug users are not the only people who might share needles. For example, people with diabetes who inject insulin or draw blood to test glucose levels might share needles.

• You have had a blood transfusion or operation in a developing country at any time.
• You had a blood transfusion in the United States between 1978 and 1985.

Is HIV/AIDS Different in Older People?

A growing number of older people now have HIV/AIDS. Almost one-fourth of all people with HIV/AIDS in this country are age 50 and older. This is because doctors are finding HIV more often than ever before in older people and because improved treatments are helping people with the disease live longer.

But there may even be many more cases than we know about. Why? One reason may be that doctors do not always test older people for HIV/AIDS and so may miss some cases during routine check-ups. Another may be that older people often mistake signs of HIV/AIDS for the aches and pains of normal aging, so they are less likely than younger people to get tested for the disease. Also, they may be ashamed or afraid of being tested. People age 50 and older may have the virus for years before being tested. By the time they are diagnosed with HIV/AIDS, the virus may be in the late stages.

The number of HIV/AIDS cases among older people is growing every year because:

• >Older Americans know less about HIV/AIDS than younger people do. They do not always know how it spreads or the importance of using condoms, not sharing needles, getting tested for HIV, and talking about it with their doctor.
• Healthcare workers and educators often do not talk with middle-aged and older people about HIV/AIDS prevention.
• Older people are less likely than younger people are to talk about their sex lives or drug use with their doctors.
• Doctors may not ask older patients about their sex lives or drug use or talk to them about risky behaviors.

Anyone facing a serious disease like HIV/AIDS may become very depressed. This is a special problem for older people, who may not have a strong network of friends or family who can help. At the same time, they also may be coping with other diseases common to aging such as high blood pressure, diabetes, or heart problems. As the HIV/AIDS gets worse, many will need help getting around and caring for themselves. Older people with HIV/AIDS need support and understanding from their doctors, family, and friends.

HIV/AIDS can affect older people in yet another way. Many younger people who are infected turn to their parents and grandparents for financial support and nursing care. Older people who are not themselves infected by the virus may find they have to care for their own children with HIV/AIDS and then sometimes for their orphaned or HIV-infected grandchildren. Taking care of others can be mentally, physically, and financially draining. This is especially true for older caregivers. The problem becomes even worse when older caregivers have AIDS or other serious health problems. Remember, it is important to get tested for HIV/AIDS early. Early treatment increases the chances of living longer.

Facts About HIV/AIDS

You may have read or heard things that are not true about how you getHIV/AIDS. Here are the FACTS:

• You cannot get HIV through casual contact such as shaking hands or hugging a person with HIV/AIDS.
• You cannot get HIV from using a public telephone, drinking fountain, restroom, swimming pool, whirlpool, or hot tub.
• You cannot get HIV from sharing a drink.
• You cannot get HIV from being coughed or sneezed on by a person with HIV/AIDS.
• You cannot get HIV from giving blood.
• You cannot get HIV from a mosquito bite.

HIV/AIDS in People of Color and Women

The number of HIV/AIDS cases is rising in people of color across the country. More than half of all people with HIV/AIDS are African America or Hispanic.

The number of cases of HIV/AIDS for women has also been growing over

the past few years. The rise in the number of cases in women of color age 50 and older has been especially steep. Most got the virus from sex with infected partners. Many others got HIV through shared needles. Because women may live longer than men, and because of the rising divorce rate, many widowed, divorced and separated women are dating these days. Like older men, many older women may be at risk because they do not know how HIV/AIDS is spread.

Women who no longer worry about getting pregnant may be less likely to use a condom and to practice safe sex. Also, vaginal dryness and thinning often occur as women age. When that happens, sexual activity can lead to small cuts and tears that raise the risk for HIV/AIDS.

Treatment and Prevention

There is no cure for HIV/AIDS. But if you become infected, there are drugs that help keep the HIV virus in check and slow the spread of HIV in the body. Doctors are now using a combination of drugs called HAART (highly active antiretroviral therapy) to treat HIV/AIDS. Although it is not a cure, HAART is greatly reducing the number of deaths from AIDS in this country.

Remember, there are things you can do to keep from getting HIV/AIDS. Practice the steps below to lower your risk:

• If you are having sex, make sure your partner has been tested and is free of HIV. Use male or female condoms (latex or polyurethane) during sexual intercourse.
• Do not share needles or any other equipment used to inject drugs.
• Get tested if you or your partner had a blood transfusion between 1978 and 1985.
• Get tested if you or your partner has had an operation or blood transfusion in a developing country at any time.

For More Information

AIDS.gov
www.aids.gov

AIDSinfo
P.O. Box 6303
Rockville, MD 20849-6303
800-448-0440 (toll-free)
Monday to Friday, 12:00 p.m. to
5:00 p.m. Eastern Time
888-480-3739 (TTY/TDD/toll-free)
www.aidsinfo.nih.gov

Centers for Disease Control and
Prevention (CDC)
1600 Clifton Road
Atlanta, GA 30333
800-232-4636 (toll-free/24 hours a day,
7 days a week/English and Spanish)
888-232-6348 (TTY/toll-free)
www.cdc.gov

CDC National Prevention
Information Network
P. O. Box 6003
Rockville, Maryland 20849-6003
800-458-5231 (toll-free)
800-243-7012 (TTY/toll-free)
www.cdcnpin.org

National Association on HIV over Fifty
23 Miner Street
Boston, MA 02215-3319
617-233-7107
www.hivoverfifty.org

National Institute of Allergy and
Infectious Diseases
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612
301-496-5717
866-284-4107 (toll-free)
800-877-8339 (TDD/toll-free)
www.niaid.nih.gov

Services & Advocacy for Gay, Lesbian,
Bisexual & Transgender Elders
305 7th Avenue
6th Floor
New York, NY 10001
212-741-2247
www.sageusa.org

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Medicines: Use Them Safely

When Jerry, age 71, came home from the drug store with his latest prescription, he placed all his pill bottles on the kitchen counter and counted them. “I take five different medications, and you take four,” he said to his wife. “We need a system. We need to know what medicines we have, what they’re for, and when we should take them.”

