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

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

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

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

Getting Help with Sleep Problems

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

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

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

Taking care of your physical health

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

Get moving: Exercise and physical activity

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

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

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

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

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

What can you do?

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

Healthy eating: Make smart food choices

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

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

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

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

What can you do?

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

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

Getting a good night’s sleep

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

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

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

What can you do?

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

Quit smoking

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

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

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

What can you do?

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

Alcohol and other substances

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

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

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

What can you do?

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

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

Go to the doctor regularly

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

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

What can you do?

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

Taking care of your mental health

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

Social isolation and loneliness

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

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

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

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

What can you do?

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

Stress

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

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

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

What can you do?

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

Depression and overall mood

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

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

What can you do?

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

Leisure activities and hobbies

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

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

What can you do?

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

Taking care of your cognitive health

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

How different factors affect cognitive health

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

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

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

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

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

How cognitive training affects health outcomes

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

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

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

Next steps

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

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

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

Wurtland Nursing and Rehabilitation is excited to share resident Sandra Huxtable’s Success Story!

Sandra Huxtable arrived at Wurtland Nursing and Rehab after a challenging hospital stay due to sepsis. Upon admission, she faced an uphill road to recovery—but with resilience, determination, and the unwavering support of our skilled nursing and therapy teams, Sandra made incredible strides! Her hard work and positive spirit paid off, and today, we are proud to celebrate her safe return home—strong, independent, and ready for the next chapter. Congratulations, Sandra!

Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be troublesome sensations. If the feeling happens often, it could be a sign of a balance problem.

Many older adults experience problems with balance and dizziness. Problems can be caused by certain medications, balance disorders, or other medical conditions. Balance problems are one reason older people fall. Maintaining good balance as you age and learning about fall prevention can help you get around, stay independent, and carry out daily activities.

Causes of balance problems

People are more likely to have problems with balance as they grow older. In some cases, you can help reduce your risk for certain balance problems, but problems often can start suddenly and without obvious cause.

Balance problems can be caused by certain medications or medical conditions. The list below covers some common causes of balance problems.

• Medications. Check with your doctor if you notice balance problems while taking certain medications. Ask if other medications can be used instead, if the dosage can be safely reduced, or if there are other ways to reduce unwanted side effects.
• Inner ear problems. A part of the inner ear called the labyrinth is responsible for balance. When the labyrinth becomes inflamed, a condition called labyrinthitis occurs, causing vertigo and imbalance. Certain ear diseases and infections can lead to labyrinthitis.
• Alcohol. Alcohol in the blood can also cause dizziness and balance problems by affecting how the inner ear works.
• Other medical conditions. Certain conditions, such as diabetes, heart disease, stroke, or problems with your vision, thyroid, nerves, or blood vessels can cause dizziness and other balance problems.

Visit the NIH National Institute on Deafness and Other Communication Disorders website for more information on specific balance disorders.

Symptoms of balance disorders

If you have a balance disorder, you might experience symptoms such as:

• Dizziness or vertigo (a spinning sensation)
• Falling or feeling as if you are going to fall
• Staggering when you try to walk
• Lightheadedness, faintness, or a floating sensation
• Blurred vision
• Confusion or disorientation

Other symptoms might include nausea and vomiting; diarrhea; changes in heart rate and blood pressure and feelings of fear, anxiety, or panic. Symptoms may come and go over short periods or last for a long time and can lead to fatigue and depression.

Treatments for balance problems and disorders

Exercises that involve moving the head and body in certain ways can help treat some balance disorders. Patient-specific exercises are developed by a physical therapist or other professional who understands balance and its relationship with other systems in the body.

Balance problems due to high blood pressure may be managed by eating less salt (sodium), maintaining a healthy weight, and exercising. Balance problems due to low blood pressure may be managed by drinking plenty of fluids such as water; avoiding alcohol; and being cautious regarding your body’s posture and movement, such as never standing up too quickly. Consult with your doctor about making any changes in your diet or activity level.

Coping with a balance disorder

Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help develop an individualized treatment plan.

Chronic balance problems can affect all aspects of your life, including your relationships, work performance, and your ability to carry out daily activities. Support groups provide the opportunity to learn from other people with similar experiences and challenges.

