Dementia — a loss of thinking, remembering, and reasoning skills that affects everyday life — is a growing concern. It’s often preceded years in advance by memory and thinking problems, including cognitive decline and mild cognitive impairment. Interventions that prevent or delay these problems might help to reduce the risk of dementia.

Some studies have linked healthy eating patterns to improved cognitive function. Examples include the Mediterranean diet, which emphasizes fruits, vegetables, and lean proteins, and the DASH eating plan, designed to treat or prevent hypertension.

The MIND diet merges key features of the Mediterranean and the DASH diets. MIND stands for Mediterranean-DASH Intervention for Neurodegenerative Delay. It aims to protect brain health. The diet features green leafy vegetables and other vegetables, prefers berries over other fruit, and endorses whole grains, beans, nuts, and at least one weekly serving of fish. It limits red meat, sweets, cheese, fast food, and fried foods.

A research team led by Dr. Russell P. Sawyer of the University of Cincinnati studied whether the MIND diet is linked to cognitive health. They also looked for potential differences between Black and White Americans and between genders. Many earlier studies of diet and cognitive health have underrepresented Black participants.

The researchers drew on data from a large ongoing NIH-supported study called REGARDS (REasons for Geographic and Racial Differences in Stroke). REGARDS is designed to assess why Black Americans and others have increased rates of stroke and related conditions that affect brain health. Of the 30,000 REGARDS participants, about 14,000 had sufficient data on their cognitive status and eating patterns to be included in the new analysis. Their average age was about 64 at the start of the study. About 57% were female, 70% were White, and 30% were Black. They were followed for about 10 years.

The research team created a score for each participant based on how closely their self-reported eating patterns adhered to MIND diet recommendations. Cognitive health was measured at the beginning and end of the study. Results were reported in Neurology on Sept. 18, 2024.

Overall, the researchers found that, after adjusting for demographic and other factors, closer adherence to the MIND diet was linked to lower cognitive impairment and slower rates of cognitive decline. Participants with greatest adherence to the MIND diet had a 4% reduced risk of cognitive impairment compared to those with lowest adherence.

The team also found that closer following of the MIND diet was associated with an 8% lower risk of cognitive decline in female participants but no difference in males. And greater adherence to the diet was a better predictor of cognitive decline in Black than in White participants.

The researchers note that their findings generally align with earlier studies that examined associations between cognitive health and MIND and similar diets. But additional studies are needed to better understand the role that healthy eating may play in cognitive health.

“With the number of people with dementia increasing with the aging population, it’s critical to find changes that we can make to delay or slow down the development of cognitive problems,” Sawyer says. “These findings warrant further study, especially to examine these varying impacts among men and women and Black and White people.”

To learn more, please visit https://www.nia.nih.gov/news/healthful-diet-linked-reduced-risk-cognitive-decline.

Medicines are intended to help us live longer and healthier, but taking medicines the wrong way or mixing certain drugs and supplements can be dangerous. Older adults often have multiple medical conditions and may take many medicines, which puts them at additional risk for negative side effects. Read on to learn how to safely take and keep track of all your medicines.

What are medicines?

Medicines, often referred to as drugs, are used to prevent or treat diseases and other health conditions. Medicines can be obtained by a prescription or over the counter (OTC). Prescription drugs are medicines that you can get only with a doctor’s order; for example, pills to lower your cholesterol or an asthma inhaler. OTC medications can be purchased without a prescription; for example, aspirin or lubricating eye drops.

Dietary supplements are not considered drugs because they are not intended to prevent or treat diseases. Rather, these products are intended to maintain or improve health, and they may help you meet your daily requirements for essential vitamins and minerals. For example, calcium and vitamin D can help build strong bones. Learn more about taking supplements safely in the NIA article, Dietary Supplements for Older Adults.

It can be dangerous to combine certain prescription drugs, OTC medicines, dietary supplements, or other remedies. For example, you should not take aspirin if you take warfarin for heart problems. To avoid potentially serious health issues, talk to your doctor about all medicines you take, including those prescribed by other doctors, and any OTC drugs, vitamins, supplements, and herbal remedies. Mention everything, even ones you use infrequently.

Starting a new medicine

Talk with your health care provider before starting any new prescription, OTC medicine, or supplement, and ensure that your provider knows everything else you are taking. Discuss any allergies or problems you have experienced with other medicines. These might include rashes, trouble breathing, indigestion, dizziness, or mood changes. Make sure your doctor and pharmacist have an up-to-date list of your allergies so they don’t give you a medicine that contains something that could cause an allergic reaction.

You will also want to find out whether you’ll need to change or stop taking any of your other prescriptions, OTC medicines, or supplements while using this new medicine. Mixing a new drug with medicines or supplements you are already taking might cause unpleasant and sometimes serious problems. For example, mixing a drug you take to help you sleep (a sedative) and a drug you take for allergies (an antihistamine) can slow your reactions and make driving a car or operating machinery dangerous.

When starting a new medication, be sure to write down the name of the drug, the dose, and why it’s being prescribed for you. Also, make note of any special instructions for how to take the medicine. For many drugs, this information is included on the bottle or prescription label.

Filling your prescription

When you get your prescriptions filled, the pharmacist can answer many of your questions about prescription drugs, OTC medicines, and supplements. Try to have all your prescriptions filled at the same pharmacy so your records are in one place. This will help alert the pharmacist if a new drug might cause a problem with something else you’re taking. If you’re unable to use just one pharmacy, share your list of medicines and supplements with the pharmacist at each location when you drop off your prescription.

