When someone close to you dies, your world changes. You are in mourning — feeling grief and sorrow at the loss. You may feel numb, shocked, and fearful. You may feel guilty for being the one who is still alive. You may even feel angry at your loved one for leaving you. All of these feelings are normal. There are no rules about how you should feel. There is no right or wrong way to mourn.

When you grieve, you can feel both physical and emotional pain. People who are grieving often cry easily and can have:

• Trouble sleeping
• Little interest in food
• Problems with concentration
• A hard time making decisions

As time passes, you may still miss your loved one. But for most people, the intense pain will lessen. There will be good and bad days. You may feel guilty or surprised for laughing at a joke or enjoying a visit with a friend. It is important to understand that these can be common feelings.

Finding a support system

There are many ways to grieve and to learn to accept loss. Try not to ignore your grief. Support may be available until you can manage your grief on your own.

While family and compassionate friends can be supportive, they may be grieving, too. Some people find that sharing memories and stories about the person who is gone is one way to help each other. Sometimes, people hesitate to bring up the loss or mention the name of the person who died because they worry this can be hurtful. But many people may find it helpful to talk directly about their loss. You are all coping with the death of someone who was important in your lives.

What is complicated grief?

It is normal to feel sad, numb, or lost for a while after someone close to you dies. But for some people, mourning can go on so long or be so distressing that it becomes unhealthy. This prolonged and intense reaction to loss is known as complicated grief. People with this condition may be unable to comprehend or accept the loss, experience intense sorrow and emotional pain, and have trouble resuming their own life and making plans for the future. Other signs of complicated grief may include having overwhelmingly negative emotions, feeling preoccupied with the person who died or the circumstances of the death, and being unable to find meaning or a purpose in life.

Complicated grief can be a serious condition. Those who have it may need additional help to overcome the loss. If sadness is making it difficult for you to carry on in your day-to-day life, help is available. Reach out to a support group, mental health professional, or loved ones for support. If cost is a factor for you, ask your doctor or other healthcare provider if they know of any local health professionals or programs that offer low-cost or free help.

How grief counseling can help

Some people find that grief counseling makes it easier to work through their sorrow. Regular talk therapy with a grief counselor or therapist can help those who are grieving learn to accept a death.

There are also support groups for grieving people to help each other. These groups can be specialized — people who have lost loved ones to Alzheimer’s disease, for example — or they can be for anyone learning to manage grief. Check with local hospitals and senior centers, nursing homes, religious groups, funeral homes, or your doctor to find support groups in your area. Hospice care professionals can also provide grief counseling, sometimes called bereavement support, to the family of someone who was under their care. You can also ask hospice workers for bereavement support even if hospice was not used before the death.

For older adults who are socially isolated or have limited family nearby, there are resources available. Try one of the suggestions below:

• Online support groups. Many online forums or support groups online are free and can help offer support from the home.
• Online therapy or counseling sessions. If you’re looking for a therapist or counselor to address your grief or loss, many offer online sessions that you can attend from your home.
• Support books. Books can be a great way to understand grief and sorrow, and they can provide tips to help overcome these feelings. Check your local library or ask a librarian for recommendations.
• Community resources. Some communities offer grief and loss counseling or resources. Check with your local community center, senior center, faith community, or hospital to learn about what they offer.

Taking care of yourself while grieving

In the beginning, you may find that taking care of details and keeping busy helps. For a while, family and friends may be around to assist you. But there comes a time when you will need to face the change in your life.

Here are some ideas to keep in mind:

• Take care of yourself. Grief can be hard on your health. Exercise regularly, eat healthy food, and try to get enough sleep. Bad habits, such as drinking too much alcohol or smoking, can put your health at risk.
• Make mealtime plans. Some people who have lost a loved one lose interest in cooking and eating. Sometimes eating at home alone feels too quiet, so it may help to have lunch with friends. Turning on the radio or TV during meals can also help. For information on nutrition and cooking for one, look for books at your local library, bookstore, or online.
• Talk with caring friends. Let family and friends know when you want to talk about your loved one. When possible, accept their offers of help and company.
• Participate in your favorite activities. Doing things you enjoy, such as painting, biking, volunteering, or social club events can help improve overall mood and well-being. Listening to uplifting music may also bring comfort.
• Reach out to your faith community. Many people who are grieving find comfort in spending time with others who share their religious beliefs, praying, or reading religious or spiritual scripture.
• See your doctor. Keep up with visits to your healthcare provider. If it has been a while, schedule a check-up and bring your doctor up to date on pre-existing medical conditions and any new health issues that may be of concern. Let your health care provider know if you are having trouble taking care of everyday activities such as personal hygiene and dressing, or fixing meals.
• Mourning takes time. It’s common to have a roller coaster of emotions for a while.

If you have children, remember that they are grieving, too. It will take time for the whole family to adjust to life without your loved one. You may find that your relationship with your children and their relationships with each other have changed. Open, honest communication is important.

When you feel ready, go through your loved one’s clothes and other personal items. It may be hard to give away these belongings. Instead of parting with everything at once, you might make three piles: one to keep, one to give away, and one “not sure.” Ask your children or others to help. Think about setting aside items such as a special piece of clothing, watch, favorite book, or picture to give to your children or grandchildren as personal reminders of your loved one.

Mourning the loss of a spouse or partner

If you have lost a spouse or partner, you may worry about how you will take care of yourself or your home. Many couples divide up their household tasks. One person may pay bills and handle car repairs. The other may cook meals and mow the lawn. Splitting up jobs often works well until there is only one person who must do it all. Learning to manage new tasks — from chores to household repairs to finances — can take time.