Modern medicine has made our lives better in many ways. It has helped us live longer, healthier lives. But people over 65 have to be careful when taking medications, especially when they’re taking many different drugs.

Some people refer to the pills, liquids, creams, or sprays they take as “medicine,” and other people call them “drugs.” Both words can mean:

• Medicines you get from a pharmacy with a doctor’s prescription
• Pills, liquids, or creams you buy without a prescription to use now and then, for example, for aches and pains, colds, or heartburn
• Vitamins or dietary supplements you take regularly

Drugs you get without a doctor’s prescription are called over-the-counter medicines. Because mixing certain medicines can cause problems, be sure to let your doctor know about all the prescription and over-the-counter drugs you are taking.

At Your Doctor’s Office

If you’ve gone to your doctor because you don’t feel well, the doctor might decide a medicine will help and will write a prescription. Be sure you:

• Tell your doctor or nurse about all the medicines you take whenever a new drug is prescribed.
• Remind your doctor or nurse about your allergies and any problems you have had with medicines, such as rashes, indigestion, dizziness, or mood changes.
• Understand how to take the medicine before you start using it. Ask questions. It might help to write down the answers.

Questions To Ask Your Doctor about a New Medicine

• What is the name of the medicine, and why am I taking it?
• How many times a day should I take it? At what times? If the bottle says take “4 times a day,” does that mean 4 times in 24 hours or 4 times during the daytime?
• Should I take the medicine with food or without? Is there anything I should not eat or drink when taking this medicine?
• What does “as needed” mean?
• When should I stop taking the medicine?
• If I forget to take my medicine, what should I do?
• What side effects can I expect? What should I do if I have a problem?

Ask Your Pharmacist

Your pharmacist is an important part of your healthcare team. If you have questions about your medicine after you leave the doctor’s office, the pharmacist can answer many of them. For example, a pharmacist can tell you how and when to take your medicine, whether a drug may change how another medicine you are taking works, and any side affects you might have. Also, the pharmacist can answer questions about over-the-counter medications.

Try to have all your prescriptions filled at the same pharmacy so your records are in one place.

The pharmacist will keep track of all your medications and will be able to tell you if a new drug might cause problems. If you’re not able to use just one pharmacy, show the new pharmacist your list of medicines and over-the-counter drugs when you drop off your prescription.

When you have a prescription filled:

• Tell the pharmacist if you have trouble swallowing pills. There may be liquid medicine available. Do not chew, break, or crush tablets without first finding out if the drug will still work.
• Make sure you can read and understand the name of the medicine and the directions on the container and on the color-coded warning stickers on the bottle. If the label is hard to read, ask your pharmacist to use larger type.
• Check that you can open the container. If not, ask the pharmacist to put your medicines in bottles that are easier to open.
• Ask about special instructions on where to store a medicine. For example, should it be kept in the refrigerator or in a dry place?
• Check the label on your medicine before leaving the pharmacy. It should have your name on it and the directions given by your doctor. If it doesn’t, don’t take it, and talk with the pharmacist.

Generic or Brand Name?

When getting a prescription filled, sometimes you can choose between either a generic or brand-name drug. Generic and brand-name medicines are alike because they act the same way in the body. They contain the same active ingredients—the part of the medicine that makes it work. A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken, and the way it should be used. Generic drugs usually cost less.

If you want a generic drug, ask your healthcare provider if that’s a choice. Not all drugs are available in the generic form, and there might be medical reasons your doctor prefers the brand-name medicine.

Now, it’s Your Turn

Your doctor has prescribed a medication. The pharmacist has filled the prescription. Now it’s up to you to take the medicine safely. Here are some tips that can help:

• Make a list of all the medicines you take, including over-the-counter products and dietary supplements. Show it to all of your healthcare providers including physical therapists and dentists. Keep one copy in your medicine cabinet and one in your wallet or pocketbook. The list should include the name of each medicine, doctor who prescribed it, reason it was prescribed, amount you take, and time(s) you take it.
• Read and save in one place all written information that comes with the medicine.
• Take your medicine in the exact amount and at the time your doctor prescribes.
• Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to change your prescription to a different one that will work better for you.
• Use a memory aid to take your medicines on time. Some people use meals or bedtime as reminders to take their medicine. Other people use charts, calendars, and weekly pill boxes. Find a system that works for you.
• Do not skip doses of medication or take half doses to save money. Talk with your doctor or pharmacist if you can’t afford the prescribed medicine. There may be less costly choices or special programs to help with the cost of certain drugs.
• Avoid mixing alcohol and medicine. Some medicines may not work correctly or may make you sick if taken with alcohol.
• Take your medicine until it’s finished or until your doctor says it’s okay to stop.
• Don’t take medicines prescribed for another person or give yours to someone else.
• Don’t take medicine in the dark. To avoid making a mistake, turn your light on before reaching for your pills.
• Check the expiration dates on your medicine bottles. Your pharmacist can probably tell you how to safely get rid of medicine you no longer need or that is out of date. The pharmacist might be able to dispose of it for you.
• Make sure you store all medicines and supplements out of sight and out of reach of children. And don’t take your medicines in front of young children. They might try to copy you.

Shopping For Medicines Online

Medicines can cost a lot. If you have a drug plan through your insurance, you can probably save money by ordering yours from them rather than at your neighborhood pharmacy. Or, you might be thinking about buying yours on the Internet. But how can you tell which websites are safe and reliable? The Food and Drug Administration (see For More Information) has more information on buying medicines and medical products online.

Medicare Prescription Drug Plans

Medicare has prescription drug plans for people with Medicare to help save money on medicines. For information please call:

1-800-633-4227
(1-800-MEDICARE)

or visit the Medicare website at www.medicare.gov

What about Over-The-Counter Medicines?