If you have trouble with your balance, talk to your doctor about whether it’s safe to drive, and about ways to lower your risk of falling during daily activities, such as walking up or down stairs, using the bathroom, or exercising. To reduce your risk of injury from dizziness, do not walk in the dark. Avoid high heels and, instead, wear nonskid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles. If necessary, use a cane or walker. Make changes to add safety features at your home and workplace, such as adding handrails.

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

Wurtland Nursing and Rehabilitation is excited to share resident Lory Taylor’s Success Story!

Following a brain hemorrhage that left her completely dependent, Lory was admitted to Wurtland Nursing and Rehab facing significant challenges. From day one, she showed unwavering dedication to her recovery, working closely with our compassionate therapy team. Through persistence and determination, Lory has made tremendous progress—she’s now back on her feet and independently managing most of her daily tasks. We’re incredibly proud of how far she’s come. Congratulations to Lory and her Care Team on their success!

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

Planning ahead for aging in place

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

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

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

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

Support for aging at home

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

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

Help you can receive at home includes:

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

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

Making your home safe and accessible

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

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

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

Resources for aging in place

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

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

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

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

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

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

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

How much will it cost to age in place?

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

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

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

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

When it’s time to leave home

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

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

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

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

Which vaccines do older adults need?

As you get older, a health care provider may recommend vaccinations, also known as shots or immunizations, to help prevent certain illnesses.

Talk with a doctor or pharmacist about which of the following vaccines you need. Make sure to protect yourself as much as possible by keeping your vaccinations up to date.

COVID-19 vaccines

COVID-19 is a respiratory disease that causes symptoms such as fever, cough, and shortness of breath. Older adults are more likely than younger people to get very sick from COVID-19. The disease can lead to serious illness and death.

Studies show that COVID-19 vaccines reduce the risk of getting this disease. The vaccine will also help keep you from getting seriously ill or having to go to the hospital if you do get COVID-19. We are still learning how effective COVID-19 vaccines are against new variants of the virus. Read more about COVID-19 vaccine effectiveness.

The Centers for Disease Control and Prevention (CDC) recommends that older adults stay up to date with COVID-19 vaccines. Read more about COVID-19 vaccines from the CDC and find out the current vaccine recommendations for older adults.

Contact your local health department or visit Vaccines.gov to find out where you can get vaccinated.

Flu vaccine for older adults

Flu — short for influenza — is a virus that can cause fever, chills, sore throat, stuffy nose, headache, and muscle aches. Flu is very serious when it gets in your lungs. Older adults are at a higher risk for developing serious complications from the flu, such as pneumonia.

The flu is easy to pass from person to person. The virus also changes over time, which means you can get it again. To ensure flu vaccines remain effective, the vaccine is updated every year.

Everyone age 6 months and older should get an annual flu vaccine, but the protection from a flu vaccine can lessen with time, especially in older adults. Still, you are less likely to become seriously ill or hospitalized with the flu if you get the vaccine. A flu vaccine is especially important if you have a chronic health condition such as heart disease or diabetes.

Ideally, you should get your vaccine by the end of October each year so you are protected when the flu season starts. It takes at least two weeks for the vaccine to be effective. However, if you have not received your flu vaccine by the end of October, it’s not too late — flu season typically peaks in December or January. As long as the flu virus is spreading, getting vaccinated will help protect you.

There are flu vaccines designed specifically for older adults. The CDC recommends that people age 65 and older receive a higher-dose flu vaccine or an adjuvanted flu vaccine (one with an additional ingredient called an adjuvant that helps create a stronger immune response). These vaccines are potentially more effective than the standard flu vaccine for people in this age group. Talk with a health care provider or pharmacist about which vaccine is best for you.

Medicare will pay for the flu vaccine, and so will private health insurance plans. You can get a flu vaccine at a doctor’s office or local health department, as well as at many grocery stores, drug stores, and pharmacies. Flu shots may also be available at other community locations, such as schools, religious centers, and workplaces. The ingredients of a specific vaccine are the same wherever you receive it.

RSV vaccine for older adults

Respiratory syncytial virus (RSV) is a common virus that usually causes mild, cold-like symptoms. However, older adults have a higher risk of developing severe symptoms if they are infected with RSV. The illness can be particularly dangerous for people who have chronic diseases or a weakened immune system. Older adults who get very sick from an RSV infection may need to be hospitalized, and the illness can even be life-threatening.