Reaching out to friends and family who are close by to help manage tasks right after your loss can help. If you don’t have loved ones nearby, local organizations may be able to help. The Administration for Community Living (ACL) offers online tools to help connect people with resources in their community. After a while, you may develop a better understanding of how to handle tasks on your own.

Being alone can also increase concerns about safety. It’s a good idea to ensure there are working locks on the doors and windows.

Facing the future without a spouse or partner can be scary, especially for those who have never lived alone. Those who are both widowed and retired may feel very lonely and become depressed. Talk with your doctor about how you are feeling.

Socializing after the death of a loved one

It may be overwhelming to think about going to parties or other social events without your loved one. It can be hard to think about coming home alone. If you were married or had a long-time partner, you may feel anxious about dating. Many people miss the feeling of closeness that marriage or other intimate relationship brings. After time, some may be ready to have a social life again.

Here are some things to remember:

• Go at a comfortable pace. There’s no rush.
• It’s okay to make the first move when it comes to planning things to do.
• Volunteer.
• Try group activities. Invite friends for a potluck dinner or participate in an activity at a local community or senior center.
• Consider lower-stress, informal outings such as walks or movies.
• Find an activity you like. You may have fun and meet people who share your interests.
• You can develop meaningful relationships with friends and family members of all ages.
• Many people find that pets provide comforting companionship.

Getting your legal and financial paperwork in order

When you feel ready, you might consider getting your legal and financial affairs in order. If you were married and your spouse died, you may need to update certain legal documents and other paperwork. For example, you might need to:

• Write a new will and update your advance care planning.
• Look into a durable power of attorney for legal matters and health care in case you are unable to make your own medical decisions in the future.
• Put joint property (such as a house or car) in your name.
• Consider changes you may need to make to your health insurance as well as to your life, car, and homeowner’s insurance.
• Make a list of bills you will need to pay in the next few months, for example, your rent or mortgage; utilities such as electricity, water, and phone and internet services; insurance; and state and federal taxes.

To learn more, please visit https://www.nia.nih.gov/health/grief-and-mourning/coping-grief-and-loss.

Hearing loss is a common problem caused by loud noise, aging, disease, and genetic variations. About one-third of older adults have hearing loss, and the chance of developing hearing loss increases with age. People with hearing loss may find it hard to have conversations with friends and family. They may also have trouble understanding a doctor’s advice, responding to warnings, and hearing doorbells and alarms.

Some people may not want to admit they have trouble hearing. Hearing problems that are ignored or untreated can get worse. If you have a hearing problem, see your doctor. Hearing aids, special training, certain medications, and surgery are some of the treatments that can help.

Signs of hearing loss

Some people have a hearing problem and don’t realize it. You should see your doctor if you:

• Have trouble understanding what people are saying over the telephone
• Find it hard to follow conversations when two or more people are talking
• Often ask people to repeat what they are saying
• Need to turn up the TV volume so loud that others complain
• Have a problem understanding speech because of background noise
• Think that others seem to mumble
• Can’t understand what’s being said when children and people with higher pitched voices speak to you

Types of hearing loss

Hearing loss comes in many forms. It can range from a mild loss, in which a person misses certain high-pitched sounds, to a total loss of hearing.

Sudden hearing loss

Sudden deafness, also known as sudden sensorineural hearing loss, is an unexplained rapid loss of hearing. It can happen to a person all at once or over a period of a few days. It should be considered a medical emergency. If you or someone you know experiences sudden hearing loss, visit a doctor immediately.

Age-related hearing loss

Age-related hearing loss, also called presbycusis, comes on gradually as a person grows older. It seems to run in families and may occur because of changes in the inner ear and auditory nerve, which relays signals from the ear to the brain. Presbycusis may make it hard for a person to tolerate loud sounds or to understand what others are saying.

Age-related hearing loss usually occurs in both ears, affecting them equally. Because the loss is gradual, people with presbycusis may not realize they have lost some of their ability to hear.

Tinnitus

Tinnitus is also common in older people. It is typically described as ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It can come and go. It can be heard in one or both ears, and it may be loud or soft. Tinnitus is sometimes the first sign of hearing loss in older adults. It can accompany any type of hearing loss.

Tinnitus is a symptom, not a disease. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. It can also be a sign of other health conditions, such as high blood pressure or allergies. Tinnitus can also occur as a side effect of certain medications.

Causes of hearing loss

Loud noise is one of the most common causes of hearing loss. Noise from lawn mowers, snow blowers, or loud music can damage the inner ear and result in permanent hearing loss. Loud noise also contributes to tinnitus. You can prevent most noise-related hearing loss by turning down the sound on your devices, moving away from loud noise, or using earplugs or other ear protection.

Earwax or fluid buildup can also cause hearing loss by blocking sounds that are carried from the eardrum to the inner ear. If wax blockage is a problem, your doctor may suggest mild treatments to soften earwax.

A ruptured eardrum can also cause hearing loss. The eardrum can be damaged by infection, pressure, or putting objects in the ear, including cotton-tipped swabs. See your doctor if you have ear pain or fluid draining from an ear.

Health conditions common in older people, such as diabetes or high blood pressure, can contribute to hearing loss. Ear infections caused by viruses and bacteria (also known as otitis media), a heart condition, stroke, brain injury, or a tumor may also affect your hearing.

Hearing loss can also result from taking certain medications that can damage the inner ear, sometimes permanently. These medications may be used to treat serious infections, cancer, or heart disease. They also include some antibiotics, and even aspirin at some dosages. If you notice a problem while taking a medication, check with your doctor.

Genetic variations can cause hearing loss as well. Not all inherited forms of hearing loss are evident at birth. Some forms can show up later in life. For example, otosclerosis, which is thought to be a hereditary disease, involves the abnormal growth of bone that prevents structures within the ear from working properly.

