Aging & Health A to Z

Smoking is still the most preventable cause of death in the United States for both men and women. Quitting can increase life expectancy, lower the risk of heart disease, and improve lung function and blood circulation.

Make a plan for quitting with your healthcare provider. You will have a better chance of quitting if you:

• Set a date for your last cigarette. On that date, get rid of all cigarettes and anything associated with them. 
• Talk to your healthcare provider about nicotine-replacement therapy if you smoke more than 10 cigarettes per day and if you want this type of therapy (i.e., patch, gum, nasal spray, inhaler). This may help reduce physical cravings. People with certain conditions should not use nicotine-replacement therapy.
• Talk to your healthcare provider about taking bupropion (Wellbutrin, Zyban), varenicline (Chantix) or similar medications instead of nicotine replacement, or both together
• Schedule reinforcement visits with your healthcare provider.
• Join support groups for people trying to quit or get counseling, in a group, individually, or by telephone.
• Avoid people or situations that tempt you to smoke.
• After quitting, switch from coffee and alcoholic drinks to juices or water, take walks instead of coffee breaks, and chew gum or suck on hard candy if you have a craving.

Even if it is not particularly strenuous, exercise can help prevent many types of health problems, including heart disease, falls, and depression. Exercise should be a regular activity several times per week.  

Your healthcare provider can work with you to create an exercise program that will work best for you. He or she will help you set short-term and long-term goals.  If you are beginning a vigorous exercise program, your healthcare professional may send you for a stress test if were previously sedentary and have more than two risk factors for heart disease such as:

• High blood pressure
• Diabetes
• Obesity
• High cholesterol or other substances in your blood
• Being a smoker
• A family history of heart disease
• Male gender
• An inactive lifestyle. 

Your exercise routine may be something you do at home, in a group program, with a physical therapist, or some combination of these. Even walking, gardening, or cleaning the house for 30 minutes per day can be very beneficial if your heart rate increases significantly while you are exercising. 

Your exercise program should focus on the following: 

• Flexibility training – stretching all parts of the body at least twice a week
• Endurance activities – at least 30 minutes at least 5 times per week
• Strength training – using weights or resistance
• Balance exercises – Tai chi or other balance training. 

Being overweight or obese, or underweight—especially if there is a sudden weight loss of at least 10 pounds within 6 months—are all risks to good health. If you are in the hospital, there is an even greater risk that you will not consume enough calories to maintain a healthy weight.

Being obese puts you at higher risk of heart and circulatory diseases.  Being heavier may also increase risk of other serious diseases such as diabetes and cancer and may lead to worse function from osteoarthritis. There are many resources, both government programs and commercial organizations, that can help you lose weight and keep it off.

Watching your diet also includes staying away from saturated and trans fats, which can raise your cholesterol and other fats in your blood and increase your risk for heart disease.

Talk to your healthcare professional about your diet, including

• Your daily consumption of calories, fluids, fats, fiber, and salt
• What types of foods you eat (fatty meats, fried foods, processed foods, sweets)
• Teeth problems that may interfere with eating
• Other problems that may lead to malnutrition such as not being able to afford good quality food, poor appetite, or disabilities that make shopping for or preparing meals difficult. 

Here are a few tips for losing weight, if you need to: 

• Talk to a healthcare professional, registered nutritionist or dietician to help you develop an individual weight-loss program that includes plenty of fruits and vegetables, fiber, lean meats, fatty fish, healthy oils, and a minimum of saturated fats, salt, and fried or processed foods.
• Exercise along with your diet. This will help take off the pounds and keep them off, while improving your overall fitness and heart health.
• Keep a food diary to help you understand your eating patterns (i.e., nighttime snacking, anxiety eating) and help you to be aware of specific problems. 

Alcohol is a problem for about 5% of people over 65 years of age. Having one drink per day (such as: one beer, one mixed drink, or one glass of wine) can reduce the risk of heart attack and stroke, but may increase the risk of breast cancer. 

For people over the age of 65, more than three drinks on one occasion, or more than 7 drinks per week for men or women, is considered too much for an older adult and can be harmful. At-risk drinking increases your likelihood of:

• injuries and accidents
• stomach or intestinal illnesses
• diseases of the liver and pancreas
• memory difficulties and other brain problems
• a lower quality of life (through neglect of other activities). 

You should not drink any alcohol at all if you:

• are taking any medications that can interact with alcohol
• have any problems with memory or brain function
• have a condition or disease that will get worse with alcohol (check with your healthcare provider). 

