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.

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

How to start the conversation about advance care planning

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

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

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

How to serve as a health care proxy

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

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

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

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

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

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

Learn more about the role of a health care proxy.

Tips for navigating the health care system

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

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

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

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

Physical activity is essential for healthy aging, and it can be beneficial at any stage of life. Some potential benefits are immediate, such as reduced feelings of anxiety, reduced blood pressure, and improved sleep. Others are long term and require consistent physical activity over time, such as reduced risk of cardiovascular disease, type 2 diabetes, and some cancers.

Importance of an active lifestyle for older adults

It’s never too late to start being physically active and to achieve the benefits of an active lifestyle. Older adults can benefit from all three types of exercise: aerobic, muscle-strengthening, and balance. Many activities, from exercise programs to household tasks, can count towards the 150 minutes of moderate-intensity aerobic activity and two days of muscle-strengthening activities recommended each week.

Physical activity can be an opportunity to participate in activities you enjoy, spend time with friends and family, get outdoors, improve fitness, and maintain a healthy weight. Additionally, being physically active as an older adult may improve your health and health-related quality of life. Active older adults also tend to live longer!

Functional ability and fall prevention

Physical activity improves physical function, making it easier to perform tasks of daily living — including household chores, getting into or out of a bed or chair, and moving around the neighborhood. This increased functional ability can help maintain independence and support independent living for older adults.

Movement and exercise may offer protection against osteoporosis and age-related loss of muscle mass, strength, and function, also known as sarcopenia. The health and functional ability of bones and muscles are especially important for older adults, who are at higher risk for falls and fall-related injuries. Improved physical function can reduce the risk of falls and likelihood of serious injury if there is a fall.

Disease risk and chronic health conditions

Physical activity helps to prevent certain diseases and chronic health conditions that are common among older adults. Older adults who are physically active have a lower risk of:

• Cardiovascular disease (including heart disease and stroke) and death caused by it
• High blood pressure
• Type 2 diabetes
• High cholesterol
• Obesity
• Cancers of the bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach
• Dementia (including Alzheimer’s disease)
• Depression

Being active can also help to slow or manage chronic disease and to delay death. For older adults who are managing a diagnosis, exercising with chronic conditions can improve quality of life and reduce the risk of developing new health conditions.

Mental and emotional health

Physical activity supports emotional and mental health in addition to physical health. Physical activity can help reduce feelings of depression and anxiety, improve sleep, and benefit overall emotional well-being. It may also improve or maintain some aspects of cognitive function, such as your ability to shift quickly between tasks, plan an activity, and ignore irrelevant information. Older adults who exercise with others get the added benefit of social connection as well.

Try these exercise ideas and see how you feel!

• Walking, bicycling, or dancing. Endurance activities increase your breathing, get your heart pumping, and boost chemicals in your body that may improve mood.
• Yoga. This mind and body practice typically combines physical postures, breathing exercises, and relaxation.
• Tai Chi. This “moving meditation” involves shifting the body slowly, gently, and precisely, while breathing deeply.
• An activity you enjoy. Whether it’s gardening, playing tennis, kicking around a soccer ball with your grandchildren, or something else, choose an activity that you want to do, not have to do.

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

As a primary care practitioner, you likely have long-established relationships with some of your patients and are in an ideal position to observe potential signs of a cognitive problem. You and your staff are often the first to address a patient’s or family’s concerns about cognitive as well as behavioral and functional changes that may have already affected their lives and resulted in, for example, a motor vehicle accident or being the victim of identity theft or financial fraud.^(1, 2) It’s important to take concerns seriously and to assess the person as early as possible to determine the potential cause of impairment. This quick guide features information about assessing cognitive, behavioral, and functional changes in older adults.

Why is it important to assess cognitive impairment in older adults?

It’s important to address any changes in an older person’s memory, language abilities, or personality as these may reflect a neurodegenerative disease process that may either be due to a reversible cause or become more serious. Whether memory or other cognition concerns are reported by the patient or a family member, or directly observed by you, the issues should be noted in the patient’s chart and followed up with a cognitive, behavioral and/or functional assessment.

Cognitive impairment in older adults has a variety of possible causes, including medication side effects; metabolic and/or endocrine dysfunction; delirium due to illness (such as a urinary tract or COVID-19 infection); depression; and dementia, including Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal disorders. Some causes, like medication side effects and depression, can be reversed or improved with treatment. Others, such as Alzheimer’s, cannot be reversed, but symptoms may be treatable for a period of time. It is important to help prepare patients and their families for additional changes that come as cognitive impairment progresses.