Health effects of hearing loss

Hearing loss can affect cognitive health. Studies have shown that older adults with hearing loss have a greater risk of developing dementia than older adults with normal hearing. Cognitive abilities (including memory and concentration) decline faster in older adults with hearing loss than in older adults with normal hearing. A recent analysis of several studies found that people who used hearing restorative devices (such as hearing aids and cochlear implants) had a lower risk of long-term cognitive decline compared to people with uncorrected hearing loss.

Older people who can’t hear well may become depressed or withdrawn from others because they feel frustrated or embarrassed about not understanding what is being said. Sometimes, older people are mistakenly thought to be confused, unresponsive, or uncooperative because they don’t hear well. These circumstances can lead to social isolation and loneliness.

Hearing loss, even small amounts, is also linked to an increased risk for falls. It also can affect public as well as personal safety, such as the ability to drive safely, when warning sounds are harder to hear.

How to cope with hearing loss

If you notice signs of hearing loss, talk with your doctor. If you have trouble hearing, you should:

• Let your family and friends know you have a hearing problem.
• Ask people to face you and to speak louder and more clearly. Ask them to repeat themselves or reword what they’re saying.
• Pay attention to what is being said and to facial expressions or gestures.
• Let the person talking know if you do not understand what was said.
• Find a good location to listen. Place yourself between the speaker and sources of noise or look for quieter places to talk.

The most important thing you can do if you think you have a hearing problem is to seek professional advice. Your family doctor may be able to diagnose and treat your hearing problem. Or your doctor may refer you to other experts, like an otolaryngologist (ear, nose, and throat doctor) or an audiologist (health professional who can identify and measure hearing loss).

Devices to help with hearing loss

Many types of assistive devices are available to help people with hearing loss. These devices can amplify sounds, provide alerts, and help you communicate with others. For example, alert systems work with doorbells, smoke detectors, and alarm clocks to send visual signals or vibrations. Devices that use keyboards, touch screens, or text-to-speech technology can help you give and receive information more effectively. Learn more about the wide range of assistive devices available for people with hearing loss from the National Institute on Deafness and Other Communication Disorders.

Hearing aids are electronic, battery-run assistive devices that make some sounds louder. There are two main ways to get a hearing aid: by prescription or over the counter.

• An audiologist or hearing aid specialist can prescribe hearing aids for people with significant or complicated hearing loss. Prescription hearing aids require a medical exam, and then the health care professional will fit and adjust the device.
• Hearing aids have recently become available without a prescription. Over-the-counter hearing aids, which are sold in stores and online, may help people with mild to moderate hearing loss.

Before buying a hearing aid, find out if your health insurance will cover part of the cost.

A cochlear implant is a different type of assistive device that can help people who are profoundly deaf or hard of hearing. Whereas hearing aids make sound louder so damaged ears can hear it, cochlear implants create electric signals that the brain recognizes as sound. The implant requires surgical placement and hearing therapy.

If you are experiencing hearing loss, talk with your doctor about assistive devices that may be available to help.

How to talk with someone who has hearing loss

Here are some tips you can use when talking with someone who has a hearing problem:

• In a group, make a point to include people with hearing loss in the conversation.
• Find a quiet place to talk to help reduce background noise, especially in restaurants and at social gatherings.
• Stand in good lighting and use facial expressions or gestures to give clues.
• Face the person and speak clearly. Maintain eye contact.
• Speak a little louder than normal, but don’t shout.
• Try to speak naturally and at a reasonable speed.
• Do not hide your mouth, eat, or chew gum while speaking.
• Repeat yourself if necessary, using different words.
• Try to make sure only one person talks at a time.
• Be patient. People with hearing loss may also be frustrated by their condition. Stay positive and relaxed.
• Ask how you can help.

To learn more, please visit https://www.nia.nih.gov/health/hearing-and-hearing-loss/hearing-loss-common-problem-older-adults.

It is not always clear whether an aging parent or relative needs help. Sometimes a person will recognize that they need help and request it, or an emergency or sudden illness will make it clear. Others may not want to cause worry or admit they’re struggling.

If you become aware of the signs that a loved one needs help, you will be better prepared to provide support for their safety and well-being.

How to tell if someone needs extra support

The best way to know what someone needs is to ask them directly. But a phone call, email, or text message is not always the best way to tell whether an older person needs help. These signs may indicate that someone needs extra support:

Changes at home. When you spend time at the person’s home, you might notice possible trouble spots. Some examples include:

• Can the person prepare meals on a stove safely?
• Are they bathing regularly and wearing appropriate clothing for the weather?
• Is the home relatively clean and free of clutter?
• Do they have the medications they need, and are they taking them regularly?

Mental health concerns. Changes in a person’s mood could indicate a need for help. Sometimes depression in older people is confused with normal aging. An older person with depression might brighten up for a phone call or short visit, but it’s harder to hide serious mood problems during an extended visit. Seek immediate help if the person says they feel hopeless or have no reason to live, or if you’re worried they may harm themselves. Call or text the 24-hour 988 Suicide & Crisis Lifeline at 988 or call 800-273-TALK (800-273-8255). For TTY, use your preferred relay service or dial 711 then 988.

Other health concerns. Signs related to the person’s general health that can raise concerns include:

• Significant weight gain or weight loss
• Poor hygiene
• Confusion
• Falls
• Loneliness or social isolation
• Trouble walking or getting around

Memory issues. Occasional forgetfulness is a normal part of aging. But more significant memory problems, changes in thinking ability or personality, or poor decision-making could indicate a serious condition that requires medical attention.

Recognizing changes if you live far away

If you don’t live close to an older family member or see them often, it may be difficult to notice if the person needs help.

