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

Checklist for getting your affairs in order

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

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

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

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

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

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

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

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

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

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

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

Which documents do you need to have in place?

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

Personal information

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

Financial information

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

Health information

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

Who can help with getting your affairs in order?

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

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

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

What other decisions can you prepare for in advance?

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

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

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

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

Phyllis’s Story

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

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

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

Acute Pain and Chronic Pain

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

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

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

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

Describing Pain

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

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

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

Attitudes About Pain

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

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

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

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

Treating Pain

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

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

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

Pain Specialist

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

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

Medicines to Treat Pain

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

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

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

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

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

Can I Get Addicted to Pain Medicine?

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

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

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

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

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

What Other Treatments Help with Pain?

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

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

Helping Yourself

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

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

Cancer Pain

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

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

Alzheimer’s Disease and Pain

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

Pain at the End of Life

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

Caring for Someone in Pain

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

Some Facts About Pain

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

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

Ask About Different Treatment Options

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

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

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

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

Questions to Ask About Treatment Options

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

Talking with Medical Specialists

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

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

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

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

Questions to Ask Your Specialist

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

If You Need Surgery

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

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

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

Questions to Ask Your Surgeon

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

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

Discuss How Prevention Can Improve Your Health

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

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

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

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

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

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

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

Questions to Ask Your Doctor About Prevention

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

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

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

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

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

What causes falls in older adults?

Many things can cause a fall.

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

Steps to take to prevent falls

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

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

What to do if you fall

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

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

Keep your bones strong to prevent fall-related fractures

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

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

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

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

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

On Thursday, November 20, the Kentucky Coalition for Aging Resources and Empowerment (KCARE) recognized top long-term care leaders and heroes in Kentucky at their quality awards banquet. Andrea Risner from West Liberty Nursing and Rehabilitation was honored to be a part of this elite group of leaders in the industry. 

“We were honored to be able to recognize the strength and resilience of our health care heroes. It is a special group of people who dedicate their lives to providing outstanding care and compassion to their residents,” said KCARE President Adam Mather. “This recognition is a testament to their dedication to their residents.” 

The KCARE Quality Awards winners are nominated by their facility. Nominations are then scored blindly by long-term care veterans and mentors. This year, over 400 nominations were submitted for the Quality Awards.  

Long-term care and assisted living providers from across the state attended the Annual Meeting & Expo in Louisville. Participants furthered their knowledge of senior care with a variety of educational options including strategies to cope with stress on the job, hiring and retaining quality staff and regulatory issues. More than 100 vendors exhibited during the expo, showcasing the latest innovations to provide quality care.  

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

How many calories do you need?

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

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

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

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

Serving and portion sizes

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

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

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

Healthy food shifts

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

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

Healthy beverage shifts

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

100-calorie snacks

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

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

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

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

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

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

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

How do you know if you need help?

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

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

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

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

How can you ask others to help?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Causes of agitation and aggression

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

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

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

Tips for coping with agitation or aggression

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

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

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

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

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

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

End-of-life care at home

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

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

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

End-of-life care in hospitals

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

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

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

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

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

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

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

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

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

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

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

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

Steps to Take

When patients and visitors should clean their hands

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

How to clean hands

With an alcohol-based hand sanitizer:

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

With soap and water:

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

Ask your healthcare provider to clean their hands

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

Speak up for clean hands in healthcare settings

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

Is there such a thing as too clean?

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

Washing with soap and water: 15 versus 20 seconds

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

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

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

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

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