When you have a prescription filled:

• Ask your pharmacist if there is a patient profile you can fill out, so the pharmacy is aware of all drugs and OTC medications, vitamins, and supplements you take.
• Tell the pharmacist if you have trouble swallowing pills. There may be liquid medicine available. Do not chew, break, or crush tablets without first asking if this will change the way the drug works.
• Make sure you can read and understand the name of the medicine as well as 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.
• Read all the information about your medication carefully. Many prescription medicines come with paper handouts, called medication guides, that contain information to help patients avoid serious side effects.
• 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 another climate-controlled place?
• Check the label on your medicine before leaving the pharmacy. It should have your name on it and the directions provided by your doctor. If it doesn’t, don’t take it, and talk with the pharmacist.

The image below points out information typically present on a prescription label. Please note that your prescription label may have a different format than the one shown. The prescription number is usually printed in the upper left corner of the label.

Talk with your doctor or pharmacist if you have questions about the written information that comes with your prescription.

Medication side effects

Unwanted or unexpected symptoms or feelings that occur when you take medicine are called side effects. Side effects can be relatively minor, such as a headache or a dry mouth. They can also be life-threatening, such as severe bleeding or damage to the liver or kidneys. The side effects of some medications can also affect your driving.

Some side effects may appear when you start taking a medicine but get better with time. Others occur once in a while. But some side effects may be ongoing while you’re on the medication. If you have uncomfortable side effects, don’t stop taking your medicine before you talk with a health care provider. Write them down so you can report them to your doctor or pharmacist accurately. Call your doctor right away if you have any problems with your medicines or if you are worried that the medicine might be doing more harm than good. Your health care provider may be able to prescribe a different medicine or help you deal with side effects in other ways.

Keeping track of your medicines

Many older people take multiple medications, and it can be challenging to keep track of everything. Here are some tips that can help:

• Make a list. Write down all medicines you take, including OTC drugs. Also include any vitamins or dietary supplements. The list should include the name of each medicine or supplement, the amount you take, and time(s) you take it. If it’s a prescription drug, also note the doctor who prescribed it and the reason it was prescribed. Show the list to all your health care providers, including physical therapists and dentists. Keep one copy in a safe place at home and one in your wallet or purse.
• Get familiar with your medicines. If you take more than one medicine, make sure you can tell them apart by size, shape, color, or the number imprinted on the pill.
• Create a file. Save all the written information that comes with your medicines and keep it somewhere you can easily refer to it. Keep these guides for as long as you’re taking the medication.
• Check expiration dates on bottles. Don’t take medicines that are past their expiration date. Your doctor can tell you if you need a refill.
• Secure your medicines. Keep your medicines out of the reach of children and pets. If you take any prescription pain medicines (for example, morphine, other opioids, or codeine), keep them in a locked cabinet or drawer. If your medicines are kept in bottles without safety caps because those are hard for you to open, be extra careful about where you store them.
• Dispose of your medicines safely. Check the expiration dates on your medication bottles and discard any unused or expired medicines as soon as possible. Timely disposal of medicines can reduce the risk of others taking them accidentally or misusing the medications on purpose. Check with your doctor or pharmacist about how to safely discard expired or unneeded medications, or review the FDA’s guidance on Where and How To Dispose of Unused Medicines.

Taking medicines safely

Here are some tips to help you take your medicines safely:

• Follow instructions. Read all medicine labels and be sure to follow instructions. Don’t take a larger dose of a medicine, thinking it will help you more. This could be very dangerous and even deadly. And don’t skip or take half doses of a prescription drug to save money.
• Take medicine on time. Some people use meals or bedtime as reminders to take their medicine. Other people use charts, calendars, or weekly pill boxes. You can also set timers and write reminders to take your medication. Medication reminder apps for smartphones are becoming more popular; these apps can help you remember when and how to take your medications each day.
• Turn on a light. Don’t take medicine in the dark; you might make a mistake.
• Report problems. Call your doctor right away if you have any trouble with your prescriptions, OTC medicines, or supplements. There may be something else you can take.
• Tell your doctor about alcohol, tobacco, and drug use. Alcohol, tobacco, and other drugs can affect how well your medicines work. Be honest with your doctor about how much you use.
• Ask your loved ones for help. Take a friend or relative with you to your doctor’s appointments if you think you may need help understanding or remembering what the doctor tells you.
• Check before stopping. Take prescription medicine until it’s finished, or your doctor says it’s all right to stop. Note that some medicines are supposed to be taken only “as needed.”
• Don’t share. Do not take medicines prescribed for another person or give yours to someone else.

To learn more, please visit Taking Medicines Safely as You Age | National Institute on Aging (nih.gov)

Many people enjoy an alcoholic beverage or two on occasion with friends or family, but alcohol can be addictive. As we age, alcohol consumption can also make existing health problems worse and have dangerous interactions with some medications. Anyone at any age can develop an unhealthy reliance on alcohol.

Sometimes, families, friends, and health care workers may overlook the concerns about older people drinking. This can be the case because the side effects of drinking in older adults are mistaken for other conditions related to aging, for example, a problem with balance. But how the body handles alcohol changes with age.

The effects of alcohol change as we age

As you grow older, health problems or prescribed medicines may require that you drink less alcohol or avoid it completely. You may also notice that your body’s reaction to alcohol is different than before. Some older people feel the effects of alcohol more strongly without increasing the amount they drink. This can make them more likely to have accidents such as falls, fractures, and car crashes. Also, older women are more sensitive than men to the effects of alcohol.

Other people develop a harmful reliance on alcohol later in life. Sometimes this is a result of major life changes, such as the death of a spouse or other loved one, moving to a new home, or failing health. These kinds of changes can cause loneliness, boredom, anxiety, or depression. In fact, depression in older adults often aligns with drinking too much.

People who drink daily do not necessarily have alcohol use disorder. And not all who misuse alcohol or have alcohol use disorder drink every day. But heavy drinking, even occasionally, can have harmful effects.

How does drinking damage the body?