With the person’s permission, you could contact people who see them regularly – neighbors, friends, doctors, or local relatives, for example – and ask them to call you with any concerns. You might also ask if you can check in periodically.

What to do when a loved one needs help

When you notice signs that your aging parent or relative needs help, it is important to know what steps to take next. Some issues have a simple fix, like needing a new glasses prescription. But other times, you may need to provide more support.

Your first step may be to talk to the older person about your concerns. Mention your worry without sounding critical, such as, “Mom, it looks like you don’t have much food in the house. Are you having trouble getting to the store?”

Then try to fulfill the person’s wishes to the extent possible. For example, if they want to keep cooking at home, you could ask, “Would you like me to arrange to have groceries delivered on a regular basis?” Try to include practical help with your suggestions and give specific examples of what can be done.

If you’re concerned about the person’s physical or mental health, suggest a visit to a health care provider. You might offer to make the appointment, give them a ride, or go with them to see the doctor.

You don’t have to do everything yourself. In many communities, a variety of services are available to help older people. Depending on the person’s needs, you might hire a home health aide to visit on a regular basis, arrange transportation so the person can run errands, or speak with a geriatric care manager to help coordinate care. You can also find ways to share caregiving responsibilities with other family members, neighbors, or friends.

Helping an aging parent or other relative plan for the future

The best time to plan is before the older person needs extensive help. Planning for the possibility of long-term care gives you and your family time to learn about services available in your community and what they cost. It also allows the older person to make important decisions while they are still able.

There may be a time when your older relative can no longer live independently at home. Learn as much as you can about housing options, which may include moving to a residential facility (such as a nursing home or assisted living) or living with a family member. These choices may depend on the person’s health, ability to perform activities of daily living, financial resources, and personal preferences. Talk about the pros and cons of each option before making a decision.

You may also need to help the older person prepare for decisions about their future medical care — a process called advance care planning. It’s important to know what they would want if they became seriously ill or unable to communicate their wishes. Having conversations about the person’s preferences and making a plan makes it more likely that they will get the care they want.

To learn more, please visit https://www.nia.nih.gov/health/caregiving/does-older-adult-your-life-need-help.

COVID-19 is a respiratory disease that continues to affect people and communities worldwide. Older adults are more likely than younger people to get very sick from the disease. The resources below are from the National Institute on Aging (NIA), part of the National Institutes of Health (NIH), and other government agencies. This information can help older adults and their caregivers learn more about COVID-19, locate resources and services in their area, and find out about participating in COVID-19 research.

Information about COVID-19 and older adults

These resources provide health information, vaccine recommendations, and other guidance for older adults.

• COVID-19 Risks and Information for Older Adults: Risk factors, prevention, and other up-to-date information from the Centers for Disease Control and Prevention (CDC)
• Stay Up to Date With COVID-19 Vaccines: The latest CDC recommendations for COVID-19 vaccines and boosters
• COVID-19 Information Resources: Materials for older adults, people with dementia, and caregivers from NIA-funded research centers and other organizations
• COVID-19 Response: What Do Older Adults and People With Disabilities Need To Know? Information from the Administration for Community Living
• What Do We Know About Long COVID? Article from NIA about long-lasting symptoms of Long COVID in older adults
• Is it a Cold, the Flu, or COVID-19? Infographic from NIA showing the common symptoms of each illness

Finding COVID-19 resources in your community

These resources can help you find COVID-19 testing, vaccines, treatment, and guidance in your local area.

• COVID.gov: Community resources and guidance by county, including where to find masks, tests, vaccines, and treatment. Visit the website, call 800-232-0233, or text your ZIP code to 438829 (GETVAX) for COVID-19 resources in your area.
• Vaccines.gov: A searchable map of COVID-19 vaccination providers by ZIP code.
• COVID-19 Test-to-Treat Locator: An interactive map of local health clinics and pharmacies that test for COVID-19 and provide medications for treatment.
• State Health Departments: A list of all state and territorial health departments that provide local resources.
• Eldercare Locator: A service of the U.S. Administration on Aging that can help older adults find housing, community and in-home services, transportation, insurance and assistance programs, and benefits information in their community. Visit the website or call 800-677-1116.

COVID-19 information for caregivers

These resources can help family, friends, health professionals, and other caregivers of older adults.

• If You Are Sick or Caring for Someone: Advice from the CDC for people with COVID-19 and their caregivers in non-health care settings
• COVID-19 Guidance for Adult Day Services Centers: Guidance from the CDC for reducing the spread of COVID-19 and maintaining safe operations
• Resources on COVID-19 for Caregivers and Older Adults: A list of resources from the Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Planning and Evaluation

COVID-19 services for veterans

These resources can help veterans and their families find COVID-19 information and services through the U.S. Department of Veterans Affairs (VA).

• COVID-19 Resources for Veterans: Latest updates and information from the VA
• COVID-19 Vaccines at VA: Eligibility and locations for COVID-19 vaccines for veterans
• Coronavirus FAQs: What Veterans Need To Know: Answers to questions about COVID-19 testing, vaccination, benefits, and research from the VA

Government programs and assistance

These resources provide information about health care coverage, financial assistance, and other government programs and benefits related to COVID-19.

• Medicare & Coronavirus: Details about Medicare coverage for COVID-19 vaccines, tests, and treatments. Visit the website or call 800-633-4227.
• Resources and Assistance for Homeowners and Renters: Information about housing concerns during COVID-19 from the U.S. Department of Housing and Urban Development. Free housing advice is also available by calling 800-569-4287.
• Protecting Your Finances During the Coronavirus Pandemic: Guidance on mortgages, student loans, and financial management from the Consumer Financial Protection Bureau.
• Avoid Coronavirus Scams: Advice for consumers from the Federal Trade Commission.

