People in the U.S. are living longer, and the number of older adults in the population is growing. As we age, our minds and bodies change. Having a healthy lifestyle can help you deal with those changes. It may also prevent some health problems and help you to make the most of your life.

A healthy lifestyle for older adults includes:

• Healthy eating. As you age, your dietary needs may change. You may need fewer calories, but you still need to get enough nutrients. A healthy eating plan includes
  • Eating foods that give you lots of nutrients without a lot of extra calories. This includes fruits and vegetables, whole grains, lean meats, low-fat dairy, nuts, and seeds.
  • Avoiding empty calories, such as foods like chips, candy, baked goods, soda, and alcohol
  • Eating foods that are low in cholesterol and fat
  • Drinking enough liquids, so you don't get dehydrated
• Regular physical activity. Being physically active may help you maintain a healthy weight and avoid chronic health problems. If you have not been active, you can start slowly and work up to your goal. How much exercise you need depends on your age and health. Check with your health care provider on what is right for you.
• Staying at a healthy weight. Being either overweight or underweight can lead to health problems. Ask your health care professional what a healthy weight for you may be. Healthy eating and exercise can help you get to that weight.
• Keeping your mind active. Lots of activities can keep your mind active and improve your memory, including learning new skills, reading, and playing games.
• Making your mental health a priority. Work on improving your mental health, for example by practicing mediation, relaxation techniques, or gratitude. Know the warning signs of a problem and ask for help if you are struggling.
• Participating in activities that you enjoy. People who are involved in hobbies and social and leisure activities may be at lower risk for some health problems. Doing things that you enjoy may help you feel happier and improve your thinking abilities.
• Playing an active role in your health care. Make sure that you get regular checkups and the health screenings that you need. You should know which medicines you are taking, why you need them, and how to take them properly.
• Not smoking. If you are a smoker, quitting is one of the most important things that you can do for your health. It can lower your risk of several different types of cancer, certain lung diseases, and heart disease.
• Taking steps to prevent falls. Older adults have a higher risk of falling. They are also more likely to fracture (break) a bone when they fall. Getting regular eye checkups, getting regular physical activity, and making your house safer can lower your risk of falling.

Following these tips can help you to stay healthy as you age. Even if you have never done them before, it's never too late to start taking care of your health. If you have questions about these lifestyle changes or need help figuring out how to make them, ask your health care provider.

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
• Find they have more 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 more extensive vocabularies and greater knowledge of the depth of meaning of words than younger adults. Older adults may also have learned from a lifetime of accumulated knowledge and experiences. Whether and how older adults apply this accumulated knowledge, and how the brain changes as a result, is an area of active exploration by researchers.

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

As we age, our brains change, but Alzheimer’s disease and related dementias are not an inevitable part of aging. In fact, up to 40% of dementia cases may be prevented or delayed. It helps to understand what’s normal and what’s not when it comes to brain health.

Normal brain aging may mean slower processing speeds and more trouble multitasking, but routine memory, skills, and knowledge are stable and may even improve with age. It’s normal to occasionally forget recent events such as where you put your keys or the name of the person you just met.

Symptoms of Dementia or Alzheimer’s Disease

In the United States, 6.2 million people age 65 and older have Alzheimer’s disease, the most common type of dementia. People with dementia have symptoms of cognitive decline that interfere with daily life—including disruptions in language, memory, attention, recognition, problem solving, and decision-making. Signs to watch for include:

• Not being able to complete tasks without help.
• Trouble naming items or close family members.
• Forgetting the function of items.
• Repeating questions.
• Taking much longer to complete normal tasks.
• Misplacing items often.
• Being unable to retrace steps and getting lost.

Conditions That Can Mimic Dementia

Symptoms of some vitamin deficiencies and medical conditions such as vitamin B12 deficiency, infections, hypothyroidism (underactive thyroid), or normal pressure hydrocephalus (a neurological condition caused by the build-up of fluid in the brain) can mimic dementia. Some prescription and over-the-counter medicines can cause dementia-like symptoms. If you have these symptoms, it is important to talk to your health care provider to find out if there are any underlying causes for these symptoms.

How is Dementia Diagnosed?

A healthcare provider can perform tests on attention, memory, problem solving and other cognitive abilities to see if there is cause for concern. A physical exam, blood tests, and brain scans like a CT or MRI can help determine an underlying cause.

What To Do If a Loved One is Showing Symptoms

Talk with your loved one about seeing a health care provider if they are experiencing symptoms of Alzheimer’s dementia to get a brain health check up.