Many people who are developing dementia or already have it do not receive a diagnosis. One study found that more than 50% of patients with dementia had not received a clinical cognitive evaluation by a physician.⁽³⁾ Another study showed that physicians were unaware of cognitive impairment in more than 40% of their cognitively impaired patients.⁽⁴⁾ Yet another analysis looking at undetected dementia globally found the U.S. rate to be 61%.⁽⁵⁾ The problem of underdiagnosis is even more pronounced in underserved populations and in those with lower educational attainment.^(6, 7) The failure to evaluate memory or cognitive complaints is likely to hinder treatment of underlying disease and comorbid conditions, and may present safety issues for the patient and others.^(8, 9) In many cases, the cognitive problem will worsen over time and may lead to preventable hospitalizations.^{(2, 8, 10, 11)}

Some older people have mild cognitive impairment (MCI). People living with MCI have more memory problems than is normal for their age, but their symptoms do not interfere significantly with their everyday lives. Older people with MCI are at greater risk for developing Alzheimer’s, but not all of them do. Some may even go back to normal cognition. It is important to determine the cause of the impairment to anticipate future needs, address any reversible causes, and try to mediate modifiable risk factors.

Most people with memory, other cognitive, or behavioral complaints want a diagnosis to understand the nature of their problem and to know what to expect.^{(10, 12, 13, 14, 15)} In a survey conducted by the Alzheimer’s Association of 2,434 U.S. adults age 18 and older, 85% of respondents said they would want to know early if they had Alzheimer’s. Reasons for wanting to know included planning for the future, allowing for earlier treatment of symptoms, taking steps to preserve existing cognitive function, and being able to understand what is happening.⁽¹⁶⁾

Some people are reluctant to mention concerns about memory or other cognitive or behavioral issues because they fear a diagnosis of dementia and how the disease will impact their lives in the future. In these cases, a primary care provider can explain the benefits of finding out what may be causing the person’s health concerns.

While pharmacological treatment options for Alzheimer’s-related memory loss and other cognitive symptoms are limited, there are medicines approved by the U.S. Food and Drug Administration to help manage symptoms, as well as newer medicines granted Accelerated Approval to treat Alzheimer’s. Learn more about these medications in NIA’s How Is Alzheimer’s Disease Treated?

In addition, there are non-drug strategies that can promote physical and emotional comfort. Assessing cognitive impairment and identifying its cause, particularly at an early stage, is beneficial so patients and families can learn about these strategies and develop a care plan in concert with their health care providers.

Clinical trials or other research studies are also an option for people with cognitive impairment. Patients may be interested in participating in clinical trials not only for themselves but also because of the potential to help future generations. Visit the Alzheimers.gov Clinical Trials Finder for more information.

Benefits of early assessment

If assessment is negative, meaning there is no evidence of cognitive impairment: Concerns may be alleviated, at least at that point in time, and it is useful for both the person with concerns as well as the clinician to have a baseline for future assessments.

If assessment is positive and further evaluation is warranted: The patient and physician can take the next step of identifying the cause of impairment because medical conditions such as tumors, vitamin deficiencies, or medication side effects can also cause serious memory problems that resemble dementia. The results of an evaluation may lead to:

• Treating the underlying disease or health condition
• Managing comorbid conditions and medications more effectively and appropriately for the diagnosis
• Averting or addressing potential safety issues
• Allowing the patient to create or update advance directives and plan long-term care
• Ensuring the patient has support services and a care network to help with medical, legal, and financial concerns
• Working with the patient and their caregiver to develop strategies to improve quality of life, modify the patient’s lifestyle, make home safety modifications, and manage emotions related to the dementia diagnosis
• Referring the patient to a geriatrician, neurologist, geriatric psychiatrist, neuropsychologist, geriatric social worker, geriatric counselor, mental health counselor, or substance abuse professional for a more specific diagnosis or help with care management
• Ensuring the caregiver receives appropriate information, referrals, and support for coping with a dementia diagnosis, managing stress, and preparing for expected changes as well as making the best use of intact abilities
• Encouraging participation in clinical research, including clinical trials and studies

Learn more at Alzheimers.gov/clinical-trials and Talking With Your Patients About Alzheimer’s and Related Dementias Clinical Trials.

When is assessment indicated?