Participating in COVID-19 research

People who participate in clinical trials and studies help scientists better understand COVID-19 and discover new ways to prevent and treat this disease. These resources provide information about clinical research and ways to get involved.

• Understanding COVID-19 Clinical Trials: General information from NIH about COVID-19 clinical trials, including how they work and the benefits of participating
• NIH COVID-19 Research Initiatives: Ongoing efforts from NIH to accelerate research-based solutions in testing, treatments, and vaccines for COVID-19
• COVID-19 Clinical Trials: A current list of COVID-19 studies seeking participants from ClinicalTrials.gov

To learn more, please visit https://www.nia.nih.gov/health/covid-19/covid-19-resources-older-adults-and-caregivers.

Boyd Nursing and Rehabilitation, in partnership with Reliant Rehabilitation, is excited to share resident Peggy Lawson’s Success Story!

Peggy came to Boyd Nursing and Rehabilitation in January for rehabilitation. Her journey to return to independent living was challenging, but with the help of physical, occupational, and speech therapy services, along with exceptional nursing care and social services assistance, Peggy overcame many obstacles to reach her goal. Her perseverance and hard work were instrumental in regaining her independence.

Before her discharge, our Care Team surprised Peggy with a house-warming shower to help furnish her new apartment! She has made many friends and looks forward to returning as a volunteer in Boyd’s Activities Department. Boyd Nursing and Rehabilitation and Reliant Rehab extend their congratulations to Peggy Lawson on her successful return to the community!

Your patients bring diverse backgrounds, customs, abilities, and experiences to their health care. Some differences are apparent, while others are not. Factors that contribute to diversity include:

• Geographic and cultural background
• Race and ethnicity
• Age
• Gender identity, gender expression, and sexual orientation
• Preferred language(s)
• Religious and family traditions
• Education and socioeconomic background
• Neurodiversity
• Cognitive, sensory, and physical abilities

Recognizing and appreciating diversity is an essential part of patient-centered care. It can lead to improved patient safety, more open communication, increased health equity, and better patient outcomes. By respecting each patient’s values and preferences, you’ll be more likely to engage them as collaborative partners in their care.

How is diversity related to health?

A patient’s culture and background will affect whether and where they seek health care, their understanding of medical information, and how they make health care decisions. Recognizing the different health issues your older patients are likely to face, as well as the factors that contribute to these differences, will help you provide the most effective care.

Many complex and interacting factors, lifelong and current, underlie disparities in health risk and disease burden. These factors include:

• Unequal access to health care services
• Availability of social support
• Neighborhood and workplace environments
• Food availability and accessibility
• Wealth and income gaps
• Racism, sexism, and other forms of discrimination

Age-related health disparities affect the health of older adults. For example:

• NIA-funded researchers have found a higher prevalence of Alzheimer’s disease among African Americans and Hispanics than among other racial and ethnic groups in the United States.
• Prostate cancer has higher incidence and mortality rates, as well as an earlier average age of onset, in non-Hispanic Black men compared with men of other backgrounds.

Scientists have also observed sex and gender differences in health and longevity. For example, women live longer than men, on average. They are also more likely to develop osteoporosis or depressive symptoms and to report functional limitations as they age. Men, on the other hand, are more likely to develop heart disease, cancer, or diabetes.

Other studies have found that lower socioeconomic status is associated with poorer health and reduced lifespan in the United States. Economic circumstances can determine whether an individual can afford quality health care and proper nutrition from early life into old age. Financial resources and health insurance often determine whether an older adult enters an assisted living facility or nursing home or stays at home to be cared for by family members.

Health care workforce diversity is important

Providers representing a variety of backgrounds and cultures can help meet the health needs of an increasingly diverse population. Some patients feel more comfortable with health care providers who share or understand their language, race, ethnicity, or other cultural characteristics. Research suggests that a diverse health care workforce may also improve patient satisfaction, patient-clinician communication, and access to care.

Communicating with a diverse patient population

Your conversational style can be a subtle but powerful way to connect with your patients. Being thoughtful about how you communicate with each individual can promote understanding, trust, and satisfaction in the patient-provider relationship.

Practical tips for effective communication include:

• Ask patients which name and other descriptive terms they prefer and use those consistently. This small effort can go a long way toward making patients feel welcome, safe, and accepted.
• Use person-first language. This language avoids defining someone by their condition or disability (e.g., people with diabetes instead of diabetics).
• Try to match your communication style to that of your patient. Conventions such as the speed and volume of speech vary across cultures. To some people, interrupting an individual who is speaking is acceptable and even expected, while it is considered rude and off-putting to others. 
• Use plain language. Avoid using medical terminology or abbreviations that your patients might not understand. Remember that certain idioms and figures of speech in English may be unfamiliar or confusing to people who have a different primary language.
• Be aware of nonverbal communication (such as hand gestures) that may have a different meaning to patients from different backgrounds. People also differ in the amount of eye contact, smiling, touching, and physical distance that are comfortable.

Tailoring how you talk with patients can help them better understand the information you are providing. Communicating in a way that makes your patients feel comfortable may help them open up about their health concerns and be more receptive to your guidance.

Providing language assistance in health care settings

Overcoming language barriers is critical for effective patient-provider communication. It allows for mutual understanding, informed decision-making, and better quality of care.

In any type of health care setting, you are likely to encounter patients with a primary language other than English. Here are several ways to support these patients:

• Identify the main languages spoken by your patient population and, whenever possible, match patients with qualified bilingual staff or have other trained medical interpretation services available.
• Start appointments by asking all new patients which language they prefer to speak and read, and whether they would like an interpreter. An “I Speak” card (PDF, 4.6M) can help patients identify their preferred language. Note preferences in their medical records.
• Provide important written materials in your patients’ preferred languages. For example, have office signage, intake and consent forms, prescription labels, and patient instructions available in multiple languages when possible. NIA provides health information for older adults in both English and Spanish as well as links to resources in other languages.
• Maintain a list of referrals to local clinicians and community service providers who speak your patients’ preferred languages, when available.