Many of the ideas in this AgePage> are also true for over-the-counter (OTC) drugs, like medicines to relieve coughs, cold, allergies, pain, and heartburn. Be careful when taking an OTC drug. For example, don’t take a cough and cold product if you only have a runny nose and no cough. And, check with your doctor before taking aspirin if you are on a blood thinning medicine, because aspirin also slows blood clotting. Other things to remember:

• >Measure the dose of a liquid OTC medicine as carefully as you would a prescription drug. Use a measuring spoon, since spoons you eat with vary in size.
• Be careful—OTC medicines can have side effects.
• Take the amount suggested on the label. If you don’t get better, see your doctor.
• Read the label—even if you have used the OTC product in the past. Important information can change.

Remember, medicines—whether prescription or over-the-counter—can hurt you if they aren’t used the right way. Learn to be a smart consumer of medicine.

For More Information

Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
1-301-427-1104
www.ahrq.gov

Centers for Medicare and
Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
1-800-633-4227
(1-800-MEDICARE/toll-free)
www.medicare.gov

Food and Drug Administration
10903 New Hampshire Avenue
Silver Spring, MD 20993
1-888-463-6332 (toll-free)
www.fda.gov

Partnership for Prescription
Assistance
1-888-477-2669 (toll-free)
www.pparx.org


For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Older Drivers

At age 78, Sheila thinks she’s a good driver, and she would like to stay that way. But lately, she has been in minor accidents. Sheila wonders how she can stay safe behind the wheel. Will taking a class for older drivers help?

You may have asked yourself this question, or maybe a family member or friend has asked about your driving. Getting older doesn’t make you a bad driver. But you should know there are changes that may affect driving skills over time.

Your Body

As you age, your joints may get stiff, and your muscles may weaken. This can make it harder to turn your head to look back, turn the steering wheel quickly, or brake safely.

What you can do:

• See your doctor if you think that pain or stiffness gets in the way of your driving.
• If possible, drive a car with automatic transmission, power steering, power brakes, and large mirrors.
• >Be physically active or exercise to keep and even improve your strength and flexibility.

Your Vision

Your eyesight may change, as you get older. At night, you may have trouble seeing things clearly. Glare can also be a problem—from oncoming headlights, streetlights, or the sun. It might be harder to see people, things, and movements outside your direct line of sight. It may take you longer to read street or traffic signs or even recognize familiar places. Eye diseases, such as glaucoma, cataracts, and macular degeneration, as well as some medicines may also change your vision.

What you can do:

• The American Academy of Ophthalmology recommends you have your vision checked at age 40. Your eye doctor will then tell you how often you should come back. Then, if you are 65 or older, see your eye doctor every 1 to 2 years. There are many vision problems your doctor can treat.
• Talk to your eye doctor if you can’t see well enough to drive because you have a cataract. You might need surgery to remove the cataract.
• If you need glasses or contact lenses to see far away while driving, make sure your prescription is correct. And always wear them when you are driving.
• Cut back on night driving if you are having trouble seeing in the dark.

Your Hearing

Your hearing may change, making it harder to notice horns, sirens, or noises from your own car. That can be a problem because these sounds warn you when you may need to pull over or get out of the way. It is important that you hear them.

What you can do:

• >Have your hearing checked. The American Speech-Language-Hearing Association recommends doing this every 3 years after age 50. Your doctor can treat some hearing problems.
• Get a hearing aid to help—don’t forget to use it when you drive.
• Try to keep the inside of the car as quiet as possible while driving.
• Pay attention to the warning lights on the dashboard. They may let you know when something is wrong with your car.

Your Reactions

In order to drive safely, you should be able to react quickly to other cars and people on the road. You need to be able to make decisions and to remember what to do. Being able to make quick decisions while driving is important so you can avoid accidents and stay safe. Changes over time might slow how fast you react. You may find that your reflexes are getting slower. Stiff joints or weak muscles can make it harder to move quickly. Your attention span may be shorter. Or, it might be harder for you to do two things at the same time.

What you can do:

• Leave more space between you and the car in front of you.
• Start braking early when you need to stop.
• Avoid high-traffic areas when you can.
• If you must drive on a fast-moving highway, drive in the right-hand lane. Traffic moves more slowly there. This might give you more time to make safe driving decisions.
• Take a defensive driving course. AARP, American Automobile Association (AAA), or your car insurance company can help you find a class near you.
• Be aware of how your body and mind might be changing, and talk to your doctor about any concerns.

Your Health

Some health problems can make it harder for people of any age to drive safely. But other conditions that are more common as you get older can also make driving difficult. For example, Parkinson’s disease, stroke, and arthritis can interfere with your driving abilities. At some point, someone with health problems may feel that he or she is no longer a good driver and may decide to stop driving.

People with illnesses like Alzheimer’s disease or other types of dementia may forget how to drive safely. They also may forget how to find a familiar place like the grocery store or even home. In the early stages of Alzheimer’s, some people are able to keep driving safely for a while. But, as memory and decision-making skills worsen, driving will be affected. If you have dementia, you might not be able to tell that you are having driving problems. Family and friends may give you feedback about your driving. Doctors can help you decide whether it’s safe to keep driving.

What you can do:

• Tell a family member or your doctor if you become confused while driving.

Your Medications

Do you take any medicines that make you feel drowsy, light-headed, or less alert than usual? Medications can have side effects. People tend to take more medicines as they age, so pay attention to how these drugs may affect your driving.

What you can do:

• Read the medicine labels carefully, and pay attention to any warnings.
• Make a list of all your medicines, and talk to a doctor or pharmacist about how they may affect your driving.
• Don’t drive if you feel light-headed or drowsy.

Are You A Safe Driver?

Maybe you already know that driving at night, on the highway, or in bad weather is a problem for you. Older drivers can also have problems when yielding the right of way, turning (especially making left turns), changing lanes, passing, and using expressway ramps.