Drinking too much at one time or on any given day, or having too many drinks over the course of a week, increases the risk of harmful consequences, including injuries and health problems. People who consistently misuse alcohol over time are also at greater risk of developing alcohol use disorder.

Drinking too much alcohol over a long time can:

• Lead to some kinds of cancer, liver damage, immune system disorders, and brain damage
• Worsen some health conditions such as osteoporosis, diabetes, high blood pressure, stroke, ulcers, memory loss, and mood disorders
• Make some medical conditions hard for doctors to accurately diagnose and treat. For example, alcohol causes changes in the heart and blood vessels. These changes can dull pain that might be a warning sign of a heart attack.
• Cause some older people to be forgetful and confused — symptoms that could be mistaken for signs of Alzheimer’s disease or a related dementia.

Cautions about mixing alcohol and medicines

Many medicines — prescription, over the counter, or herbal remedies — can be dangerous or even deadly when mixed with alcohol. Many older people take medications every day, making this a particular concern.

Before taking any medicine, ask your doctor or pharmacist if you can safely drink alcohol.

Here are some examples of potential dangers caused by mixing alcohol with some medicines:

• If you take aspirin and drink, your risk of stomach or intestinal bleeding increases.
• When combined with alcohol, cold and allergy medicines (antihistamines) may make you feel very sleepy.
• Alcohol used with large doses of acetaminophen, a common painkiller, may cause liver damage.
• Some medicines, such as cough syrups and laxatives, have a high alcohol content. If you simultaneously drink alcohol, that will add to the effects.
• Alcohol used with some sleeping pills, pain pills, or anxiety/anti-depression medicine can be deadly.

Learn more about mixing alcohol with medicines.

How alcohol affects safety

Drinking even a small amount of alcohol can lead to dangerous or even deadly situations because it can impair a person’s judgment, coordination, and reaction time. This increases the risk of falls, car crashes, and other accidents.

Alcohol is a factor in about 30% of suicides and fatal motor vehicle crashes, 40% of fatal burn injuries, 50% of fatal drownings and homicides, and 65% of fatal falls. People should not drink alcohol if they plan to drive, use machinery, or perform other activities that require attention, skill, or coordination.

In older adults, especially, too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries. Older people have thinner bones than younger people, so their bones break more easily. Studies show that the rate of various types of fractures in older adults increases with heavy alcohol use.

Adults of all ages who drink alcohol and drive are at higher risk of traffic accidents than those who do not drink. Drinking slows reaction times and coordination, and interferes with eye movement and information processing. People who drink even a moderate amount are at higher risk for traffic accidents, possibly resulting in injury or death to themselves and others. (Note that even without alcohol, the risk of a car accident goes up starting at age 55.) Also, older drivers tend to be more seriously hurt in crashes than younger drivers. Alcohol adds to these age-related risks.

In addition, alcohol misuse or alcohol use disorder can strain relationships with family members, friends, and others. At the extreme, heavy drinking can contribute to domestic violence and child abuse or neglect. Alcohol use is often involved when people become violent, as well as when they are violently attacked. If you feel that alcohol is endangering you or someone else, call 911 or obtain similar help right away.

What are signs of alcohol misuse or alcohol use disorder?

Alcohol misuse or alcohol use disorder is a pattern of drinking that can cause harm to a person’s health and social relationships. Drinking too much at one time or on any given day or having too many drinks over the course of a week increases the risk of harmful consequences, including injuries and health problems. Men should not have more than two drinks a day and women only one. Drinking less alcohol is better for health than drinking more.

The definition of “one drink” means:

• One 12-ounce can or bottle of regular beer, ale, or hard seltzer
• One 8- or 9-ounce can or bottle of malt liquor
• One 5-ounce glass of red or white wine
• One 1.5-ounce shot glass of 80-proof distilled spirits like gin, rum, tequila, vodka, or whiskey.

Understanding these “standard” drink sizes can make it easier to follow health guidelines. Another thing to keep in mind is that drinks may be stronger than you think they are if the actual serving sizes are larger than the standard sizes. In addition, drinks within the same beverage category, such as beer, can contain different percentages of alcohol. It’s important to read the label to understand and be aware of how much you’re actually drinking.

Getting the help you need for alcohol misuse or alcohol use disorder

Some people have no trouble cutting back on their drinking. But others will need to stop drinking completely. Alcohol problems can happen to people from all walks of life at any age, and, each year, millions of people seek help for alcohol problems.

If you or someone you love is thinking of changing their habits around alcohol, the “Rethinking Drinking” website, hosted by NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA), provides information on signs of a problem and tools that can help lead to better health.

Making a change in your drinking habits can be hard. Don’t give up! If you don’t reach your goal the first time, try again. The good news is you’re not in this alone. Don’t be afraid to talk with a doctor and ask your family and friends for help.

Here are some approaches to try to get started:

• Ask your doctor about advances in medication that might help you stick with alcohol abstinence longer or reduce cravings. Your health care professional may also be able to give you advice about treatment.
• Talk to a trained counselor who knows about alcohol problems in older people.
• Find a support group for older people with alcohol problems. Many people find group counseling sessions or meetings helpful.
• Choose individual, family, or group therapy, depending on what works for you.
• Check out an organization such as Alcoholics Anonymous that offers support and programs for people who want to stop drinking.
• Consider websites or mobile applications that can help you track your alcohol intake and offer positive support as you make progress toward your goals.

Strategies to help cut back or quit drinking

Many older adults decide to quit drinking in later life. You can do it, too. Here are some ways to cut back or stop drinking:

• Count how many ounces of alcohol you are getting in each drink.
• Keep track of the number of drinks you have each day.
• Decide how many days a week you want to drink. Plan some days that are free of alcohol.
• In place of alcohol, try drinking water, juice, or soda. You could also try nonalcoholic “mocktails” or low-alcohol beer.
• Remove alcohol from your home.
• Ask for support from your family and advice from your health care provider. Get the help you need to cut back or quit.