It can be logistically challenging to provide language assistance services. As a result, some clinicians rely on interpretation by patients’ family members or on bilingual staff members who are untrained in medical interpretation. However, experts strongly discourage this practice. An informal interpreter may be unable to convey medical terminology accurately, may inadvertently misinterpret information, or may be reluctant to share difficult news. Informal interpretation can also interfere with patient privacy.

Using qualified medical interpreters can improve communication, understanding, clinical outcomes, and patient satisfaction with care. Trained interpreters will help ensure that everything said during a medical appointment is relayed accurately and objectively. This checklist (PDF, 207K) provides tips for working with an interpreter.

Providing language assistance isn’t just good medical practice: In some cases, it’s also required by law. Federal policies require health care providers who receive government funds, such as Medicare and Medicaid payments, to make interpretive services and written translations of critical documents available at no cost to people with limited English proficiency. Visit LEP.gov for details about these requirements.

Some states have professional associations and foundations that may provide funding for medical interpreters. Additionally, Medicaid offers reimbursement for some medical interpretation services.

If you are looking for a qualified medical interpreter, the National Board of Certification for Medical Interpreters and the Certification Commission for Healthcare Interpreters have online registries of certified interpreters. The Registry of Interpreters for the Deaf provides a searchable list of certified interpreters in American Sign Language. Many state government websites also provide directories of interpreters and translators to help you locate services in your area.

Tips for culturally sensitive care

How can you work with your patients in a way that respects their diversity? To start, avoid making assumptions about a person’s beliefs, attitudes, or behaviors based on their culture or background. Instead, engage with patients to find out about their individual values and preferences.

Additional ideas for providing culturally sensitive care include:

• Reflect on your own background, beliefs, and values, and consider how they inform your practice. For example, think about your own feelings about aging and how they might influence your interactions with your older patients.
• Get to know the community that you serve. What are the most common racial and ethnic groups? Which languages do they speak? What health, social, and environmental issues do they face? Adapt programs and health care practices so they are appropriate to the groups you serve most often.
• Recognize that a healthy diet plan may differ among cultural traditions. Patients will have difficulty following dietary advice if it doesn’t take their food preferences and cooking methods into account. The Nutrition.gov Culture and Food page provides nutrition guidance, food options, and recipes from around the world.
• Understand that some patients may value having other family members involved in their health care decisions. Clarify how the patient sees the role of family and any specific information they want shared with relatives.
• For patients nearing the end of life, ask about their health care goals. There may be cultural or religious differences in attitudes toward end-of-life decision-making, such as creating advance directives; disclosing a terminal diagnosis to the sick person or family members; and pursuing life-prolonging treatments, such as a feeding tube.

Different beliefs about aging

People from different cultures and traditions have varied attitudes about aging. For example, in some cultures, older adults are customarily respected for their wisdom and experience. Other cultures tend to be more youth-centered, valuing the qualities of youth over those of old age.

When societies prefer youth over old age, it can lead to ageism. This often underrecognized form of discrimination comprises stereotypes and prejudices directed toward people on the basis of their age. Ageism has serious implications for the health of older people: Studies have associated age-based discrimination with poorer physical and mental health, reduced quality of life, and even earlier death.

Because ageism is so pervasive, it’s easy for well-intentioned health care providers to make assumptions about their older patients and inadvertently reinforce harmful stereotypes. For example, patients and their providers may dismiss otherwise treatable health problems as an inevitable part of aging. As a result, older patients may suffer preventable discomfort and disability.

For tips on avoiding ageism when talking with your patients, see the World Health Organization’s Quick Guide to Avoid Ageism in Communication.

Clinical research needs diversity

It is important for clinical trials and studies to include a diverse range of participants so the results will have broader applicability. Researchers need older adults from many different backgrounds to participate in research so they can learn more about how new drugs, tests, and other interventions will work in diverse populations.

Clinical research also needs scientists from diverse backgrounds, particularly from groups that have been historically underrepresented. Diversity in scientific teams can lead to more creative and innovative thinking, which can help biomedical research represent and benefit people from all backgrounds.

To learn more, please visit https://www.nia.nih.gov/health/health-care-professionals-information/providing-care-diverse-older-adult-population.

There are many things you can do to help boost your health as you age, including making healthy food choices and not smoking. But did you know that participating in social and other activities you enjoy can also help support healthy aging?

As you grow older, you may find yourself spending more time at home alone. Being lonely or socially isolated is not good for your overall health. For example, it can increase feelings of depression or anxiety, which can have a negative impact on many other aspects of your health. If you find yourself spending a lot of time alone, try participating in activities you find meaningful — those that create a sense of purpose in your daily life. These can include hobbies, volunteer activities, or time with family and friends.

Benefits of an Active Lifestyle

Engaging in social and productive activities you enjoy, such as taking an art class, joining a hiking club, or becoming a volunteer in your community, may help to maintain your well-being and independence as you age. An active lifestyle is more than just getting your daily steps in. It includes doing activities that are meaningful to you and benefit your mind, spirit, and body.