The sixth leading cause of death among people 65 years and older is accidents, especially because of falls, hazards in your home, and car accidents. 

Falls:  An unexpected fall can cause serious injury requiring hospitalization, surgery, care in a rehabilitation facility, or even long-term nursing home care. Such injuries are often the first step in the loss of independent living. 

To avoid a fall, ask your healthcare provider how you can lower your falling risk. He or she will:

• evaluate your balance, walking ability (gait), bone health, blood pressure, heart health, and look for other physical disabilities
• check your medications and suggest changes if necessary
• ask about the circumstances if you have had a fall
• make sure you are getting enough calcium and vitamin D
• send a professional to assess your home environment and suggest changes (i.e., hand rails and grab bars, bright lighting, loose rug and electrical cord removal)
• make sure your vision and hearing are assessed and managed
• recommend an exercise and balance training program if necessary. 

Hazards in your home: You can reduce your risk of accidental injury by:

• lowering the water temperature in your hot-water heater (<120F) to prevent serious burns
• installing smoke carbon monoxide detectors
• installing alarms and automatic shut-off features on appliances like electric kettles
• getting rid of or safely storing firearms
• knowing how to use any medical equipment in your home, such as oxygen. 

Your home can be checked for hazards by specially trained occupational therapists or other specialists. Ask your healthcare provider if you think you need someone to check the safety of your home. 

Car accidents:  Car accidents are the leading cause of fatal injuries in adults up to age 75. The crash rate for older drivers is higher than for any other age group except for drivers under 25. People with severe visual or hearing loss, dementia, or certain neurologic diseases should not drive. 

To reduce the risk of a car accident:

• Always wear seat belts
• Have regular driving tests
• Yake a refresher driving course (available through AARP or the AAA)
• Have your vision checked regularly and wear the right eyeglasses
• Don’t drink and drive
• Don’t use your cell phone or text while you are driving. 

Daily tooth brushing with a fluoride-containing toothpaste and using dental floss at least once a day are necessary for good oral health. Visit your dentist at least twice each year. Unhealthy or missing teeth or diseased gums can make it difficult for you to eat normally and is often a factor in being malnourished. 

Your dentist will identify common problems, including:

• gingivitis (infected gums)
• dry mouth
• pre-cancerous conditions and oral cancer. 

You may have heard that taking an aspirin every day will prevent a heart attack or stroke. However, you should only consider a daily aspirin if you have already had a heart attack or a stroke or if you are at high risk of having either one. You are at higher risk of heart attack or stroke if you:

• smoke
• have diabetes, high blood pressure, obesity, high LDL cholesterol, low HDL cholesterol
• do not exercise
• are under a lot of stress
• drink too much alcohol
• have a family history of heart disease or stroke. 

Check with your healthcare provider first to determine:

• your risk of gastrointestinal bleeding or stroke (aspirin can increase the risk of a serious bleed)
• other medications you take that might interact with the aspirin or increase the risk of bleeding (e.g., warfarin, heparin, ibuprofen)
• other conditions that might worsen with aspirin therapy (e.g., severe liver disease, stomach ulcers, uncontrolled high blood pressure, asthma, heart failure)
• the correct aspirin dosage for you (e.g., 81 mg – “baby” aspirin, 375 mg – regular adult dose) 

If you have been taking a daily aspirin, check with your doctor before stopping it suddenly, since this could increase your risk of a blood clot. Also, tell all healthcare professionals, including your dentist, that you are taking aspirin if you are going to have a surgical or dental procedure, since the aspirin may make you bleed more than usual. 

Older people need to be vaccinated against certain common illnesses. The costs of many of these shots are covered by Medicare. 

The Centers for Disease Control and Prevention strongly recommend the following vaccinations for people over the age of 65:

• Influenza (flu) – every year just before the start of flu season – September to mid-November
• Tetanus – every 10 years (more if you have never been vaccinated)*
• Herpes zoster (to prevent shingles) – once
• Pneumonia –once at age 65 

*A new Tetanus/Diphtheria/Pertussis (adult whooping cough) shot called a “Tdap” is now available.  It is recommended that adults over age 65 receive this vaccination once.  The Tdap is specifically recommended for adults aged 65 and older who have close contact with an infant aged less than 12 months. 