Learn your patterns and plan ahead

As you evaluate your alcohol use, you may find that you drink more often in particular settings or in reaction to certain emotions, such as stress or boredom. Take time to learn about your habits and plan ahead on ways to make a change. Here are some ideas:

• Develop interests that don’t involve alcohol.
• Avoid people, places, and situations that may trigger your drinking.
• Avoid drinking when you’re angry or upset or if you’ve had a bad day.
• Plan what you will do if you have an urge to drink.
• Learn to say “no, thanks” when you’re offered an alcoholic drink.
• Remember to stay healthy for the fun things in life, such as the birth of a grandchild, a long-anticipated trip, or a holiday party.

Your body changes as you get older and that can affect daily routines. Be alert to these changes and think about adjusting your alcohol use so you can enjoy your life to the fullest.

Learn more about available types of alcohol treatment. To find alcohol treatment for yourself or a loved one, visit the NIAAA Alcohol Treatment Navigator.

Other than skin cancer, breast cancer is the most common cancer among American women. For many women, mammograms are the best way to find breast cancer early, when it is easier to treat. Mammograms can find cancer before it is big enough to feel or cause symptoms.

Symptoms

There are different symptoms of breast cancer, and some people have no symptoms at all. Symptoms can include:

• Any change in the size or the shape of the breast.
• Pain in any area of the breast.
• Nipple discharge other than breast milk (including blood).
• A new lump in the breast or underarm.

If you have any signs that worry you, see your doctor right away.

Risk factors

Some main factors that affect your chance of getting breast cancer include:

• Being a woman.
• Being older. Most breast cancers are found in women who are 50 or older.
• Having changes in your BRCA1 or BRCA2 genes.

How to lower your risk

You can do things to help lower your breast cancer risk.

• Keep a healthy weight and be physically active.
• Choose not to drink alcohol, or drink alcohol in moderation.
• If you are taking hormone replacement therapy or birth control pills, ask your doctor about the risks.
• Breastfeed your children, if possible.

Fast facts

• Each year in the United States, about 270,000 women get breast cancer and 42,000 women die from the disease.
• Men also get breast cancer, but it is not very common. About 1 out of every 100 breast cancers diagnosed in the United States is found in a man.
• Most breast cancers are found in women who are 50 years old or older, but breast cancer also affects younger women.

To learn more, please visit https://www.cdc.gov/cancer/features/breast-cancer.html.

Doctor-patient communication is an essential, though sometimes challenging, aspect of the health care process. The following suggestions can help you work with older patients to optimize care and make the most of your time and resources.

Tips for communicating with older patients

Effective communication can help build satisfying relationships with older patients to best manage their care. It can strengthen the patient-provider relationship, lead to improved health outcomes, help prevent medical errors, and make the most of limited interaction time.

Interpersonal communication skills are considered so important that they are a core competency identified by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties.

These key communication tips can help facilitate successful interactions with all of your patients, including older adults:

• peak to the patient as a fellow adult. Having physical, sensory, or cognitive impairments does not lessen the maturity of an adult patient. Those who are older might be used to more formal terms of address. Establish respect right away by using formal language as a default (such as Mr. or Ms.) and avoiding familiar terms, such as “dear,” which could be perceived as disrespectful. You or your staff can also ask patients how they prefer to be addressed.
• Make older patients comfortable. Ask staff to ensure patients have a comfortable seat in the waiting room and, if necessary, help with filling out forms. Staff should check on them often if they have a long wait before they are seen. Patients with impaired mobility may need to be escorted to and from exam rooms, offices, restrooms, and the waiting area. They may require assistance with climbing on to the exam table or removing clothing or shoes.
• Avoid hurrying older patients. Be mindful if you are feeling impatient with an older person’s pace. Some people may have trouble following rapid-fire questioning or torrents of information. Try speaking more slowly to give them time to process what is being asked or said, and don’t interrupt. Once interrupted, a patient is less likely to reveal all of their concerns. If time is an issue, you might suggest that your patients prepare a list of their health concerns in advance of appointments.
• Speak plainly. Do not assume that patients know medical terminology. Use simple, common language and ask if clarification is needed. Check to be sure your patient understands the health issue, what they need to do, and why it is important to act.
• Address the patient face-to-face. Don’t talk to patients with your back turned or while typing. Many people with hearing impairment understand better when they can read lips as well as listen. Watching a patient’s body language can also help you know whether they understand what you’re saying.
• Write down or print out takeaway points. It can often be difficult for patients to remember everything discussed during an appointment. Older adults with more than one medical condition or health concern benefit especially from having clear and specific written notes or printed handouts. That way, they have information to review later about their health conditions, treatments, and other major points from visits.
• Recognize that people from different backgrounds may have different expectations. Be sensitive to cultural differences that can affect communication with your patients. When needed, provide professional translation services and written materials in different languages.

Compensating for hearing deficits

Age-related hearing loss is common: About one-third of older adults have hearing loss, and the chance of developing hearing loss increases with age. Here are a few tips to make it easier to communicate with a person who may have difficulty hearing:

• Make sure your patient can hear you. Ask if the patient has a working hearing aid, look at the auditory canal for excess earwax, and be aware of background noises, such as whirring computers and office equipment.
• Talk clearly and in a normal tone. Shouting or speaking in a raised voice distorts language sounds and can give the impression of anger, and a high-pitched voice can be hard to hear.
• Face the person directly, at eye level, so that they can lip read or pick up visual clues.
• Indicate to your patient when you are changing the subject, such as by pausing briefly, speaking a bit louder, gesturing toward what will be discussed, gently touching the patient, or asking a question.
• Keep a notepad handy so you can write down important points, such as diagnoses, treatments, and important terms.
• Use amplification devices if they are available in your clinic or hospital.
• If your patient has difficulty hearing the difference between certain letters and numbers, give context for them. For instance, “m as in Mary” or “five, six” instead of “56.” Be especially careful with letters that sound alike.