What you can do:

• When in doubt, don’t go out. Bad weather like rain or snow can make it hard for anyone to drive. Try to wait until the weather is better, or use buses, taxis, or other transportation services available in your community.
• Look for different routes that can help you avoid places where driving can be a problem. Left turns can be quite dangerous because you have to check so many things at the same time. You could plan routes to where you want to go so that you only need to make right turns.
• Have your driving skills checked. There are driving programs and clinics that can test your driving and also make suggestions about improving your driving skills.
• Update your driving skills by taking a driving refresher course. (Hint: Some car insurance companies may lower your bill when you pass this type of class.)

Is It Time To Give Up Driving?

We all age differently. For this reason, there is no way to set one age when everyone should stop driving. So, how do you know if you should stop? To help you decide, ask yourself:

• Do other drivers often honk at me? Have I had some accidents, even if they are only “fender benders”?
• Do I get lost, even on roads I know?
• Do cars or people walking seem to appear out of nowhere?
• Have family, friends, or my doctor said they are worried about my driving?
• Am I driving less these days because I am not as sure about my driving as I used to be?
• Do I have trouble staying in my lane?
• Do I have trouble moving my foot between the gas and the brake pedals, or do I confuse the two?

More Tips for Safe Driving

Planning before you leave:

• lan to drive on streets you know.
• Limit your trips to places that are easy to get to and close to home.
• Take roads that will avoid risky spots like ramps and left turns.
• Add extra time for travel if driving conditions are bad.
• Don’t drive when you are stressed or tired.

While you are driving:

• Always wear your seat belt.
• Stay off the cell phone.
• Avoid distractions such as eating, listening to the radio, or having conversations.
• Make sure there is enough space behind your car. (Hint: If someone follows you too closely, slow down and pull over if needed to let that person pass you.)
• Use your window defrosters to keep both the front and back windows clear.
• Keep your headlights on at all times.

Car safety:

• Drive a car with air bags.
• Check your windshield wiper blades often and replace them when needed.
• Keep your headlights clean and aimed in the right direction.
• Think about getting hand controls for both the gas and brake pedals if you have leg problems.

How Will You Get Around?

Are you worried that, if you stop driving, you won’t be able to do the things you want and need to do? You’re not alone. Many people have this concern, but there may be more ways to get around than you think. For example, some areas offer free or low-cost bus or taxi service for older people. Some communities also have carpools that you can join without a car. Religious and civic groups sometimes have volunteers who will drive you where you want to go. Your local Area Agency on Aging can help you find services in your area. Call 1-800-677-1116, or go to www.eldercare.gov to find the nearest Area Agency on Aging.

You can also think about taking taxis. Sound pricey? Don’t forget—it costs a lot to own a car. If you don’t have to buy a car or pay for insurance, maintenance, gas, oil, or other car expenses, then you may be able to afford to take taxis or other public transportation. You can also help buy gas for friends or family who give you rides.

For More Information

Making decisions about your driving skills is hard, but it is important to find the safest option for you and the others who share the road with you.

Here are some helpful resources.

AAA Foundation for Traffic Safety
6071 4th Street, NW, Suite 201
Washington,DC 20005
1-202-638-5944
www.seniordrivers.org

AARP
601 E Street,NW
Washington,DC 20049
1-888-227-7669(toll-free)
www.aarp.org/families/driver_safety


Administration on Aging
Washington,DC 20201
1-202-619-0724
www.aoa.gov

American Association of Motor Vehicle Administrators
4301WilsonBoulevard,Suite400
Arlington,VA22203
1-703-522-4200
www.granddriver.info

Federal Highway Administration
Office of Safety -HSSI, E71-318
1200 New Jersey Avenue, SE
Washington, DC 20590
1-202-366-6836
http://safety.fhwa.dot.gov

The Hartford
One Hartford Plaza
690 Asylum Avenue
Hartford, CT 06115
1-860-547-5000
www.thehartford.com/alzheimers

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Shots For Safety

There are many shots, or vaccinations, that may keep you from getting sick. Some of these shots may also protect you from getting a serious form of an illness. Here is a list of shots that may keep you healthy. Talk to your doctor about which ones you need.

Flu

Flu is the short name for influenza. It can cause fever, chills, sore throat, and stuffy nose, as well as headache and muscle aches. It’s easy to pass from person to person. Flu is very serious when it gets in your lungs. That’s why it’s important for everyone 6 months and older to get the flu shot each year. You need a flu shot every year for two reasons. First, flu viruses change.

Each year’s virus may be just a little different. If the virus changes, the vaccine used in the flu shot is changed. Second, the protection you get from a flu shot lessens with time, especially in older people. It takes a while for the flu shot to start protecting you, so you should get your flu shot between September and November. Then you will be protected when the winter flu season starts.

Pneumococcal Disease

Pneumococcal disease is a serious infection that is spread from person to person by droplets in the air. It can cause pneumonia in your lungs, or it can affect other parts of the body. People 65 and older should get a pneumococcal shot. It’s safe and can be given at the same time as the flu shot. Most people only need the shot once. But, if you were younger than 65 when you had the shot, you may need a second shot to stay protected.

Tetanus and Diphtheria

Getting a shot is the best way to keep from getting tetanus and diphtheria. Tetanus (sometimes called lockjaw) is caused by bacteria found in soil, dust, and manure. It enters the body through cuts in the skin. Diphtheria is also caused by bacteria. It can affect the tonsils, throat, nose, or skin. It can spread from person to person. Diphtheria is a very serious illness.

Most people get their first shots for tetanus and diphtheria as children. For adults, a booster shot keeps you protected; it’s important to get it every 10 years. Ask your doctor if you need a booster shot.

Shingles

If you had chickenpox when you were young, the virus is still in your body. When you are older, the virus may become active again, and you can develop shingles. Shingles causes a rash of blisters on the body or face. It can be a very painful disease. Even when the rash disappears, the pain can stay. Now there is a shot for people 50 or older that may prevent shingles. Ask your doctor if you should get the shingles vaccine.