RSV vaccines are available to protect older adults from the serious health problems that can occur with RSV infection. The CDC recommends that adults 60 years and older talk with their health care provider about whether they should receive the RSV vaccine. Like the flu, RSV infections are most common in the fall and winter months, so consider getting vaccinated before RSV season starts. However, you can benefit from the RSV vaccine at any time of year.

You can get the RSV vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Vaccines to help prevent pneumonia

Pneumococcal disease is a serious infection that spreads from person to person by air. It often causes pneumonia in the lungs and it can affect other parts of the body. Older adults are at higher risk than younger people of getting very sick or dying from pneumococcal disease.

The CDC recommends that all adults age 50 and older get pneumococcal vaccination. This vaccine helps protect you from getting a serious infection, including pneumonia. There are multiple forms of the pneumococcal vaccine: Talk to a health care provider to find out which is best for you. You can also visit the CDC’s Pneumococcal Vaccination webpage to learn more about the types of vaccines that are available.

Medicare will pay for the pneumococcal vaccine, as will many private insurance plans. You can get the vaccine at a doctor’s office, your local health department, and many pharmacies. Pneumococcal vaccines may also be available at other community locations, such as schools, religious centers, and workplaces.

Tetanus, diphtheria, and pertussis (whooping cough) vaccines

Tetanus, diphtheria, and pertussis are diseases caused by bacteria that can lead to serious illness and death.

• Tetanus (sometimes called lockjaw) is caused by bacteria found in soil, dust, and manure. It can enter the body through a deep cut or burn.
• Diphtheria is a serious illness that can affect the tonsils, throat, nose, or skin. It can spread from person to person.
• Pertussis, also known as whooping cough, causes uncontrollable, violent coughing fits that make it hard to breathe. It can spread from person to person.

Getting vaccinated is the best way to prevent tetanus, diphtheria, and pertussis. Most people get vaccinated as children, but you also need booster shots as you get older to stay protected against these diseases. The CDC recommends that adults get a Tdap (tetanus, diphtheria, and pertussis) or Td (tetanus, diphtheria) booster shot every 10 years. Ask a health care provider when you need your booster shot.

You can get the Tdap or Td vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Shingles vaccine for older adults

Shingles is caused by the same virus as chickenpox. If you had chickenpox, the virus is still in your body. As you get older, the virus could become active again and cause shingles.

Shingles affects the nerves. Common symptoms include burning, shooting pain, tingling, and/or itching, as well as a rash with fluid-filled blisters. Even when the rash disappears, the pain can remain. This is called post-herpetic neuralgia, or PHN.

The shingles vaccine is safe, and it may keep you from getting shingles and PHN. Healthy adults age 50 and older should get vaccinated with the shingles vaccine, Shingrix, which is given in two doses. (Zostavax, an earlier shingles vaccine, is no longer available in the United States.)

You should get a shingles vaccine even if you’ve already had chickenpox or the chickenpox vaccine, or if you don’t remember whether you had chickenpox. You should also get the shingles vaccine if you’ve already had shingles or received Zostavax. However, you should not get a vaccine if you currently have shingles, are sick or have a fever, have a weakened immune system, or have had an allergic reaction to Shingrix. Check with a health care provider if you are not sure what to do.

You can get the shingles vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Travel vaccines

Check with a doctor, a pharmacist, or your local health department about vaccines you need if you’re planning to travel to other countries. The vaccines that are required and recommended are based on your destination, planned activities, and medical history. Sometimes multiple vaccines or doses are needed. It’s best to get them at least four to six weeks before you travel to allow time to build up immunity and get the best protection, particularly from those that may require multiple doses.

Contact Medicare or your private health insurance plan to find out whether they cover the travel vaccines you need. You may be able to get some travel vaccines from a local health care provider. Others are available from health departments and travel medicine clinics. For more information, visit the CDC Traveler’s Health website or call its information line at 800-232-4636.

Vaccine safety and side effects

Vaccines are very safe, and they can help keep you from getting serious or life-threatening diseases. The most common side effects for all these vaccines are mild and may include pain, swelling, or redness where the vaccine was given.