Be Empowered to Discuss Memory Problems

More than half of people with memory loss have not talked to their healthcare provider, but that doesn’t have to be you. Get comfortable with starting a dialogue with your health care provider if you observe any changes in memory, or an increase in confusion, or just if you have any questions. You can also discuss health care planning, management of chronic conditions, and caregiving needs.

Many people worry about becoming forgetful as they age. They think it is the first sign of Alzheimer’s disease. But some forgetfulness can be a normal part of aging.

Many people can become more forgetful as they age. How can you tell the difference between mild forgetfulness and serious memory problems like Alzheimer's disease? See what's typical and what's not:

• Normal aging
  • Making a bad decision once in a while
  • Missing a monthly payment
  • Forgetting which day it is and remembering later
  • Sometimes forgetting which word to use
  • Losing things from time to time
• Alzheimer's disease
  • Making poor judgments and decisions a lot of the time
  • Problems taking care of monthly bills
  • Losing track of the date or time of year
  • Trouble having a conversation
  • Misplacing things often and being unable to find them

Although some forgetfulness comes with age, don't ignore changes in memory or thinking that concern you. Talk with your doctor if you notice you have more serious memory problems than normal.

Age-related changes in the digestive system begin in the mouth and can affect virtually every aspect of the digestive system. Taste buds become less sensitive, so food isn’t as appetizing as it once was. A slice of pizza is a challenge, not a treat, when you have lost teeth, your gums are diseased, and your salivary glands aren’t producing enough saliva. Swallowing can be difficult, and ingested food moves slowly through the alimentary canal because of reduced strength and tone of muscular tissue. Neurosensory feedback is also dampened, slowing the transmission of messages that stimulate the release of enzymes and hormones.

Pathologies that affect the digestive organs—such as hiatal hernia, gastritis, and peptic ulcer disease—can occur at greater frequencies as you age. Problems in the small intestine may include duodenal ulcers, maldigestion, and malabsorption. Problems in the large intestine include hemorrhoids, diverticular disease, and constipation. Conditions that affect the function of accessory organs—and their abilities to deliver pancreatic enzymes and bile to the small intestine—include jaundice, acute pancreatitis, cirrhosis, and gallstones.

Female fertility (the ability to conceive) peaks when women are in their twenties, and is slowly reduced until a women reaches 35 years of age. After that time, fertility declines more rapidly, until it ends completely at the end of menopause. Menopause is the cessation of the menstrual cycle that occurs as a result of the loss of ovarian follicles and the hormones that they produce. A woman is considered to have completed menopause if she has not menstruated in a full year. After that point, she is considered postmenopausal. The average age for this change is consistent worldwide at between 50 and 52 years of age, but it can normally occur in a woman’s forties, or later in her fifties. Poor health, including smoking, can lead to earlier loss of fertility and earlier menopause.

As a woman reaches the age of menopause, depletion of the number of viable follicles in the ovaries due to atresia affects the hormonal regulation of the menstrual cycle. During the years leading up to menopause, there is a decrease in the levels of the hormone inhibin, which normally participates in a negative feedback loop to the pituitary to control the production of FSH. The menopausal decrease in inhibin leads to an increase in FSH. The presence of FSH stimulates more follicles to grow and secrete estrogen. Because small, secondary follicles also respond to increases in FSH levels, larger numbers of follicles are stimulated to grow; however, most undergo atresia and die. Eventually, this process leads to the depletion of all follicles in the ovaries, and the production of estrogen falls off dramatically. It is primarily the lack of estrogens that leads to the symptoms of menopause.

The earliest changes occur during the menopausal transition, often referred to as peri-menopause, when a women’s cycle becomes irregular but does not stop entirely. Although the levels of estrogen are still nearly the same as before the transition, the level of progesterone produced by the corpus luteum is reduced. This decline in progesterone can lead to abnormal growth, or hyperplasia, of the endometrium. This condition is a concern because it increases the risk of developing endometrial cancer. Two harmless conditions that can develop during the transition are uterine fibroids, which are benign masses of cells, and irregular bleeding. As estrogen levels change, other symptoms that occur are hot flashes and night sweats, trouble sleeping, vaginal dryness, mood swings, difficulty focusing, and thinning of hair on the head along with the growth of more hair on the face. Depending on the individual, these symptoms can be entirely absent, moderate, or severe.