Measles, Mumps, and Rubella

The vaccine given to children to prevent measles, mumps, and rubella has made these diseases rare. Measles, mumps, and rubella are often more serious in adults than in children. If you don’t know if you’ve had the diseases or the shot, you can still get the vaccine.

Side Effects of Shots

Common side effects for all of these shots are mild and include pain, swelling, or redness on the arm where the shot was given. It’s a good idea to keep your own shot record listing the types and dates of your shots, as well as any side effects or problems.

Travel

Check with your doctor or local health department about the shots that you need if you’re going to travel to other countries. Sometimes a series of shots is needed. It’s best to get them early, at least 2 weeks before your travel. For more information, visit the Centers for Disease Control and Prevention website at www.cdc.gov/travel, or call the information line for international travelers at 1-800-232-4636.

Keep Up-To-Date

Most of the illnesses listed in this fact sheet are hard on adults. Take the time to protect yourself by keeping your vaccinations up-to-date.

For More Information

Here are some helpful resources:

American Lung Association
1301 Pennsylvania Avenue, NW Suite 800
Washington ,DC 20004
1-800-586-4872(toll-free)
www.lungusa.org

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-800-232-4636(toll-free)
1-888-232-6438(TTY/toll-free)
www.cdc.gov www.flu.gov

National Institute of Allergy and Infectious Diseases
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612
1-866-284-4107 ree)
1-800-877-8339(TTY/toll-free)
www.niaid.nih.gov


For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Smoking: It’s Never Too Late To Stop

I’ve smoked a pack of cigarettes a day for 40 years—what’s the use of quitting now?”“

If you quit smoking, you are likely to add years to your life, breathe more easily, enjoy food more, and save money. Whether you are young or old, you will also:

• Lower your risk for cancer, heart attack, and lung disease
• Have better blood circulation
• Improve your sense of taste and smell
• Over time, get rid of the smell of smoke in your clothes and house
• Set a healthy example for your children and grandchildren

Smoking can shorten your life. Smoking makes millions of Americans sick by causing:

• Lung disease. Smoking damages your lungs and airways, sometimes causing chronic bronchitis. It can also cause a lung disease called emphysema that destroys your lungs, making it very hard for you to breathe.
• Heart disease. If you have high blood pressure or high cholesterol (a fatty substance in the blood) and also smoke, you increase your chance of having a heart attack.
• Cancer. Smoking can cause cancer of the lungs, mouth, larynx (voice box), esophagus, stomach, liver, pancreas, kidney, bladder, and cervix.
• Respiratory problems. If you smoke, you are more likely than a nonsmoker to get the flu (influenza), pneumonia, or other infections that can interfere with your breathing.
• Osteoporosis. You have a greater chance of developing osteoporosis as you get older. If you also smoke, your chance of developing weak bones is greater.

Nicotine Is a Drug

Nicotine is the drug in tobacco that makes tobacco products addictive. People become addicted to nicotine. That’s one reason why the first few weeks after quitting are the hardest. Some people who give up smoking have withdrawal symptoms. They may become grumpy, hungry, or tired. Some people have headaches, feel depressed, or have problems sleeping or concentrating. On the other hand, some people have no withdrawal symptoms.

Breaking The Addiction

Josephine remembers she started smoking in high school because she wanted to be part of the “cool” crowd. That was more than 50 years ago. Now, she wishes she had never started. She has trouble breathing, many of her clothes have burns from cigarette ash, and even worse, her grandchildren complain she smells like smoke. She wonders if she’ll be able to stop after all these years.

Many people say the first step to stop smoking is to make a firm decision to quit and pick a definite date you will stop. Then make a clear plan for how you will stick to it. Your plan might include:

• Reading self-help information
• Using individual or group counseling
• Joining a support group
• Asking a friend to quit with you
• Using nicotine replacement therapy
• Taking medicine to help with symptoms of nicotine withdrawal

Find what works best for you. Some people say that using many approaches to quitting is the answer.

Help With Quitting

Miguel joined the Navy right after college. He thought smoking made him look older. Pretty soon he was hooked. Now, at 61, the doctor has told him he has emphysema and needs to stop smoking. His wife and children want him to stop, too. He wonders what can help him with withdrawal symptoms.

When you quit, you may need support to cope with your body’s desire for nicotine. Nicotine replacement therapy can help some smokers quit. You can buy nicotine replacement products like chewing gum, patches, or lozenges over-the-counter.

There are also nicotine replacement products that require a doctor’s prescription. A nicotine nasal spray or inhaler can reduce withdrawal symptoms, and make it easier for you to quit smoking. Other drugs can also be helpful with some of the withdrawal symptoms not caused by nicotine. Talk to your doctor about what medicines would be the best for you.

Cigars, Pipes, Chewing Tobacco, And Snuff Are Not Safe

Some people think smokeless tobacco (chewing tobacco and snuff), pipes, and cigars are safe. They are not.

Using smokeless tobacco can cause cancer of the mouth, pre-cancerous lesions known as oral leukoplakia, nicotine addiction, and possibly cancer of the larynx and esophagus, as well as gum problems. Pipe and cigar smokers may develop cancer of the mouth, lip, larynx, esophagus, and bladder. Those who inhale are also at increased risk of getting lung cancer.

Secondhand Smoke

Smokers create secondhand smoke, which can cause health problems for everyone exposed to the smoke. Secondhand smoke is very dangerous for people who have lung conditions or heart disease. It may cause bronchitis, pneumonia, an asthma attack, or lung cancer. In babies and young children, it can cause inner ear infections

Good News About Quitting

The good news is that after you quit:

• Your lungs, heart, and circulatory system will begin to function better
• Your chance of having a heart attack or stroke will drop
• Your breathing will improve
• Your chance of getting cancer will be lower

No matter how old you are, all of these health benefits are important reasons for you to think about making a plan to stop smoking.