Research has shown that older adults with an active lifestyle:

• Are less likely to develop certain diseases. Participating in hobbies and other social activities may lower risk for developing some health problems, including dementia, heart disease, stroke, and some types of cancer.
• Have a longer lifespan. Studies looking at people’s outlooks and how long they live show that happiness, life satisfaction, and a sense of purpose are all linked to living longer. Doing things that you enjoy may help cultivate those positive feelings.
• Are happier and less depressed. Studies suggest that older adults who participate in activities they find meaningful, such as volunteering in their communities or being physically active, say they feel happier and healthier.
• Are better prepared to cope. When people feel happier and healthier, they are more likely to be resilient, which is our ability to bounce back and recover from difficult situations. Positive emotions, optimism, physical and mental health, and a sense of purpose are all associated with resilience.
• May be able to improve their thinking abilities. Research suggests that participating in certain activities, such as those that are mentally stimulating or involve physical activity, may have a positive effect on memory — and the more variety the better. Other studies are providing new information about ways that creative activities, such as music or dance, can help older adults with memory problems or dementia.

Find the Right Balance

Everyone has different limits to the amount of time they can spend on social or other activities. What is perfect for one person may be too much for another. You might start by adding one or two activities to your routine and see how you feel. You can always add more. Remember: Participating in activities you enjoy should be fun, not stressful.

Activities to Consider

Read and share this infographic and spread the word about ways that may help foster healthy aging.

There are plenty of places to look for opportunities to engage in activities you enjoy, depending on your interests and ability. Following are ideas that might work for you. Some of these include activities that can be enjoyed even from a distance using phones, computers, and other devices. Others can be done alone. So even if you’re in a rural area or have other restrictions, you can still find ways to engage in activities you like.

Connect with Family and Friends

• Play cards or other games with friends in person or online.
• Travel with a group of older adults, such as a retiree group.
• Video chat or call your friends and family members.
• Try different restaurants with your loved ones.
• Listen and share favorite music with your family.
• Join a group interested in a hobby, such as knitting, hiking, birdwatching, painting, or wood carving.
• Reconnect with old friends through your high school or college alumni association.

Learn Something New

• Take a cooking, art, dance, language, or computer class. Get in touch with your local community college or library. Many offer free or discounted courses for older adults. You may even be able to find classes online.
• Form or join a book or film club
• Try yoga, tai chi, or another new physical activity
• Learn (or relearn) how to play a musical instrument
• Visit local museums. Many offer free group tours and educational programs.

Become More Active in Your Community

• Visit a community or senior center and take part in its events and activities
• Serve meals or organize clothing donations for people in need
• Run errands for people with limited mobility or access to transportation
• Join a committee or help out with an activity at your place of worship
• Volunteer at a school, library, museum, hospital, or animal shelter
• Help with gardening at a community garden or park
• Organize a park clean-up through your local recreation center or community association
• Sing in a community choral group, or play in a local band or orchestra
• Take part in a local theater troupe
• Get a local part-time job or explore opportunities online
• Teach a favorite pastime or skill, such as embroidery, photography, building models, chess, baking, woodworking, calligraphy, or quilting, to a new generation

Go Out and Get Moving

• Garden (indoors or out) or do yard work
• Take an exercise class or do exercises at home
• Go dancing
• Join a sports club for older adults, like a bowling club or bocce league
• Walk or bicycle with a friend or neighbor
• Take a swimming class
• Play with your grandchildren. Teach them a game or dance you remember from childhood
• Take a stroll around the neighborhood or on nature trails

Adopt Healthy Stress-Relieving Habits

• Read a good book, magazine, or newspaper
• Practice gratitude and mindfulness
• Do tai-chi or yoga
• Cook your favorite healthy meal
• Enjoy the little things, such as a cup of coffee or sunrise

To learn more, please visit https://www.nia.nih.gov/health/healthy-aging/participating-activities-you-enjoy-you-age.

Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. It’s important for older adults to plan ahead and let their caregivers, doctors, or family members know your end-of-life preferences in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to health care providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.

If the person is no longer able to make health care decisions for themselves, a caregiver or family member may have to make those decisions. Caregivers have several factors to consider when choosing end-of-life care, including the older person’s desire to pursue life-extending treatments, how long he or she has left to live, and the preferred setting for care.

What is Palliative Care?

Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. Palliative care is meant to enhance a person’s current care by focusing on quality of life for them and their family.

Who Can Benefit from Palliative Care?

Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, and many others. Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed.

In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life.

Who Makes up the Palliative Care Team?

A palliative care team is made up of multiple different professionals that work with the patient, family, and the patient’s other doctors to provide medical, social, emotional, and practical support. The team is comprised of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains. A person’s team may vary based on their needs and level of care. To begin palliative care, a person’s health care provider may refer him or her to a palliative care specialist. If he or she doesn’t suggest it, the person can ask a health care provider for a referral.

Where is Palliative Care Provided?

Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home. Medicare, Medicaid, and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover.

Visit the National Hospice and Palliative Care Organization website to find palliative care near you.

In palliative care, a person does not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis. Over time, if the doctor or the palliative care team believes ongoing treatment is no longer helping, there are two possibilities. Palliative care could transition to hospice care if the doctor believes the person is likely to die within six months (see What does the hospice six-month requirement mean?). Or, the palliative care team could continue to help with increasing emphasis on comfort care.

What is Hospice Care?

Increasingly, people are choosing hospice care at the end of life. Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.

At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease’s progress.

Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person’s illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course.

It’s important for a patient to discuss hospice care options with their doctor. Sometimes, people don’t begin hospice care soon enough to take full advantage of the help it offers. Perhaps they wait too long to begin hospice and they are too close to death. Or, some people are not eligible for hospice care soon enough to receive its full benefit. Starting hospice early may be able to provide months of meaningful care and quality time with loved ones.

Where is Hospice Care Provided and Who Provides it?

Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings — at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.

Read more about where end-of-life care can be provided.

Hospice care brings together a team of people with special skills — among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the person who is dying, the caregiver, and/or the family to provide the medical, emotional, and spiritual support needed.