After menopause, lower amounts of estrogens can lead to other changes. Cardiovascular disease becomes as prevalent in women as in men, possibly because estrogens reduce the amount of cholesterol in the blood vessels. When estrogen is lacking, many women find that they suddenly have problems with high cholesterol and the cardiovascular issues that accompany it. Osteoporosis is another problem because bone density decreases rapidly in the first years after menopause. The reduction in bone density leads to a higher incidence of fractures.

Hormone therapy (HT), which employs medication (synthetic estrogens and progestins) to increase estrogen and progestin levels, can alleviate some of the symptoms of menopause. In 2002, the Women’s Health Initiative began a study to observe women for the long-term outcomes of hormone replacement therapy over 8.5 years. However, the study was prematurely terminated after 5.2 years because of evidence of a higher than normal risk of breast cancer in patients taking estrogen-only HT. The potential positive effects on cardiovascular disease were also not realized in the estrogen-only patients. The results of other hormone replacement studies over the last 50 years, including a 2012 study that followed over 1,000 menopausal women for 10 years, have shown cardiovascular benefits from estrogen and no increased risk for cancer. Some researchers believe that the age group tested in the 2002 trial may have been too old to benefit from the therapy, thus skewing the results. In the meantime, intense debate and study of the benefits and risks of replacement therapy is ongoing. Current guidelines approve HT for the reduction of hot flashes or flushes, but this treatment is generally only considered when women first start showing signs of menopausal changes, is used in the lowest dose possible for the shortest time possible (5 years or less), and it is suggested that women on HT have regular pelvic and breast exams.

Osteoporosis is a disease characterized by a decrease in bone mass that occurs when the rate of bone resorption exceeds the rate of bone formation, a common occurrence as the body ages. Notice how this is different from Paget’s disease. In Paget’s disease, new bone is formed in an attempt to keep up with the resorption by the overactive osteoclasts, but that new bone is produced haphazardly. In fact, when a physician is evaluating a patient with thinning bone, he or she will test for osteoporosis and Paget’s disease (as well as other diseases). Osteoporosis does not have the elevated blood levels of alkaline phosphatase found in Paget’s disease.

While osteoporosis can involve any bone, it most commonly affects the proximal ends of the femur, vertebrae, and wrist. As a result of the loss of bone density, the osseous tissue may not provide adequate support for everyday functions, and something as simple as a sneeze can cause a vertebral fracture. When an elderly person falls and breaks a hip (really, the femur), it is very likely the femur that broke first, which resulted in the fall. Histologically, osteoporosis is characterized by a reduction in the thickness of compact bone and the number and size of trabeculae in cancellous bone.

The diagram shows that women lose bone mass more quickly than men starting at about 50 years of age. This occurs because 50 is the approximate age at which women go through menopause. Not only do their menstrual periods lessen and eventually cease, but their ovaries reduce in size and then cease the production of estrogen, a hormone that promotes osteoblastic activity and production of bone matrix. Thus, osteoporosis is more common in women than in men, but men can develop it, too. Anyone with a family history of osteoporosis has a greater risk of developing the disease, so the best treatment is prevention, which should start with a childhood diet that includes adequate intake of calcium and vitamin D and a lifestyle that includes weight-bearing exercise. These actions, as discussed above, are important in building bone mass. Promoting proper nutrition and weight-bearing exercise early in life can maximize bone mass before the age of 30, thus reducing the risk of osteoporosis.

For many elderly people, a hip fracture can be life threatening. The fracture itself may not be serious, but the immobility that comes during the healing process can lead to the formation of blood clots that can lodge in the capillaries of the lungs, resulting in respiratory failure; pneumonia due to the lack of poor air exchange that accompanies immobility; pressure sores (bed sores) that allow pathogens to enter the body and cause infections; and urinary tract infections from catheterization.

Current treatments for managing osteoporosis include bisphosphonates (the same medications often used in Paget’s disease), calcitonin, and estrogen (for women only). Minimizing the risk of falls, for example, by removing tripping hazards, is also an important step in managing the potential outcomes from the disease.

Bones feel solid, but the inside of a bone is actually filled with holes like a honeycomb. Bone tissues are broken down and rebuilt all the time. While some cells build new bone tissue, others dissolve bone and release the minerals inside.

As we get older, we begin to lose more bone than we build. The tiny holes within bones get bigger, and the solid outer layer becomes thinner. In other words, our bones get less dense. Hard bones turn spongy, and spongy bones turn spongier. If this loss of bone density goes too far, it’s called osteoporosis. More than 53 million people nationwide either already have osteoporosis or are at high risk due to weak bones.