Before getting any vaccine, talk with a doctor or pharmacist about your health history, including past illnesses and treatments, as well as any allergies. A health care provider can address any concerns you have.

It’s a good idea to keep your own vaccination record, listing the types and dates of your shots, along with any side effects or problems.

Learn more about vaccine safety and side effects.

What Is Telehealth?

Telehealth is a service that uses video calling and other technologies to help you see your doctor or other health care provider from home instead of at a medical facility. Telehealth may be particularly helpful for older adults with limited mobility and for those living in rural areas, as they will have the opportunity to see and talk with their doctor from their home. For older adults, talking with their doctor online, through a phone, tablet, or other electronic device, can often be easier, faster, and less expensive than making a trip to an office.

Telehealth can also help support family caregivers who are taking care of their loved ones either close by or from afar. If a caregiver needs to ask the doctor a question, they can do so through an online health portal rather than waiting for and traveling to an in-person appointment.

How to Prepare for a Telehealth Appointment: Tips for Older Adults

The transition from in-person to online appointments can be difficult for some people, especially those who are not familiar with the technology. By taking a few minutes before your appointment to prepare, you can set yourself up for a more successful visit.

• Add online appointments to your calendar. Once your appointment is confirmed, add it to your calendar so you don’t forget.
• Try to use the best camera you can find. This may be attached to your phone, laptop, tablet, or desktop computer. A clear picture can help your doctor understand and address your concerns more easily and effectively.
• Test the camera in advance. Practice in advance with a family member or a friend to make sure you understand how to use your camera when you have your online visit with your doctor.
• Test the sound and video on your device. Most devices have built-in microphones and speakers, but you may have to turn them on or enable the telehealth software or website to access them. Video calling a friend before your appointment can help ensure that everything is working properly. Using headphones or earbuds may make it easier for you to hear your doctor and for your doctor to hear you, but it’s good to test these out first to see what works best.
• Use the best internet connection possible. If you are not using Wi-Fi, try getting the best signal by using a wired connection to your router or an Ethernet cable. If you are using Wi-Fi, being physically close to the internet router and minimizing devices connected to it can help improve your connection.
• Charge your device. If you are using a wireless device, like a phone, laptop, or tablet, check to make sure your battery is charged enough to last through your appointment. Try charging it the night before your appointment.
• Find a quiet space and adjust lighting. Limit distractions and clutter in your space. Try finding a place with good lighting so your doctor can see you properly.
• Position yourself. Place your device on a sturdy surface so you can move around if you need to. Try positioning your device so your head and shoulders are in the camera frame.
• Prepare a list of questions/concerns. Being prepared for your appointment will help make it easier for you and your doctor to cover everything you need to talk about.

Are Telehealth Appointments Covered by Insurance?

Many insurance providers, including Medicaid and some private insurers, are beginning to cover telehealth services. However, telehealth coverage varies widely from state to state with differences in how telehealth is defined and paid for. Because insurance coverage policies differ, it’s important to check with insurance providers or your health care provider’s billing department directly for the latest information about coverage for telehealth services.

Will Medicare Cover My Telehealth Appointment?

If you are enrolled in Medicare Part B, certain telehealth services, like doctor’s visits, outpatient care, medical supplies, and preventive services may be covered.

The specific amount you will owe may depend on several factors, including:

• Other insurance you may have
• How much your doctor charges
• The type of facility
• Where you get your test, item, or service

Medicare also covers virtual check-ins and E-visits.

Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits. These plans may offer more telehealth benefits than Original Medicare.

Medicare plans are constantly changing and updating. Check with your provider to see what telehealth benefits are offered for your plan.

Learn more about Medicare and telehealth services.

Online Clinical Research Assessments and Trials

Are you involved in a clinical trial or considering participating in research? Typically, clinical trials require in-person visits. However, some clinical trials are conducting initial surveys or tests for research online, while some studies and trials are being conducted entirely online. Conducting clinical studies online can help encourage people to participate. Online clinical trials help eliminate travel time to trial sites and allow patients to participate from the comfort of their own home. This is increasingly beneficial for older adults who have limited mobility.

Find a clinical trial that works for you using the Clinical Trials Finder or ClinicalTrials.gov.