In its 2020 review and recommendation regarding routine screening for cognitive impairment in adults 65 years old and older, the U.S. Preventive Services Task Force noted that “although there is insufficient evidence to recommend for or against screening for cognitive impairment, there may be important reasons to identify cognitive impairment early. Clinicians should remain alert to early signs or symptoms of cognitive impairment (e.g., problems with memory or language) and evaluate the individual as appropriate.”⁽¹⁷⁾

Other risk factors that could indicate the need for dementia screening include: history of type 2 diabetes, stroke, depression, trouble managing money or medications, and being older than 80.⁽¹⁸⁾ Tools such as the Dementia Screening Indicator can help guide clinician decisions about when it may be appropriate to screen for cognitive impairment in the primary care setting.⁽¹⁸⁾

How can physicians and staff find time for assessment?

Trained staff need only 10 minutes or less to initially assess a patient for cognitive impairment. While results alone are insufficient to diagnose dementia, they are an important first step. The AD8, QDRS, and Mini-Cog are among many possible tools and some can be filled out by the person or the caregiver while in the waiting room.

Disclaimer: NIA does not endorse any specific cognitive assessment tools. The selection of an assessment tool depends on a variety of factors, including the setting, target population age and demographics, language, and expertise of the administrator. Research is underway to create and validate new tools for cognitive assessment in primary care settings. For more information, visit Cognitive Assessment Considerations: Understanding the Evidence.

How to assess for cognitive impairment

Assessment for cognitive impairment can be performed at any visit but is a required component of the Medicare Annual Wellness Visit.^(8, 19) Coverage for yearly wellness visits, and importantly, for follow-up visits for cognitive assessment and care plan services, is available to patients with Medicare Part B coverage.

Visit the Centers for Medicare & Medicaid Services (CMS) for more information on cognitive assessment and care plan services (code 99483), including what it covers and how to bill for it. CMS also created a related educational video for health care providers. The Alzheimer’s Association also offers information on cognitive assessment and care planning services.

Positive results from a brief assessment warrant further evaluation. A combination of neuropsychological evaluation, including self- and informant-reports from a person who has frequent contact with the person being evaluated, such as a spouse or other care provider, is the best way to assess cognitive impairment more fully.⁽²⁰⁾

A primary care provider may conduct an evaluation or refer to a specialist, such as a geriatrician, neurologist, geriatric psychiatrist, or neuropsychologist. If available, a local memory disorders clinic or an NIA-funded Alzheimer’s Disease Research Center may also accept referrals.

Genetic testing, neuroimaging, and biomarker testing have been recommended for limited clinical uses.^(2, 21) These tests are primarily conducted in research settings and may require consultation with the medical provider, a counselor, and the family and caregivers as there are complex ethical, legal, and social implications that should be considered. In addition, some new Alzheimer’s medications may require or warrant the confirmation of beta-amyloid plaques before prescribing, as well as brain imaging during treatment to evaluate for amyloid-related imaging abnormalities (ARIA).

Interviews to assess memory, behavior, mood, and functional status of the patient are best conducted without family members or companions present who may prompt the person’s responses. However, family members or close companions can also be good sources of information. It can be beneficial to speak with them while the patient is in the room, as well as privately to allow for a more candid discussion. Per HIPAA regulations, the patient should give permission in advance. Brief, easy-to-administer tools, such as the Short IQCODE (PDF, 1.9M), the AD8, or the QDRS for the caregiver are available.

Note that people who are only mildly impaired may be adept at covering up their cognitive decline and reluctant to address the problem. In some cases, patients may not have insight into their cognitive and functional problems due to the nature of their illness.

Additional resources are available to help health care teams in their detection of cognitive impairment and support of patients. For example, the American Academy of Family Physicians developed a Cognitive Care Kit, and the Gerontological Society of America developed the GSA KAER Toolkit for Primary Care Teams.

For more information on cognitive assessment tools, and other resources for health professionals, visit Alzheimer’s and Related Dementias Resources for Professionals.

What to do after assessment

After assessment for cognitive impairment is complete, take time to reflect on your relationship with the person to determine the best way to deliver the results.

Some people may prefer a cautious, reserved explanation. Other patients may prefer more precise language and appreciate when specific words, such as “Alzheimer’s disease,” are referenced.

The American College of Physicians Foundation and Alzheimer’s Association have produced an 11-minute video, Disclosing an Alzheimer’s Diagnosis, that may be helpful. Written materials can also be helpful: NIA’s Alzheimer’s and related Dementias Education and Referral Center has free tools and publications you can give to your patients, including Next Steps After an Alzheimer’s Diagnosis. Local resources can also be found using the Eldercare Locator.

Communicating with older patients

If possible, schedule additional time for the appointment or a follow-up, so that you can listen and respond to the patient’s and caregiver’s concerns. Ask the patient if there is a family member or friend who can help with medical, legal, and financial concerns going forward. Suggest making these arrangements as early as possible and ensure that the patient has given you formal authorization to include the caregiver in the conversation about your patient’s care. Keep that person’s name and contact information in your notes for future reference.