Clyde’s doctor told him he needed to quit smoking. Then, when his 16-year-old granddaughter asked him to stop smoking, he decided to try. Whenever he felt the urge to smoke, he ate nuts or chewed gum instead. Sometimes, he would take a fast walk until the urge to smoke passed. The walk had the added benefit of helping him lose some weight. A year later, he’s proud of his success and his granddaughter’s smile makes it all worthwhile.

For More Information

Here are some helpful resources:

American Cancer Society
250 Williams Street, NW
Atlanta, GA 30303
1-800-227-2345 (toll-free)
1-866-228-4327(TTY/toll-free)
www.cancer.org

American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
1-800-242-8721 (toll-free)
www.heart.org

Centers for Disease Control and Prevention
Office on Smoking and Health
4770 Buford Highway
MSK-50
Atlanta,GA30341-3717
1-800-232-4636(toll-free)
1-888-232-6348(TTY/toll-free)
www.cdc.gov/tobacco

National Cancer Institute
Public Inquiries Office
6116 Executive Boulevard, Suite 300
Bethesda, MD 20892-8322
1-800-4-CANCER(1-800-422-6237/toll-free)
www.cancer.gov

National Heart, Lung, and Blood Institute
Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
1-301-592-8573
1-240-629-3255(TTY)
www.nhlbi.nih.gov

National Library of Medicine
MedlinePlus www.medlineplus.gov

Smokefree.gov
1-800-QUITNOW(1-800-784-8669/toll-free)
1-800-332-8615(TTY/toll-free)
www.smokefree.gov

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Stroke

Luis and Inez were playing cards one night when Luis asked Inez a question. She tried to answer but couldn’t speak. Luis knew something was very wrong. Could it be a stroke? Without waiting, he called 911. The ambulance took Inez to the hospital. Emergency doctors said it was a stroke — Luis was right. Because Luis called for help quickly, Inez got the medical care she needed without delay. She started getting well, her speech came back, and once again she’s having long talks with Luis.

Inez was lucky. A stroke can cause lasting physical and mental problems and even death in older people. Knowing the symptoms of a stroke and acting quickly could mean the difference between life and death. You can also take steps to lower your chance of even having a stroke.

What Is a Stroke?

A stroke happens when something changes how blood flows through the brain. Blood brings oxygen and nutrients to brain cells. If blood can’t flow to a part of the brain, cells there could soon start to die. If brain cells are only damaged, they sometimes get better. But brain cells that have died can’t be brought back to life. So, someone who has had a stroke may have trouble speaking, thinking, or walking.

There are two major types of strokes. The most common kind (ischemic) is caused by a blood clot or the narrowing of a blood vessel (artery) leading to the brain. This keeps blood from flowing into other parts of the brain and keeps needed oxygen and nutrients from reaching brain cells there. In the second major kind of stroke (hemorrhagic), a broken blood vessel causes bleeding in the brain. This break in the vessel also stops oxygen and nutrients from reaching brain cells.

Stroke Is an Emergency.

Call 911.

Never ignore the symptoms of stroke. Call 911 if you have any stroke symptoms, even if they don’t last long.

Call 911 RIGHT AWAY if you see or have any of these symptoms:

• Sudden numbness or weakness in the face, arm, or leg—especially on one side of the body
• Sudden confusion or trouble speaking or understanding
• Sudden problems seeing in one eye or both eyes
• Sudden dizziness, loss of balance or coordination, or trouble walking
• Sudden severe headache with no known cause

Sometimes the symptoms of a stroke last only a few minutes and then go away. That could be a TIA (transient ischemic attack), also called a mini-stroke. A TIA is a medical emergency. You should get medical help right away. If a TIA is not treated quickly, it could be followed within hours or days by a major disabling stroke.

What Will the Doctor Do?

The doctor will diagnose a stroke based on symptoms, medical history, and medical tests, like a CT scan. A CT scan is a kind of test that lets doctors look closely at pictures of the brain.

All strokes benefit from immediate medical treatment! But, only people with ischemic stroke, the kind caused by a clot, can be helped by a drug called t-PA (tissue-plasminogen activator). This drug breaks up blood clots and can greatly lessen the damage caused by an ischemic stroke. Starting treatment with the drug t-PA within 3 hours after an ischemic stroke is key to recovery. Getting to a hospital right away allows time for a CT scan of the brain. This scan will show whether this clot busting medicine is the right treatment choice.

What Happens After a Stroke?

A stroke can cause a variety of health problems. Someone who has a stroke might be paralyzed or have weakness, usually on one side of the body. He or she might have trouble speaking or using words. There could be swallowing or memory problems. Someone who has had a stroke might feel depressed or find it hard to control emotions. There might be pain or numbness.

There are many different ways to help people get better after a stroke. Many treatments start in the hospital and continue at home. Drugs and physical therapy can help improve balance, coordination, and some problems such as trouble speaking and using words. Occupational therapy can make it easier to do things like taking a bath or cooking.

A family doctor can provide follow-up care. Some people make a full recovery soon after a stroke. Others take months or even years. But, sometimes the damage is so serious that therapy cannot really help.

Lower Your Risk of Stroke

Talk to your doctor about what you can do to lower your risk of stroke. Even if you’re in perfect health, follow these suggestions:

• Control your blood pressure. Have your blood pressure checked often. If it is high, follow your doctor’s advice to lower it. Treating high blood pressure lowers the risk of both stroke and heart disease.
• Stop smoking. Smoking increases your risk for stroke. It’s never too late to quit.
• Control your cholesterol. If you have high cholesterol, work with your doctor to lower it. Cholesterol, a type of fat in the blood, can build up on the walls of your arteries. In time, this can block blood flow and lead to a stroke.
• Control your diabetes. Untreated diabetes can damage blood vessels and also leads to narrowed arteries and stroke. Follow your doctor’s suggestions for keeping diabetes under control.
• Eat healthy foods. Eat foods that are low in cholesterol and saturated fats. Include a variety of fruits and vegetables every day.
• Exercise regularly. Try to make physical activity a part of your everyday life. Doing things like taking a brisk walk, riding a bicycle, swimming, and working around the yard lower your chance of stroke. You might check with your doctor before you begin if you are over 50 and aren’t used to energetic activity. The National Institute on Aging, listed in For More Information, has a free booklet on exercise.