Healthy eating can help you lose or maintain weight, feel better overall, and possibly decrease your chances of getting certain diseases. Making smart food choices is important at any age. But eating healthy can be difficult even if you know which foods you should buy and prepare. Your budget, physical issues, mood changes, and dietary restrictions can be roadblocks to eating food that’s best for you. Here are suggestions for dealing with common problems that can make it harder for older adults to follow through on smart food choices.

Trying to eat healthy on a budget?

Even when you know which healthy foods to choose, people living on fixed or limited incomes may not be able to buy what’s ideal. Start by deciding how much you can afford to spend on food.

There are a number of resources that can help you plan a food budget. For example, the U.S. Department of Agriculture supports Iowa State University’s Spend Smart-Eat Smart program. This website also features more than 100 inexpensive recipes, with nutrition information and cost per serving.

Once you have decided on your budget, look for grocery store advertising in the newspaper or online to see what is on sale. Try to plan some meals around featured items and consider purchasing extra nonperishables such as canned goods when they’re on sale. Use coupons when possible and ask your grocery store staff if they have a senior discount or loyalty rewards program. Consider buying store-brand products, which are often the same as more expensive brand-name ones. Focus on buying healthy and inexpensive produce. Many nutritious fruits and vegetables — such as bananas, apples, oranges, lettuce, green peppers, and carrots — may be reasonably priced.

Tired of cooking or eating alone?

Maybe you are tired of planning and cooking dinners every night. Have you considered potluck meals? If everyone brings one part of the meal, cooking is a lot easier, and there might be leftovers to share. Or try cooking with a friend to make a meal you can enjoy together. Food delivery services are yet another option. You could also look into having some meals at a nearby senior center, community center, or religious facility. Not only will you enjoy a free or low-cost meal, but you will also have some company while you eat. Visit the Eldercare Locator to search for centers in your area.

Problems chewing or swallowing food?

Do you avoid some foods because they are hard to chew? People who have problems with their teeth or dentures often avoid eating meat, fruits, or vegetables and might miss out on important nutrients. If you are having trouble chewing, see your dentist to check for problems. If you wear dentures, the dentist can check the fit.

If food seems to get stuck in your throat or is hard to swallow, it might be that you don’t have enough saliva in your mouth. Or, there may be other reasons, including problems with the muscles or nerves in your throat, problems with your esophagus, or gastroesophageal reflux disease. Talk to your doctor about what might be causing your swallowing issues.

Physical problems making it hard to eat?

Sometimes illnesses such as Parkinson’s disease, stroke, or arthritis can make it harder to cook or feed yourself. Your doctor might recommend an occupational therapist. The therapist might make a custom splint for your hand, give you special exercises to strengthen your muscles, or suggest rearranging things in your kitchen. Special utensils and plates might make mealtimes easier or help with food preparation.

Food tastes different?

Are foods not as tasty as you remember? It might not be the cook’s fault! Maybe your sense of taste, smell, or both has changed. Growing older, having dental problems, and medication side effects can cause your senses to change. Taste and smell are important for a healthy appetite and eating. Try adding fresh herbs, spices, or lemon juice to your plate.

Smoking and drinking alcohol can also affect your sense of taste. If you smoke, quitting may not only improve your sense of taste and smell, but also your health in many other ways. If you drink alcohol, consider stopping or cutting back.

Some medicines can change how food tastes, make your mouth dry, or reduce your appetite. In turn, some foods can change how certain medicines work. You might have heard that grapefruit juice is a common culprit when used with any of several drugs. Chocolate, licorice, and alcohol are some others. Whenever your doctor prescribes a new drug for you, be sure to ask about any food-drug interactions.

Just not hungry?

Changes to your body as you age can cause some people to feel full sooner than they did when they were younger. Lack of appetite can also be a side effect of a medicine you are taking. Talk with your doctor about any side effects you may be experiencing. Your doctor may be able to suggest a different drug.

Try to be more active. In addition to all the other benefits of exercise and physical activity, these may make you hungrier. If you aren’t hungry because food just isn’t appealing, there are ways to make it more interesting. Make sure your foods are seasoned well, but not by adding extra salt. Try using lemon juice, vinegar, or herbs to boost the flavor.