A member of the hospice team visits regularly, and someone is usually always available by phone — 24 hours a day, seven days a week. Hospice may be covered by Medicare and other insurance companies. Check to see if insurance will cover the person’s particular situation.

It is important to remember that stopping treatment aimed at curing an illness does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter into hospice care, then the chemotherapy will stop. Other medical care may continue as long as it is helpful. For example, if the person has high blood pressure, he or she will still get medicine for that.

Although hospice provides a lot of support, the day-to-day care of a person dying at home is provided by family and friends. The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.

To learn more, please visit https://www.nia.nih.gov/health/hospice-and-palliative-care/what-are-palliative-care-and-hospice-care.

The brain controls many aspects of thinking — remembering, planning and organizing, making decisions, and much more. These cognitive abilities affect how well we do everyday tasks and whether we can live independently.

Some changes in thinking are common as people get older. For example, older adults may:

• Be slower to find words and recall names
• Have problems with multitasking
• Experience mild decreases in the ability to pay attention

Aging may also bring positive cognitive changes. For example, many studies have shown that older adults have larger vocabularies and greater knowledge of the depth of meaning of words than younger adults. Older adults may also have learned from their many years of accumulated knowledge and experiences. Whether and how older adults apply this knowledge, and how the brain changes as a result, is an area that researchers are actively exploring.

Despite the changes in cognition that may come with age, older adults can still do many of the things they have enjoyed their whole lives. Research shows that older adults can still:

• Learn new skills
• Form new memories
• Improve vocabulary and language skills

How the brain changes as people age

As a person gets older, changes occur in all parts of the body, including the brain.

• Certain parts of the brain shrink, including those important to learning and other complex mental activities.
• In certain brain regions, communication between neurons may be less effective.
• Blood flow in the brain may decrease.
• Inflammation, which occurs when the body responds to an injury or disease, may increase.

These changes in the brain can affect mental function, even in healthy older people. For example, some older adults may find that they don’t do as well as younger individuals on complex memory or learning tests. However, if given enough time to learn a new task, they usually perform just as well. Needing that extra time is normal as people age. There is growing evidence that the brain maintains the ability to change and adapt so that people can manage new challenges and tasks as they age.

Talk with your doctor if you’re concerned about changes in your thinking and memory. They can help you determine whether those changes are normal or whether it could be something else.

The brain-body connection

There is growing scientific evidence of the brain-body connection. Not only can changes in our brain affect our thinking, but also changes in our physical health may affect our brains.

For example, an NIA-funded study of almost 3,000 older adults showed that healthy lifestyle factors — physical activity, not smoking, not drinking heavily, following the Mediterranean-style diet, and engaging in mentally stimulating activities — can have important benefits. People who engaged in four or five of these behaviors had a 60% lower risk of developing Alzheimer’s compared to those who only followed one or none. People who followed two or three of the activities had a 37% lower risk.

In another study, older adults with higher levels of physical activity showed slower rates of cognitive decline than peers who were less active. Another example of how physical health can affect brain health has to do with the heart. Observational studies have found that high blood pressure in middle age, along with other cerebrovascular risk factors, such as diabetes and smoking, increase the risk of developing dementia.

Results from observational studies such as these can’t prove cause and effect, but they point to how a combination of modifiable behaviors may affect the brain as people age and identify promising avenues to be tested further.

To learn more, please visit https://www.nia.nih.gov/health/brain-health/how-aging-brain-affects-thinking

In recent years, the United States has experienced a number of significant natural disasters. Several of these events happened with little or no warning. One key lesson that we have learned from these unfortunate circumstances is to “be prepared,” a message that is especially important for older Americans and people with disabilities. September is officially designated National Preparedness Month, but preparedness is something we should be thinking about all year long.

Unfortunately, natural disasters can disproportionately impact older people and those with disabilities. These populations are frequently less able to withstand periods of time without food, water, medication, and rest—and they may have mobility or communications limitations that impact their ability to respond. Half of the people who died during and after Hurricane Katrina were over the age of 75. People with disabilities who rely on service providers for meals, personal care, and medical assistance often go without critical support systems during a crisis. As we saw during Hurricane Sandy, the loss of electricity to power medical devices, such as ventilators, or assistive technology, can be life-threatening.

That is why it is critical that older adults and people with disabilities plan for emergencies before they happen. Here are three important steps to consider in preparing for a natural disaster:

• Involve your community. When putting together a plan, individuals with disabilities and older adults should talk with their neighbors, family members, caregivers, and community members about emergency preparedness. Planning should be informed by individuals’ needs and preferences and should focus on creating a support team that can assist with evacuation, finding appropriate shelter, and meeting basic needs during a crisis. Planning should also take into account those situations when local services and supports are not available, and an individual needs to relocate out of the community. Consider including out-of-town relatives or friends in disaster preparedness plans.
• Pack an emergency medical kit. People with disabilities and older people with chronic health conditions should pack an emergency kit. It should contain food, water, medication, copies of medical records, instructions for medical devices, and, if necessary, things like extra wheelchair batteries and oxygen tanks.
• Make a plan for pets and service animals. Millions of people have pets and service animals that they love dearly. Owners should create evacuation and emergency response plans that include the needs of their animals. This includes packing an emergency kit for animals with food, water, and medication Pet owners should learn which shelters in their communities accept non-service animals and enlist the support of friends and neighbors to help with pet care if local shelters are not an option.

Every state is unique in terms of the local risks and types of natural disasters that can take place. But no matter where you are, it is important to take time to ensure that older Americans and people with disabilities engage in emergency planning so they are prepared to weather the storms that come.

For more information and links to resources about emergency preparedness for older adults and people with disabilities, please visit ACL’s emergency preparedness webpage.