Compensating for visual deficits

Visual disorders become more common as people age. Here are some things you can do to help manage the difficulties in communication that can result from visual deficits:

• Make sure there is adequate lighting, including sufficient light on your face. Try to minimize glare.
• Check that your patient has brought and is wearing eyeglasses or contact lenses, if needed.
• Make sure that handwritten instructions are clear. When using printed materials, make sure the type is large enough (at least 14-point font) and the typeface is easy to read.
• If your patient has trouble reading because of low vision, consider providing alternatives, such as audio instructions, large pictures or diagrams, and large pillboxes with raised markings.

Families and caregivers as part of the health care team

Family members and other informal caregivers play a significant role in the lives of their loved ones. They may provide transportation and accompany an older adult to medical appointments. In many cases, they act as facilitators to help the patient express concerns and can reinforce the information you give. But first, to protect and honor patient privacy, check with the patient by asking how they see the companion’s role in the appointment.

It is important to keep the patient involved in their own health care and conversation. Whenever possible, try to sit so that you can address both the patient and companion face-to-face. Be mindful not to direct your remarks only to the companion.

You might ask the companion to step out of the exam room during part of the visit so you can raise sensitive topics and provide the patient some private time if they wish to discuss personal matters. For example, if you’re conducting a test of a patient’s cognitive abilities, you might ask the companion to step out so they can’t answer questions or cover for the patient’s cognitive lapses.

Some patients may ask that you contact their long-distance caregivers to discuss conditions or treatment plans. Make sure these patients fill out any necessary paperwork giving permission for you to speak with specific family members or friends if they are not present at the appointment.

Families may want to make decisions for a loved one. Adult children especially may want to step in for a parent who has cognitive impairment. If a family member has been named the health care agent or proxy, under some circumstances they have the legal authority to make care decisions. However, without this authority, the patient is responsible for making their own choices. When necessary, set clear boundaries with family members and encourage others to respect them.

Discussing medical conditions and treatments

Approximately 85% of older adults have at least one chronic health condition, and 60% have at least two chronic conditions. Clinicians can play an important role in educating patients and families about chronic health conditions and can connect them with appropriate community resources and services.

Most older patients want to understand their medical conditions and learn how to manage them. Likewise, family members and other caregivers can benefit from having this information. Physicians typically underestimate how much patients want to know and overestimate how long they spend giving information to patients. Devoting more attention to educating patients and their caregivers can improve patients’ adherence to treatment, increase patients’ well-being, and save you time in the long run.

Clear explanations of diagnoses are critical. Uncertainty about a health problem can be upsetting, and when patients do not understand their medical conditions, they are less likely to follow their treatment plans. It is helpful to begin by finding out what the patient understands about their condition, what they think will happen, and how much more they want to know. Based on the patient’s responses, you can correct any misconceptions and provide appropriate information.

Treatment plans need to involve patients’ input and consent. Ask about their goals and preferences for care and focus on what matters most to them. Check in with your patient about feasibility and acceptability throughout the process, thinking in terms of joint problem-solving and collaborative care. This approach can increase the patient’s satisfaction while reducing demands on your time.

Treatment might involve lifestyle changes, such as a more nutritious diet and regular exercise, as well as medication. Tailor the plan to the patient’s situation and lifestyle and try to reduce disruption to their routine. Keep medication plans as simple and straightforward as possible, indicating the purpose of each medication and when it should be taken. Tell the patient what to expect from the treatment.

These tips may help discussions about medical conditions and treatment plans:

• A doctor’s advice generally receives the greatest credence, so the doctor should introduce treatment plans. Other medical team members can help build on the doctor’s original instructions.
• Let your patients know that you welcome questions. Tell them how to follow up if they think of any additional questions later.
• Some patients won’t ask questions even if they want more information. Consider making information available even if it’s not explicitly requested.
• Offer information through more than one channel. In addition to talking with the patient, you can use fact sheets, drawings, models, or videos. In many cases, referrals to websites and support groups can be helpful.
• Encourage the patient or caregiver to take notes. It’s helpful to offer a pad and pencil. Active involvement in recording information may help your patient better retain information and adhere to the treatment plan.
• Repeat key points about the health problem and treatment plan at every office visit, providing oral and written instructions, and check that the patient and their caregiver understand the information.
• Provide encouragement and continued reinforcement for treatment or necessary lifestyle changes. Call attention to the patient’s strengths and offer ideas for improvement.
• Make it clear that a referral to another doctor, if needed, does not mean you are abandoning the patient.

Confusion and cognitive problems

A patient may still seem confused despite your best efforts to communicate clearly. In those instances, work to:

• Support and reassure the patient, acknowledging when responses are correct or understood.
• Make it clear that the conversation is not a “test” but rather a search for information to help the patient.
• Consider having someone from your staff call the patient to follow up on instructions.

Cognitive impairment, however, is more than general confusion or normal cognitive aging. If you observe changes in an older patient’s cognition or memory, follow up with screening and diagnostic testing, as appropriate.

There are a variety of possible causes of cognitive problems, such as side effects from medications, metabolic and/or endocrine changes, delirium, or untreated depression. Some of these causes can be temporary and reversed with proper treatment. Other causes of cognitive problems, such as Alzheimer’s disease, are chronic conditions but may be treated with medications or nondrug therapies. Having an accurate diagnosis also can help families wanting to improve the person’s quality of life and better prepare for the future.

Read more about Assessing Cognitive Impairment in Older Patients and Caring for Older Patients With Cognitive Impairment.