Almost half of new cases of serious cervical cancer are in women 65 years old and older. If you are over 65 years old and have had only normal Pap smears in the past, you probably do not need more Pap screening. If you are over 65 years of age and have never had a Pap test, however, you should have one test per year for two years, and discontinue them afterwards if both tests are normal. If you have had a hysterectomy that was not because of cancer and no longer have a cervix, Pap smears are unnecessary. 

A mammogram is a type of x-ray that screens for breast cancer. Women should have a mammogram every two years between the ages of 50 to 75, along with a breast examination. Mammograms may be appropriate for women after the age of 75 if you are likely to live at least five more years but it is important to discuss the risks and benefits of mammography screening with your doctor. If you are at high risk – that is, with a history of breast cancer or have had a breast biopsy that showed abnormal cell – a mammogram once a year is recommended. Medicare covers the cost of annual mammograms. 

A procedure known as a colonoscopy screens you for colon cancer, and is usually done every 10 years from age 50 to age 75. Your healthcare provider may instead decide to test for bleeding in your colon by checking for blood in your stool with an annual fecal occult blood test or FOBT.  A sigmoidoscopy, another test similar to a colonoscopy and performed every 5 years, can also help your doctor identify any abnormalities in your colon. These tests are particularly important if you have risk factors for colon cancer such as:

• a close relative with colon cancer or family history of the disease
• history of breast, ovarian, or uterine cancer
• inflammatory bowel disease, polyps, or previous colon or rectal cancer. 

Medicare will cover a colonoscopy every 10 years, a fecal occult blood test every year, and a sigmoidoscopy every 5 years. 

Screening for prostate cancer is controversial because the disease usually progresses very slowly and research to support the benefit of treatment early in the disease is lacking.  Therefore, screening is no longer recommended for most older men. Your healthcare provider can advise you whether or not you should be screened for prostate cancer based on risk factors like a family history of the disease. 

If you answer “yes” to any of the questions below, you may be drinking too much alcohol. Talk to your healthcare provider about your alcohol use periodically. 

• Have you ever felt you should cut down?
• Does other’s criticism of your drinking annoy you?
• Have you ever felt guilty about drinking?
• Have you ever had an "eye opener" to steady your nerves or get rid of a hangover? 

Your healthcare provider will do a blood test to check you for type 2 diabetes (the most common type in older adults) at least every three years if you have high blood pressure or other risk factors. 

Be sure to tell your healthcare provider if you have notice any of these warning signs of diabetes: 

• Unusual thirst and frequent need to urinate
• Increased hunger and need to eat
• Unexplained weight loss despite eating more
• Fatigue
• More infections and slower healing, e.g., a skin infection that will not clear up
• Blurred vision. 

If you have few or no risk factors for heart disease, electrocardiograms (ECG or EKG), exercise stress tests, or electron-beam CT scans are not recommended for screening purposes. If, however, you are about to start a vigorous exercise program, a cardiac stress test may be considered in the following cases:

• You have not been exercising or active before
• You have at least two risk factors for heart disease such as male gender, a smoking habit, high blood pressure, diabetes, high cholesterol, obesity, or a family history of heart disease. 

If you have had a heart attack, controlling risk factors such as cigarette smoking, high cholesterol, and high blood pressure is very important to prevent another heart attack. 

Depression is common in older adults, but often goes unrecognized because:

• Older people often do not mention symptoms of depression
• Depression is thought to be fatigue or some other physical symptom
• Symptoms are thought to be a normal part of aging.  

Your healthcare provider should ask a few questions you about your general mood and emotional state at each annual visit. 

If your healthcare provider thinks you may be depressed, you may be asked to complete a short questionnaire. Your answers will help you and your healthcare provider determine whether you are depressed and would benefit from treatment, such as talking therapy or counseling, medication, or a combination of both. Other treatments may also be helpful, and exercise often helps with depression. 

The chances of developing high blood pressure increase with age. Treating high blood pressure in older adults can reduce the chance of stroke and heart attack. Your healthcare professional will check your blood pressure at least once each year. It may be checked standing as well as sitting (blood pressure often decreases when you are standing). 

There are many ways to control high blood pressure, through:

• Diet and salt restriction
• Exercise (30-45 minutes of moderate exercise most days of the week)
• Medication
• Stopping smoking if you are a smoker
• Weight control if you are overweight. 