For More Information

The National Library of Medicine of the National Institutes of Health has a website, www.medlineplus.gov, with information on many health subjects, including stroke. Click on Health Topics. Choose subjects like Stroke, Aphasia, and Transient Ischemic Attack by clicking on the first letter of the topic you want and scrolling down the list.

Here are som eother helpful Federal and non-Federal resources.

American Stroke Association
7272 Greenville Avenue
Dallas, TX 75231
1-888-478-7653(toll-free)
www.strokeassociation.org

National High Blood Pressure Education Program
National Heart, Lung, and Blood Institute Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
1-301-592-8573
1-240-629-3255(TTY)
www.nhlbi.nih.gov


National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824-5801
1-800-352-9424(toll-free)
www.ninds.nih.gov

National Stroke Association


9707 East Easter Lane
Building B Centennial,CO 80112
1-800-787-6537(toll-free)
www.stroke.org

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Taking Care of Your Teeth and Mouth

Max is shocked. His dentist told him that he has a tooth that needs to come out. The 63-year-old had been sure he would keep his teeth forever. Max is going to work with his dentist on taking better care of his remaining teeth.

Healthy teeth and gums make it easy for you to eat well and enjoy good food. There are a number of problems that can affect the health of your mouth, but good care should keep your teeth and gums strong.

Tooth Decay

Teeth are covered in a hard, outer coating called enamel. Every day, a thin film of bacteria called dental plaque builds up on your teeth. The bacteria in plaque produce acids that can begin to harm enamel. Over time, the acids can cause a hole in the enamel. This hole is called a cavity. Brushing and flossing your teeth can protect you from decay, but once a cavity happens, a dentist has to fix it.

You can protect your teeth from decay by using fluoride toothpaste. If you are at a higher risk for tooth decay (for example, if you have a dry mouth because of medicines you take), you might need more fluoride. Your dentist or dental hygienist may give you a fluoride treatment during an office visit. Or, the dentist may tell you to use a fluoride gel or mouth rinse at home.

Gum Diseases

Gum disease begins when plaque builds up along and under the gum line. This plaque causes infections that hurt the gum and bone that hold teeth in place. Sometimes gum disease makes your gums tender and more likely to bleed. This problem, called gingivitis, can often be fixed by daily brushing and flossing.

A more severe form of gum disease, called periodontitis, needs to be treated by a dentist. If not treated, this infection can ruin the bones, gums, and other tissues that support your teeth. Over time, your teeth may have to be removed.

To prevent gum disease:

• Brush your teeth twice a day with fluoride toothpaste.
• Floss once a day.
• Visit your dentist regularly for a checkup and cleaning.
• Eat a well-balanced diet.
• Quit smoking. Smoking increases your risk for gum disease.

Cleaning Your Teeth and Gums

There is a right way to brush and floss your teeth. Every day:

• Gently brush your teeth on all sides with a soft-bristle brush and fluoride toothpaste.
• Use small circular motions and short back-and-forth strokes.
• Take the time to brush carefully and gently along the gum line.
• Lightly brush your tongue to help keep your mouth clean.

People with arthritis or other conditions that limit hand motion may find it hard to hold and use a toothbrush. Some helpful ideas are:

• Use an electric or battery-operated toothbrush.
• Slide a bicycle grip or foam tube over the handle of the toothbrush.
• Buy a toothbrush with a larger handle.
• Attach the toothbrush handle to your hand with a wide elastic band.

You also need to clean around your teeth with dental floss every day. Careful flossing will take off plaque and leftover food that a toothbrush can’t reach. Be sure to rinse after you floss.

See your dentist if brushing or flossing causes your gums to bleed or hurts your mouth. If you have trouble flossing, a floss holder may help. Ask your dentist to show you the right way to floss.

Dentures

Sometimes, false teeth (dentures) are needed to replace badly damaged teeth. Partial dentures may be used to fill in one or more missing teeth. Dentures may feel strange at first. In the beginning, your dentist may want to see you often to make sure the dentures fit. Over time, your gums will change shape and your dentures may need to be adjusted or replaced. Be sure to let your dentist handle these adjustments.

When you are learning to eat with dentures, it may be easier if you:

• Start with soft, non-sticky food.
• Cut your food into small pieces.
• Chew slowly using both sides of your mouth.

Be careful when wearing dentures because it may be harder for you to feel hot foods and drinks or notice bones in your mouth from your food.

Keep your dentures clean and free from food that can cause stains, bad breath, or swollen gums. Brush them every day with a denture care product. Take your dentures out of your mouth at night, and put them in water or a denture-cleansing liquid.

Dry Mouth

Dry mouth happens when you don’t have enough saliva, or spit, to keep your mouth wet. Many common medicines can cause dry mouth. That can make it hard to eat, swallow, taste, and even speak. Dry mouth can cause tooth decay and other infections of the mouth.

There are some things you can try that may help with dry mouth. Try sipping water or sugarless drinks. Don’t smoke and avoid alcohol and caffeine. Sugarless hard candy or sugarless gum may help. Your dentist or doctor might suggest that you use artificial saliva to keep your mouth wet. Or they may have other ideas on how to cope with dry mouth.

Oral Cancer

Cancer of the mouth can grow in any part of the mouth or throat. It is more likely to happen in people over age 40. A dental checkup is a good time for your dentist to look for signs of oral cancer. Pain is not usually an early symptom of the disease. Treatment works best before the disease spreads. Even if you have lost all your natural teeth, you should still see your dentist for regular oral cancer exams.