Vary the shape, color, and texture of foods you eat. When you go shopping, look for a new vegetable, fruit, or seafood you haven’t tried before or one you haven’t eaten in a while. Some grocery stores have recipe cards near items, or you can ask the staff for suggestions about preparing the new food or find recipes online. Foods that are overcooked tend to have less flavor. Try cooking or steaming your vegetables for a shorter time and see if that gives them a crunch that will help spark your interest.

Food allergies or dietary restrictions?

Some older adults have allergies to certain foods, such as wheat, nuts, or dairy. Others may have dietary restrictions for religious, ethical, or personal reasons. Whatever your dietary needs are, it is still possible to choose healthy foods.

Avoiding dairy? Talk to your health care provider about how to get enough calcium and vitamin D. Even lactose-intolerant people might be able to have small amounts of milk when taken with food. There are also nondairy food sources of calcium, lactose-free milk and milk products, calcium- and vitamin D-fortified foods, and supplements.

Gluten sensitivity or allergy? Check out these resources that explain the different types of gluten sensitivities and allergies and learn how to make smart food choices for each type.

Vegetarian or vegan? Check out these resources for incorporating plant-based protein into your diet.

To learn more, please visit https://www.nia.nih.gov/health/healthy-eating-nutrition-and-diet/overcoming-roadblocks-healthy-eating.

During an emergency or at the end of life, you may face questions about their medical treatment and not be able answer them. You may assume your loved ones know what you would want, but that’s not always true. In one study, people guessed nearly one out of three end-of-life decisions for their loved one incorrectly.

Research shows that you are more likely to get the care you want if you have conversations about your future medical treatment and put a plan in place. It may also help your loved ones grieve more easily and feel less burden, guilt, and depression.

What is advance care planning?

Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes. Having meaningful conversations with your loved ones is the most important part of advance care planning. Many people also choose to put their preferences in writing by completing legal documents called advance directives.

What are advance directives?

Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes.

The two most common advance directives for health care are the living will and the durable power of attorney for health care.

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

Think of your advance directives as living documents that you review at least once each year and update if a major life event occurs such as retirement, moving out of state, or a significant change in your health.

Who needs an advance care plan?

Advance care planning is not just for people who are very old or ill. At any age, a medical crisis could leave you unable to communicate your own health care decisions. Planning now for your future health care can help ensure you get the medical care you want and that someone you trust will be there to make decisions for you.

What happens if you do not have an advance directive?

If you do not have an advance directive and you are unable to make decisions on your own, the state laws where you live will determine who may make medical decisions on your behalf. This is typically your spouse, your parents if they are available, or your children if they are adults. If you are unmarried and have not named your partner as your proxy, it’s possible they could be excluded from decision-making. If you have no family members, some states allow a close friend who is familiar with your values to help. Or they may assign a physician to represent your best interests. To find out the laws in your state, contact your state legal aid office or state bar association.

Will an advance directive guarantee your wishes are followed?

An advance directive is legally recognized but not legally binding. This means that your health care provider and proxy will do their best to respect your advance directives, but there may be circumstances in which they cannot follow your wishes exactly. For example, you may be in a complex medical situation where it is unclear what you would want. This is another key reason why having conversations about your preferences is so important. Talking with your loved ones ahead of time may help them better navigate unanticipated issues.

There is the possibility that a health care provider refuses to follow your advance directives. This might happen if the decision goes against:

• The health care provider’s conscience
• The health care institution’s policy
• Accepted health care standards

In these situations, the health care provider must inform your health care proxy immediately and consider transferring your care to another provider.

Other advance care planning forms and orders

You might want to prepare documents to express your wishes about a single medical issue or something else not already covered in your advance directives, such as an emergency. For these types of situations, you can talk with a doctor about establishing the following orders:

• Do not resuscitate (DNR) order: A DNR becomes part of your medical chart to inform medical staff in a hospital or nursing facility that you do not want CPR or other life-support measures to be attempted if your heartbeat and breathing stop. Sometimes this document is referred to as a do not attempt resuscitation (DNR) order or an allow natural death (AND) order. Even though a living will might state that CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your hospital bed might avoid confusion in an emergency. Without a DNR order, medical staff will attempt every effort to restore your breathing and the normal rhythm of your heart.
• Do not intubate (DNI) order: A similar document, a DNI informs medical staff in a hospital or nursing facility that you do not want to be on a ventilator.
• Do not hospitalize (DNH) order: A DNH indicates to long-term care providers, such as nursing home staff, that you prefer not to be sent to a hospital for treatment at the end of life.
• Out-of-hospital DNR order: An out-of-hospital DNR alerts emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in a hospital.
• Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms: These forms provide guidance about your medical care that health care professionals can act on immediately in an emergency. They serve as a medical order in addition to your advance directive. Typically, you create a POLST or MOLST when you are near the end of life or critically ill and understand the specific decisions that might need to be made on your behalf. These forms may also be called portable medical orders or physician orders for scope of treatment (POST). Check with your state department of health to find out if these forms are available where you live.

You may also want to document your wishes about organ and tissue donation and brain donation. As well, learning about care options such as palliative care and hospice care can help you plan ahead.

How can you get started with advance care planning?

To get started with advance care planning, consider the following steps:

• Reflect on your values and wishes. This can help you think through what matters most at the end of life and guide your decisions about future care and medical treatment.
• Talk with your doctor about advance directives. Advance care planning is covered by Medicare as part of your annual wellness visit. If you have private health insurance, check with your insurance provider. Talking to a health care provider can help you learn about your current health and the kinds of decisions that are likely to come up. For example, you might ask about the decisions you may face if your high blood pressure leads to a stroke.
• Choose someone you trust to make medical decisions for you. Whether it’s a family member, a loved one, or your lawyer, it’s important to choose someone you trust as your health care proxy. Once you’ve decided, discuss your values and preferences with them. If you’re not ready to discuss specific treatments or care decisions yet, try talking about your general preferences. You can also try other ways to share your wishes, such as writing a letter or watching a video on the topic together.
• Complete your advance directive forms. To make your care and treatment decisions official, you can complete a living will. Similarly, once you decide on your health care proxy, you can make it official by completing a durable power of attorney for health care.
• Share your forms with your health care proxy, doctors, and loved ones. After you’ve completed your advance directives, make copies and store them in a safe place. Give copies to your health care proxy, health care providers, and lawyer. Some states have registries that can store your advance directive for quick access by health care providers and your proxy.
• Keep the conversation going. Continue to talk about your wishes and update your forms at least once each year or after major life changes. If you update your forms, file and keep your previous versions. Note the date the older copy was replaced by a new one. If you use a registry, make sure the latest version is on record.

Everyone approaches the process differently. Remember to be flexible and take it one step at a time. Start small. For example, try simply talking with your loved ones about what you appreciate and enjoy most about life. Your values, treatment preferences, and even the people you involve in your plan may change over time. The most important part is to start the conversation.

How to find advance directive forms

You can establish your advance directives for little or no cost. Many states have their own forms that you can access and complete for free. Here are some ways you might find free advance directive forms in your state:

• Contact your State Attorney General’s Office.
• Contact your local Area Agency on Aging. You can find your area agency phone number by visiting the Eldercare Locator or by calling 800-677-1116.
• Download your state’s form online from one of these national organizations: AARP, American Bar Association, or National Hospice and Palliative Care Organization.
• If you are a veteran, contact your local Veteran’s Affairs (VA) office. The VA offers an advance directive specifically for veterans.

Some people spend a lot of time in more than one state. If that’s your situation, consider preparing advance directives using the form for each state, and keep a copy in each place, too.

There are also organizations that enable you to create, download, and print your forms online, but they may charge fees. Before you pay, remember there are several ways to get your forms for free. Some free online resources include:

• PREPARE for Your Care: An interactive online program that was funded in part by NIA. It is available in English and Spanish.
• The Conversation Project: A series of online conversation guides and advance care documents available in English, Spanish, and Chinese. The Conversation Project is a public engagement initiative led by the Institute for Healthcare Improvement.

If you use forms from a website, check to make sure they are legally recognized in your state. You should also make sure the website is secure and will protect your personal information. Read the website’s privacy policy and check that the website link begins with “https” (make sure it has an “s”) and that it has a small lock icon next to its web address.

Some people also choose to carry a card in their wallet indicating they have an advance directive and where it is kept. Below is an example from the American Hospital Association (PDF, 40KB).

To learn more, please visit https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care.