Informing family members or others that the patient may have Alzheimer’s, or any cognitive impairment, may be done in a telephone conference or group meeting, which should be arranged with the consent of the patient. It is the patient’s choice on how, whether, and with whom they want to share this information. Let everyone know that you will continue to be available for care, information, guidance, and support. And provide them with resources, such as the 24/7 helpline, in writing. Make them aware that there are support groups and other ways to get help.

Consider how your practice can coordinate and integrate care for the patient and caregiver across the many specialists and services that will be involved. Nonprofit support and community organizations can provide information about planning, social services, and care.

Learn more in Caring for Older Patients With Cognitive Impairment.

Communicating with caregivers

All caregivers face challenges, but these challenges are compounded for people caring for patients with Alzheimer’s or other forms of cognitive impairment. Here are some approaches that can be especially useful when communicating with caregivers:

• Explain that much can be done to improve the patient’s quality of life. Measures such as modifications in daily routine and medications may help. If the patient is in the later stages of dementia, consider bringing in a palliative care consultant to help with symptom management.
• Provide information about the consumer resources and services available from local organizations, as well as support groups.
• Encourage caregivers to get regular respite, especially when patients require constant attention. Ask if the caregiver, who is at considerable risk for stress-related disorders, is receiving adequate support. Encourage the caregiver to speak with their own health care provider. They may have trouble recognizing their own needs when they are so focused on their loved one; assure them that it is crucial to take care of themselves in order to best support their loved one.

Points to remember

• People should be assessed for cognitive impairment if:
  • The individual, family members, or others express concerns about changes in the person’s memory, thinking, or behavior
  • As the health care provider, you observe problems/changes in the patient’s memory, thinking, or behavior
• Brief assessments are available and can be used in an office visit.
• Assessment for cognitive impairment is a required component of the Medicare Annual Wellness Visit.
• People, particularly those who express a concern, likely want to know what the underlying problem is. It is important to emphasize that, no matter what the diagnosis is, there are options for support and care for the person and their caregivers.
• It’s important to talk with the patient and caregiver about potential challenges and how to cope with their results.

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

Dietary supplements can be beneficial at any age, but they can also have unwanted side effects, such as unsafe prescription drug interactions. They could also not work at all.

It’s important to understand the supplements you are taking and why you are taking them. Talk with your doctor if you are considering taking a supplement.

What is a dietary supplement?

Dietary supplements are substances you might use to add nutrients to your diet or to lower your risk of health problems such as osteoporosis or arthritis. Dietary supplements come in the form of pills, capsules, powders, gel capsules and tablets, extracts, or liquids. They might contain vitamins, minerals, fiber, amino acids, herbs or other plants, or enzymes. Sometimes, the ingredients in dietary supplements are added to foods and drinks. A doctor’s prescription is not needed to buy dietary supplements.

Should I take a dietary supplement?

Eating a variety of healthy foods is the best way to get the nutrients you need. However, some people may not get enough vitamins and minerals from their daily diet. When that’s the case, their doctors may recommend a dietary supplement to provide missing nutrients.

If you are thinking about using dietary supplements:

• Learn. Find out as much as you can about any dietary supplement you might take. Talk with your doctor, pharmacist, or a registered dietitian. A supplement that seemed to help your neighbor might not work for you. If you are reading fact sheets or checking websites, be aware of the source of the information. Could the writer or group profit from the sale of a particular supplement? Read more about choosing reliable health information websites.
• Remember. Just because something is said to be “natural” doesn’t mean it is safe or good for you. It could have side effects. It might make a medicine your doctor prescribed for you either weaker or stronger. It could also be harmful to you if you have certain medical conditions.
• Tell your doctor. Before deciding to start taking a dietary supplement to treat any health condition, check with your doctor. Do not take a supplement to try to diagnose or treat any health condition without first checking with your doctor. Learn how medications can interact with dietary supplements. For more information, visit the National Center for Complementary and Integrative Health.
• Buy wisely. Choose brands that your doctor, dietitian, or pharmacist recommend. Don’t buy dietary supplements with ingredients you don’t need. Don’t assume that more is better — it can actually be harmful to take too many supplements or those with a very high concentration of a nutrient. It is possible to waste money on unneeded supplements.
• Check the science. Make sure any claim about a dietary supplement is based on scientific proof. Look for the United States Pharmacopeia (USP) verified mark. USP verifies the identity, quality, strength, and purity of supplements. Information on some dietary supplements is available on MedlinePlus, but it’s important to note that most supplements listed have limited evidence of any benefit. If something sounds too good to be true, it probably is.
• Be a savvy consumer. Some advertisements for dietary supplements in magazines, online, or on TV promise that some of these products will make you feel better, keep you from getting sick, or even help you live longer. It’s important to know that often, there is little, if any, science supporting these claims.