You should have a screening test for osteoporosis (thinning or brittle bones) at least once if you are a woman over the age of 65 years, a man over the age 70 or earlier if you have suffered a non-traumatic bone fracture or at high risk of osteoporosis. The bone density test is a low-strength x-ray that checks various parts of your body, usually including your back and hip. The results, called your bone mineral density (BMD) are compared to a normal range of BMD to determine whether you are at risk of, or already have, osteoporosis.  People who are at high risk of broken bones should have a bone density test at age 60. Your healthcare provider can explain the importance of getting enough calcium and vitamin D in your diet, exercising, stopping smoking, and avoiding falls. 

Seeing and hearing well will help keep you active and engaged with family and friends, less likely to fall, and able to enjoy life more fully. 

You should have your eyes examined by an ophthalmologist (a specialist eye doctor) once every year after the age of 65. The doctor will recommend the best type of eyeglasses for you and also check for eye diseases that are common in older adults, and often easily treatable. These include

• Glaucoma – too much pressure within the eye
• Cataracts – clouding of the lens of the eye
• Macular degeneration – loss of central vision.

If you have certain conditions, such as diabetes, you may need more frequent eye exams. 

An annual evaluation of your hearing should also be on your agenda. Hearing loss can lead to a feeling of isolation and withdrawal from your social life and make work difficult. Modern hearing aids can help make the difference between feeling shut-out of life and being part of the conversation again. Your otolaryngologist (a doctor that specializes in hearing, among other things) or audiologist can help adjust your hearing aids so that they are comfortable and effective. 

Your chance of having a heart attack, stroke, or other problems with your heart and blood vessels is higher if you have elevated levels of certain fats, called lipids, in your blood. These unhealthy types of lipids include cholesterol (LDL or “bad” cholesterol, and vLDL) and triglycerides. 

In contrast, HDL cholesterol (the “good” cholesterol) is thought to be protective. To maintain your heart and blood vessels in peak condition, you should try to keep these lipid levels within the following ranges:

• LDL cholesterol: below 130 mg/dL
• HDL cholesterol: above 40 mg/dL (or 50 in women)
• Triglycerides: below 150 mg/dL. 

If your lipid levels are close to the recommended ranges, simple changes in lifestyle – such as improving your diet and exercising more – can make all the difference. In more severe cases of high cholesterol, your doctor may recommend a lipid-lowering medication such as a statin. 

This test can inform your healthcare provider if there has been any damage to your heart. If you have at least one risk factor for coronary artery disease, your healthcare provider may order this simple blood test at least once. 

Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) both become more common as we age. Your healthcare provider may order a blood test to screen for these conditions. A test every other year is recommended. 

An annual screening by a skin doctor (dermatologist) is encouraged because of the significant increase in skin cancers in recent decades. These common cancers include basal cell carcinoma (almost always curable) and melanoma (a more serious type of cancer).  But do not wait for your annual visit to your dermatologist if you notice:

• Change in size, shape, color, or borders of a mole on your skin
• Change in appearance of your skin in general
• Any new unexplained area of discoloration, scaliness, roughness
• New appearance of a nodule or pale, sunken area. 

Limit the amount of time you spend in direct sunlight, and wear protective clothing and sunscreen (at least 30 spf). People who are fair-skinned have a higher risk of developing skin cancer. 

Dermatologists can perform simple out-patient procedures if you are at risk of skin cancer or if a cancer is found at an early stage. For a serious cancer such as melanoma, early detection is the key to a cure. 

If you think you are having trouble with memory it is important to tell your doctor so that they can screen you for cognitive impairment—a decline in mental ability.  It is important to be tested  if you have any symptoms or your family is noticing symptoms because early detection allows you to benefit from medications, education, and counseling – not only for you but for your family as well. Remember that there is a normal loss of mental function as we get older. Having a little trouble with the test does not mean you have dementia, but only suggests to your doctor that further screening might be considered. 

In cases of dementia caused by Alzheimer’s disease or blood vessel conditions, it may be particularly helpful to control risk factors such as high blood pressure or elevated cholesterol and triglycerides. 

Staying mentally active by reading, learning new things, or working crossword puzzles may also help delay or prevent dementia. 

If you have many risk factors for coronary artery disease, your healthcare provider may feel that an electron-beam computed tomography (CT) scan would give him or her useful information. This type of scan shows how much calcium has been deposited in the blood vessels that bring blood to your heart muscle, and indicates if you have any blockage in your arteries. With this knowledge, your healthcare provider can prescribe the most effective medications and other therapies, or make decisions about further tests or treatments.