Sensitive topics

Caring for an older patient requires discussing sensitive topics related to safety, independence, and health. Older patients may be hesitant to bring up certain problems and other concerns such as:

• Advance care planning
• Driving
• Elder abuse
• End of life
• Health care costs
• Long-term care
• Mental health issues, such as depression
• Sexuality and sexual health
• Social isolation and loneliness
• Substance use/misuse, including alcohol
• Urinary incontinence

There are techniques for broaching sensitive subjects that can help you successfully start the conversation. Try to take a universal, nonthreatening approach that frames the subject as a common concern of many older patients (such as, “Many people experience …” or “Some people taking this medication have trouble with…”). You can also share anecdotes about patients in similar circumstances, though always clearly maintaining patient confidentiality, to ease your patient into the discussion.

Some patients will still avoid issues that they think are inappropriate to discuss with clinicians. One way to overcome this hesitation is to keep informative brochures and materials readily available in the exam room and waiting areas.

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

Many falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. There are many changes you can make to your home that will help prevent falls and better ensure your safety.

Floors, stairways, and hallways

• Ensure there are handrails on both sides of any stairs, and make sure they are secure. Hold the handrails when you go up or down stairs, even when you are carrying something. Don’t let anything you’re carrying block your view of the steps.
• Ensure there is good lighting with light switches at the top and bottom of stairs and on each end of a long hall. Consider using motion-activated lights that plug into electrical outlets and automatically turn on when you walk by them to help illuminate stairwells and pathways.
• Keep areas where you walk tidy. Don’t leave books, papers, clothes, or 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, which you can buy at any hardware store, on tile and wooden floors.
• Don’t use throw rugs or small area rugs.
• Don’t walk on slippery, newly washed floors.

Bathrooms

• Mount grab bars near toilets and on both the inside and outside of your tub and shower.
• Place nonskid mats, strips, or carpet on all surfaces that may get wet.
• Remember to leave a light on in the bathroom at night or use a night light that turns on automatically in the dark.

Bedrooms

• Put night lights and light switches close to your bed.
• Keep a flashlight by your bed in case the power goes out and you need to get up.
• Place a landline or well-charged phone near your bed.

Kitchen

• Keep frequently used pots, pans, and kitchen utensils in a place where they are easy to reach.
• Clean up spills immediately.
• Prepare food while seated to prevent fatigue or loss of balance.

Outdoor spaces

• If you have steps leading to your front door, make sure they are not broken or uneven.
• Add non‐slip material to outdoor stairways.
• Keep the lawn, deck, or porch areas clear of debris, such as fallen branches.
• Consider installing a grab bar near the front door to provide balance while you are locking or unlocking the door.
• Turn on your porch light at night and if you leave during the day but plan on returning home after dark.
• In the winter, treat outdoor walkways with an ice melt product or sand to make them less slippery.

Other living areas

• Keep electrical cords near walls and away from walking paths.
• 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 easily.
• Keep items you use often at waist level or 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’s 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 a list of emergency numbers in large print near each landline phone and save them under “favorites” on your mobile phone.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These health care providers can assess your home’s safety and advise you about making changes to lower your risk of falls.

Tools to get help

If you’re concerned about falling, set up systems to ensure you can get help if you fall. One option is installing an emergency response system. If you fall or need emergency help, you push a button on a special necklace or bracelet to alert 911. There is a fee for this service, and it’s usually not covered by insurance.

Another option is to carry a well-charged cordless or mobile phone with you as you move throughout the house. Have close friends and family on speed dial. Consider setting up a smart home device (a small speaker that listens and responds to commands when you call its name) that can quickly connect you to contacts or emergency response teams. Some smartwatches can be set up to make emergency calls at the push of a button and others can even detect sudden fall-like movements and automatically call for help. Ask family and friends for help setting up these tools.

Home improvement resources

Many state and local governments have education and/or home modification programs to help older people prevent falls. Check with your local health department, search the Eldercare Locator, or call 800-677-1116 to find your local Area Agency on Aging to see if there is a program near you.

To learn more, please visit https://www.nia.nih.gov/health/falls-and-falls-prevention/preventing-falls-home-room-room.

Many of us have favorite songs that can help us relax after a hectic day or get us moving on the dance floor. Music can also be a powerful gateway to memory; for example, a song from our past may bring back memories that trigger strong emotions.

But what is happening in our brains when we hear a song that is meaningful to us? Could music make older adults not only feel better but also improve their health? Much more research is needed before any definitive conclusions can be drawn, but there is growing scientific interest in music’s effects on the brain and body as we age.

How the brain is wired for music and memory

Psyche Loui, Ph.D., leads the Music, Imaging, and Neural Dynamics (MIND) Lab at Northeastern University in Boston. She also plays the violin in Boston’s Longwood Symphony Orchestra and in a variety of local pop and chamber music groups. In the laboratory, she seeks to understand how the parts of the brain that relate to musical perception and processing interact with brain regions controlling learning, memory, and emotions. Interested in music and science most of her life, she first became curious about how music might help people with dementia while volunteering at a nursing home as a high school student.

After little response from residents with advanced dementia to the Beethoven pieces she played on the piano, staff members encouraged her to try something a bit livelier from a book of traditional folk songs. “I just played some old familiar ditties and tunes, and then, amazingly, some of the residents knew all the words and started singing along in close harmony,” said Loui. “That just really struck me.”

Our brains are hard-wired to predict and anticipate familiar rhythms and melodies, Loui explained. It starts with the auditory cortex, the brain region that receives and processes sounds, including voices and music. “When we hear something that we enjoy, that engages not only the auditory cortex, but also the brain’s reward systems that are driven by the neurotransmitter dopamine, which motivates us to seek out and learn new information.”

Another key part of the brain’s dopamine-based reward system is the medial prefrontal cortex, which also processes memories about ourselves. “If I’m listening to music that I’ve enjoyed throughout my life, and that I find familiar, then the auditory system is active, but it’s also communicating and connecting with the medial prefrontal cortex,” said Loui.