Dietary supplements for older adults

People over age 50 may need more of some vitamins and minerals than younger adults do. Your doctor or a dietitian can tell you whether you need to change your diet or take a vitamin or mineral supplement to get enough of these:

• Calcium: Calcium works with vitamin D to keep bones strong at all ages. Bone loss can lead to fractures in both older women and men. Calcium is found in milk and milk products (fat-free or low-fat is best), canned fish with soft bones, dark-green leafy vegetables like kale, and foods with calcium added, such as breakfast cereals.
• Vitamin D: Most people in the United States consume less than recommended amounts of vitamin D. Talk with your doctor about adding vitamin D-fortified milk and milk products, vitamin D-fortified cereals, and fatty fish to your diet, or using a vitamin D supplement.
• Vitamin B6: This vitamin is needed to form red blood cells. It is found in potatoes, bananas, chicken breasts, and fortified cereals.
• Vitamin B12: This helps keep your red blood cells and nerves healthy. While older adults need just as much vitamin B12 as other adults, some have trouble absorbing the vitamin naturally found in food. If you have this problem, your doctor may recommend that you eat foods like fortified cereals with this vitamin added, or take a B12 supplement. Strict vegetarians and vegans are at greater risk of developing vitamin B12 deficiency because natural food sources of vitamin B12 are limited to animal foods. Talk with your doctor about whether taking a B12 supplement is right for you.

What are antioxidants?

You might hear about antioxidants in the news. These are natural substances in food that might help protect you from some diseases. Here are some common antioxidants that you should be sure to include in your diet:

• Beta-carotene: Found in fruits and vegetables that are either dark green or dark orange
• Selenium: Found in seafood, liver, meat, and grains
• Vitamin C: Found in citrus fruits, peppers, tomatoes, and berries
• Vitamin E: Found in wheat germ, nuts, and sesame seeds; and canola, olive, and peanut oils

Currently, research results suggest that large doses of supplements with antioxidants will not prevent chronic diseases such as heart disease or diabetes. In fact, some studies have shown that taking large doses of some antioxidants could be harmful. Again, it is best to check with your doctor before taking a dietary supplement.

Herbal supplements and older adults

Herbal supplements are dietary supplements that come from plants. These types of supplements are taken by mouth, whether it’s by a capsule, tablet, powder, or liquid.

A few that you may have heard of are ginkgo biloba, ginseng, echinacea, and black cohosh. Researchers are looking at using herbal supplements to prevent or treat some health problems, but it’s too early to know if these are both safe and useful. Previous studies of certain herbal supplements have not shown any benefits.

It’s important to know that just because a supplement is natural, or comes from plants, that doesn’t necessarily mean it’s safe.

Are dietary supplements safe?

The U.S. Food and Drug Administration (FDA) checks prescription medicines, such as antibiotics or blood pressure drugs, to make sure they are safe and do what they promise. The same is true for over-the-counter drugs such as pain and cold medicines. However, the FDA does not have authority over dietary supplements, which do not have to be approved by this agency for safety or efficacy before being sold to the public.

The federal government does not regularly test what is in dietary supplements, and companies are not required to share information about the safety of these products with the FDA before they sell them. So, just because a dietary supplement is on a store shelf, that does not mean it is safe, does what the label says it will, or contains what the label states.

If the FDA receives reports of possible problems with a supplement, it will issue warnings about the product. The FDA may also take supplements that are found to be unsafe off the market.

The Federal Trade Commission investigates reports of ads that might misrepresent what dietary supplements do. A few private groups, such as the U.S. Pharmacopeia, NSF International, ConsumerLab.com, and the Natural Products Association, have their own “seals of approval” for dietary supplements. To earn such a seal, products must be made by following good manufacturing procedures, must contain what is listed on the label, and must not have harmful levels of ingredients that don’t belong there, such as lead.

Whether you take dietary supplements or not, it’s still important to follow a healthy lifestyle. Try sticking to a healthy diet, being physically active, keeping your mind active, not smoking, and seeing your doctor regularly.

To learn more, please visit https://www.nia.nih.gov/health/vitamins-and-supplements/dietary-supplements-older-adults.