You can lower your risk of getting oral cancer in a few ways:

• Do not use tobacco products— cigarettes, chewing tobacco, snuff, pipes, or cigars.
• If you drink alcohol, do so only in moderation.
• Use lip balm with sunscreen.

Finding Low-Cost Dental Care

Sometimes dental care can be costly. Medicare does not cover routine dental care. Very few states offer dental coverage under Medicaid. You may want to check out private dental insurance for older people. Make sure you are aware of the cost and what services are covered. The following resources may help you find low-cost dental care:

• Some dental schools have clinics where students get experience treating patients at a reduced cost. Qualified dentists supervise the students. Visit www.ada.org for a list of U.S. dental schools.
• Dental hygiene schools may offer supervised, low-cost care as part of the training experience for dental hygienists. See schools listed by State at www.adha.org.
• Call your county or State health department to find dental clinics near you that charge based on your income.
• Call 1-888-275-4772 (toll-free) to locate a community health center near you that offers dental services, or visit www.hrsa.gov (scroll down to “Find a Health Center”).
• United Way chapters may be able to direct you to free or reduced-cost dental services in your community. Call “211” to reach a local United Way chapter.

For More Information

Here are some helpful resources:

American Dental Association
211 East Chicago Avenue
Chicago, IL 60611-2678
1-800-621-8099 (toll-free)
www.ada.org

American Dental Hygienists’ Association 444 North Michigan Avenue
Suite 3400
Chicago, Il 60611
1-312-449-8900
www.adha.org

Health Resources and Services Administration Information Center P.O. Box 2910
Merrifield, VA 22116
1-888-275-4772 (toll-free)
1-877-489-4772 (TTY/toll-free)
www.hrsa.gov

National Institute of Dental and Craniofacial Research
National Oral Health Information
Clearinghouse
1-866-232-4528
www.nidcr.nih.gov

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Urinary Incontinence

Sarah loves to spend time with her friends talking about grandchildren and visiting with neighbors. But lately she’s been having a big problem that keeps her from enjoying life. Because she can’t get to the bathroom in time, she’s starting to wet her pants. Sarah doesn’t know what’s happening, but the problem keeps her at home. Sarah may have a problem with bladder control called urinary incontinence. While it may happen to anyone, urinary incontinence is more common in older people. Women are more likely than men to have incontinence. If this problem is happening to you, there is help. Incontinence can often be cured or controlled. Talk to your doctor about what you can do.

Causes of Incontinence

Incontinence is often seen as part of aging. But it can occur for many other reasons. For example, a urinary tract infection, vaginal infection or irritation, constipation, and some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

• Weak bladder muscles
• Overactive bladder muscles
• Damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson’s disease
• Diseases such as arthritis that may make it difficult to get to the bathroom in time
• Blockage from an enlarged prostate in men

Bladder Control

The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. Incontinence occurs if the muscles tighten or relax without warning.

Diagnosis

The first step in treating incontinence is to see a doctor. He or she will give you a physical exam and take your medical history. The doctor will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests. These might include:

• Urine and blood tests
• Tests that measure how well you empty your bladder

In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine.

Types of Incontinence

There are different types of urinary incontinence:

• Stress incontinence happens when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. It’s the most common type of bladder control problem in younger and middle-age women. It may also begin around the time of menopause.
• Urge incontinence happens when people have a sudden need to urinate and aren’t able to hold their urine long enough to get to the toilet in time. It is often, but not only, a problem for people who have diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
• Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injury can also cause this type of incontinence.
• Functional incontinence happens in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.

Treatment

Today, there are more treatments for urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.

Bladder Control Training

Your doctor may suggest bladder training to help you get better control of your bladder. With bladder training, you can change how your body stores and releases urine. There are several ways to do this:

• Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer.
• Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful when learning pelvic muscle exercises.
• Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
• Lifestyle changes that may help with incontinence include losing weight, quitting smoking, avoiding alcohol, drinking less caffeine (found in coffee, tea, and many sodas), preventing constipation, and not lifting heavy objects.

Management

Besides bladder control training, you may want to talk to your doctor about other ways to help manage incontinence:

• Some drugs can help the bladder empty more fully during urination. Other drugs tighten muscles and can lessen leakage. Talk with your doctor about the benefits and side effects of using these medicines.
• A doctor may inject a substance that thickens the area around the urethra to help close the bladder opening. This reduces stress incontinence in women. This treatment may have to be repeated.
• Special devices for both men and women could help control incontinence.
• Surgery can sometimes improve or cure incontinence if it’s caused by a change in the position of the bladder or blockage due to an enlarged prostate.
• You can buy special absorbent underclothing that can be worn under everyday clothing.

If you suffer from urinary incontinence, tell your doctor. Remember, under a doctor’s care, incontinence can be treated and often cured. Even if treatment is not fully successful, careful management can help you feel more relaxed and confident.

For More Information

Here are some helpful Federal and Non-Federal resources:

National Association for Continence
P.O. Box 1019
Charleston, SC 29402-1019
800-252-3337 (toll-free)
www.nafc.org

National Institute of Diabetes and Digestive and Kidney Diseases
National Kidney and Urologic Diseases
Information Clearinghouse
3 Information Way


Bethesda, MD 20892-3580

800-891-5390 (toll-free)
www.niddk.nih.gov

National Library of Medicine
Medline Plus
www.medlineplus.gov

Simon Foundation for Continence
P.O. Box 815
Wilmette, IL 60091
800-237-4666 (toll-free)
www.simonfoundation.org

For more information on health and aging, contact:
National Institute on Aging
Information Center
P.O. Box 8057
Gaithersburg,
MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free) www.nia.nih.gov
www.nia.nih.gov/espanol

To sign up for regular email alerts about new publications and other information from the NIA, go to www.nia.nih.gov/health.
Visit www.nihseniorhealth.gov, a senior friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.