Working with like-minded researchers in the Boston area at the Berklee College of Music and Harvard Medical School, Loui and colleagues developed an eight-week mindful music-based listening program for healthy older adults. Participants showed stronger increases in functional connectivity between the auditory system and the medial prefrontal cortex — areas that generally become less active with age — compared to control groups. Their team is now testing out this intervention in older adults with memory impairments, hoping that music can help revive learning and memory functions through this connectivity.

Loui’s latest project is the Multimodal Musical Stimulation for Healthy Neurocognitive Aging study, which is designing and testing a device that pairs music selected by participants with rhythmic, colored LED light patterns. Supported with NIA small business funding, the technology is based on mouse studies in which Alzheimer’s disease-related brain deposits of tau and beta-amyloid proteins were reduced through light and sound stimuli. Loui and colleagues are working on prototypes to test the light and sound intervention as a potential therapy for older adults and for people living with mild cognitive impairment or dementia.

Singing to build cognitive and social connections

Another interesting area of research is the exploration of whether music can strengthen connections not just between our neurons, but also between people, to enhance social networks and reduce isolation and loneliness among older adults.

Can music reduce patient delirium in the ICU?

Between 70% and 80% of intensive care unit (ICU) patients who receive respiratory support from mechanical ventilators experience delirium — a syndrome of sudden, acute confusion that can occur after major surgery or during a serious illness. In some patients, delirium can cause agitation, aggression, or hallucinations while others may be drowsy. Patients who experience delirium tend to have longer stays in the ICU, and more than 30% of patients who develop it experience long-term cognitive impairment. They are also more likely to be transferred to nursing homes or rehabilitation facilities after they leave the hospital.

Soothing sleep with music in people living with dementia

People living with Alzheimer’s or a related dementia often experience sleep disturbances, such as insomnia or waking up during the night. These sleep problems can also disrupt their caregivers’ sleep, contributing to poorer physical and mental health in people who may already feel overwhelmed. For those living with dementia, sleep disruption has been associated with more time in health care facilities, poorer cognitive function, and faster disease progression.

Testing music to reduce agitation and aggression

Other investigators are testing whether music can ease daytime dementia-related issues such as agitation, anxiety, and aggression, all of which can be troubling for people with dementia and their caregivers. The METRIcAL – Music and MEmory: A Pragmatic TRIal for Nursing Home Residents with ALzheimer’s Disease project, led by Vincent Mor, Ph.D., and his colleague Ellen McCreedy, Ph.D., MPH, with the Brown University School of Public Health, explored whether customized playlists of preferred music could reduce disruptive or disturbing behaviors like pacing, calling out verbally, sundowning, or other common dementia symptoms, and lessen reliance on antipsychotic drugs.

The METRIcAL study was conducted in a real-world setting, with almost 1,000 residents with dementia in 54 nursing centers in 10 states. While the study did not find that personalized music was significantly effective in reducing agitated behaviors or psychotropic drug use, there were many lessons learned that could help inform the design of future trials.

Working in harmony: How can we use what we know?

NIA continues to fund research to investigate the potential of music as a therapy. In the meantime, Petrovsky encourages families and caregivers to pay attention to how a person they are caring for responds when music is playing, and which songs they seem to connect with the most.

Evidence on the effectiveness of music on medical conditions continues to be collected. In the meantime, older adults who enjoy music can consider if they want to include it as part of their future care preferences.

To learn more, please visit https://www.nia.nih.gov/news/could-musical-medicine-influence-healthy-aging.

Many people live far away from their family or friends who need help. If you don’t live nearby, you can still provide support and assistance as a long-distance caregiver. This article provides information and resources if you find yourself in a long-distance caregiving role.

What tasks can a long-distance caregiver help with?

Long-distance caregivers take on different roles. From a distance, you may be able to:

• Assist with finances, money management, insurance claims, or paying bills
• Arrange for care management or in-home care by hiring formal caregivers such as home health aides
• Order medical equipment, medicines, and other supplies the person needs
• Serve as an information coordinator by researching information about relevant health conditions and medicines, navigating changing needs, and overseeing insurance benefits
• Help with advance care planning, such as choosing a health care proxy and preparing a living will
• Help find, organize, and update important paperwork and records
• Research long-term care options, such as an assisted living facility or nursing home

You will probably be coordinating these tasks with family, friends, or other caregivers who live nearby. Read more about sharing caregiving responsibilities with family members.

Staying connected from far away

When you don’t live close by, it may take more effort to find out what’s going on and stay up to date with an older person’s needs. Here are some strategies and technologies that long-distance caregivers can use to stay connected:

• Create a list of important phone numbers and email addresses. Keep it in a shared document or spreadsheet online and update it regularly.
• Set up a shared calendar online or in a smartphone app to coordinate with other caregivers.
• With permission, attend the person’s telehealth visits. Telehealth visits are remote appointments with health care providers often done with videoconferencing.
• Participate remotely in conference calls or video meetings with the assisted living facility team or nursing home staff.
• Help the older person learn about the features of their mobile or smart phone, such as texting and video calls.
• If the older person is comfortable using a computer or tablet, set up an email account for them and teach them how to stay safe online.

Making the most of a short visit with an aging parent or relative

Talk to the person ahead of time and find out what they would like to do during your visit. Also check with the primary caregiver, if appropriate, to learn what they need. You may be able to handle some of their caregiving responsibilities while you are in town. These conversations can help you set clear-cut and realistic goals for the visit. Decide on your top priorities — that may mean reserving other tasks for a future visit.

Because there’s a lot to do during a short visit, it’s easy to overlook simply spending time with the person and doing things together. Try to make time for activities unrelated to being a caregiver, such as watching a movie, playing a game, enjoying music, or taking a drive. Finding time to enjoy something simple and relaxing together is good for everyone.

Supporting the person doing day-to-day caregiving

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

Here are some ways you can help, even if you don’t live nearby:

• Ask what you can do that would be most helpful.
• Stay in regular contact with the primary caregiver by phone or email. Just listening may not sound like much, but it can mean a lot.
• Travel to stay with the older person for a few days so the primary caregiver can take a vacation or just have some time off.
• Arrange for regular respite care in the form of a volunteer, an in-home aide, or an adult day care program.

In time, the older person may have to move to a residential (live-in) facility, such as assisted living or a nursing home. If that happens, the primary caregiver will need your support. You can work together to select a facility and coordinate the move. The primary caregiver may need extra support while adjusting to the person’s absence and to living alone at home.

To learn more, please visit https://www.nia.nih.gov/health/long-distance-caregiving/what-long-distance-caregiving.

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, arthritis, chronic pain, high blood pressure, or diabetes. In fact, physical activity may help. For most older adults, physical activities like brisk walking, riding a bike, swimming, weightlifting, and gardening are safe, especially if you build up slowly. You may want to talk with your doctor about how your health condition might affect your ability to be active.

Staying physically active: Alzheimer’s disease and related dementias

Researchers are assessing the benefit of exercise to delay mild cognitive impairment (MCI) in older adults and to improve brain function in older adults who may be at risk for developing Alzheimer’s disease. Older adults with MCI may be able to safely do more vigorous forms of exercise, similar to older adults without MCI, provided there are no other underlying health concerns.

Being active and getting exercise may help people with Alzheimer’s or another dementia feel better and can help them maintain a healthy weight and have regular toilet and sleep habits. If you are a caregiver, you can exercise together to make it more fun.

Exercising with arthritis

For people with arthritis, exercise can reduce joint pain and stiffness. It can also help with losing weight, which reduces stress on the joints.

Flexibility exercises such as upper- and lower-body stretching and tai chi can help keep joints moving, relieve stiffness, and give you more freedom of movement for everyday activities.

Strengthening exercises, such as overhead arm raises, will help you maintain or add to your muscle strength to support and protect your joints.

Endurance exercises make the heart and arteries healthier and may lessen swelling in some joints. Try activities that don’t require a lot of weight on your joints, such as swimming and biking.

If you have arthritis, you may need to avoid some types of activity when joints are swollen or inflamed. If you have pain in a specific joint area, for example, you may need to focus on another area for a day or two.

Physical activity and COPD (Chronic Obstructive Pulmonary Disease)

If you have COPD, talk with your healthcare provider or a pulmonary therapist to learn what he or she recommends. You may be able to learn some exercises to help your arms and legs get stronger and/or breathing exercises that strengthen the muscles needed for breathing.

Pulmonary rehabilitation is a program that helps you learn to exercise and manage your disease with physical activity and counseling. It can help you stay active and carry out your day-to-day tasks.

Exercising with type 2 diabetes

For people with diabetes, exercise and physical activity can help manage the disease and help you stay healthy longer. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. Set a goal to be more active most days of the week, and create a plan for being physically active that fits into your life and that you can follow. Your healthcare team can help.

A few easy steps to be more active:

• Stretch during TV commercial breaks.
• Walk around when you talk on the phone.
• Take more steps by parking farther away from stores, movie theaters, or your office.

Exercise and heart health

Your heart keeps your body running. As you grow older, some changes in the heart and blood vessels are normal, but others are caused by disease. Choices you might make every day, such as eating healthy, maintaining a healthy weight, and aiming to be more physically active, can contribute to heart health. Inactive people are nearly twice as likely to develop heart disease as those who are active. A lack of physical activity can worsen other heart disease risk factors as well, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity. Being physically active is one of the most important things you can do to keep your heart healthy. Aim for at least 150 minutes of moderate-intensity aerobic activity a week.

Exercising with osteoporosis

Weight-bearing exercises, which force you to work against gravity, such as walking, jogging, or dancing three to four times a week, are best for building muscle and strengthening bones. Try some strengthening and balance exercises, too, to help avoid falls, which could cause a broken bone. Doing these exercises is good for bone health for people with osteoporosis and those who want to prevent it.

Exercising with chronic pain

Most people living with chronic pain can exercise safely, and it can assist with pain management. In fact, being inactive can sometimes lead to a cycle of more pain and loss of function. Talk to your doctor about what exercises/activities might be right for you. Each type of exercise—endurance, strength, balance, and flexibility—has its own benefits, so a combination may be best.

Exercise can help you maintain a healthy body weight, which may relieve knee or hip pain. Putting on extra weight can slow healing and make some pain worse. Remember to listen to your body when exercising and participating in physical activities. Avoid over-exercising on “good days.” If you have pain, swelling, or inflammation in a specific joint area, you may need to focus on another area for a day or two. If something doesn’t feel right or hurts, seek medical advice right away.

Quick tip

Pain rarely goes away overnight. Talk with your doctor about how long it may take before you feel better. As your pain lessens, you can likely become even more active.

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

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

How to start the conversation about advance care planning

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

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

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

How to serve as a health care proxy

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

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

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

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

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

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

Learn more about the role of a health care proxy.

• What to do when your loved one can no longer make decisions

If your loved one can no longer make their own decisions, you may need to make decisions on their behalf. This can be difficult if you haven’t discussed their preferences before. Even if you have, there may be unexpected situations and decisions that arise. Talking with close loved ones and the person’s health care team can help you prepare and feel more supported when decisions arise. Try to:

• Talk to family members, friends, or others who know the person well.
• Think about how the person lived their life. What values and wishes did they express in the past? What did they find most meaningful in life?
• Talk with the doctor and health care team about what to expect and the types of decisions you may need to make.

Learn more about making decisions for someone at the end of life.

Tips for navigating the health care system

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

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

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

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