It’s normal for bones to break in bad accidents. But if your bones are dense enough, they should be able to stand up to most falls. Bones weakened by osteoporosis, though, are more likely to break.

“It’s just like any other engineering material,” says Dr. Joan McGowan, an NIH expert on osteoporosis. If you fall and slam your weight onto a fragile bone, “it reaches a point where the structures aren’t adequate to support the weight you’re putting on them.”

Broken bones can lead to serious problems for seniors. The hip is a common site for osteoporosis, and hip fractures can lead to a downward spiral of disability and loss of independence. Osteoporosis is also common in the wrist and the spine.

The hormone estrogen helps to make and rebuild bones. A woman’s estrogen levels drop after menopause, and bone loss speeds up. That’s why osteoporosis is most common among older women. But men get osteoporosis, too.

“A third of all hip fractures occur in men, yet the problem of osteoporosis in men is frequently downplayed or ignored,” says Dr. Eric Orwoll, a physician-researcher who studies osteoporosis at Oregon Health and Science University. Men tend to do worse than women after a hip fracture, Orwoll says.

Experts suggest that women start getting screened for osteoporosis at age 65. Women younger than age 65 who are at high risk for fractures should also be screened. Men should discuss screening recommendations with their health care providers.

Screening is done with a bone mineral density test at the hip and spine. The most common test is known as DXA, for dual-energy X-ray absorptiometry. It’s painless, like having an X-ray. Your results are often reported as a T-score, which compares your bone density to that of a healthy young woman. A T-score of −2.5 or lower indicates osteoporosis.

There’s a lot you can do to lower your risk of osteoporosis. Getting plenty of calcium, vitamin D, and exercise is a good start, Orwoll says.

Calcium is a mineral that helps bones stay strong. It can come from the foods you eat—including milk and milk products, dark green leafy vegetables like kale and collard greens—or from dietary supplements. Women over age 50 need 1,200 mg of calcium a day. Men need 1,000 mg a day from ages 51 to 70 and 1,200 mg a day after that.

Vitamin D helps your body absorb calcium. As you grow older, your body needs more vitamin D, which is made by your skin when you’re in the sun. You can also get vitamin D from dietary supplements and from certain foods, such as milk, eggs, fatty fish, and fortified cereals. Talk with your health care provider to make sure you’re getting a healthy amount of vitamin D. Problems can arise if you’re getting too little or too much.

Exercise, especially weight-bearing exercise, helps bones, too. Weight-bearing exercises include jogging, walking, tennis, and dancing. The pull of muscles is a reminder to the cells in your bones that they need to keep the tissue dense.

Smoking, in contrast, weakens bones. Heavy drinking does too—and makes people more likely to fall. Certain drugs may also increase the risk of osteoporosis. Having family members with osteoporosis can raise your risk for the condition as well.

The good news is, even if you already have osteoporosis, it’s not too late to start taking care of your bones. Since your bones are rebuilding themselves all the time, you can help push the balance toward more bone growth by giving them exercise, calcium, and vitamin D.

Several medications can also help fight bone loss. The most widely used are bisphosphonates. These drugs are generally prescribed to people diagnosed with osteoporosis after a DXA test, or to those who’ve had a fracture that suggests their bones are too weak. Bisphosphonates have been tested more thoroughly in women, but are approved for men too.

Researchers are trying to develop drugs that increase bone growth. Two are now available that are related to parathyroid hormone, which helps the body use and store calcium. These drugs are approved to help build bone in people with osteoporosis who are at high risk for having a fracture.

Another important way to avoid broken bones is to prevent falling and occasions for fracture in the first place. Unfortunately, more than 2 million so-called fragility fractures (which wouldn’t have happened if the bones had been stronger) occur nationwide each year. “To reduce the societal burden of fracture, it’s going to take a combined approach of not only focusing on the skeleton but focusing on fall prevention,” says Dr. Kristine Ensrud, a physician-researcher who studies aging-related disorders at the University of Minnesota and Minneapolis VA Health Care System.

Many things can affect the risk for a fall, such as how good a person’s balance is and how many trip hazards are in the environment. The kind of fall matters, too. Wrist fractures often occur when a person falls forward or backward. “It’s the active older person who trips and puts her hand out,” McGowan says. Hip fractures often arise when a person falls to the side. Your hip may be strong enough to handle weight that goes up and down, but not an impact from another direction.

“That’s why exercise that builds balance and confidence is very good at preventing fractures,” McGowan says. For example, she says, tai chi won’t provide the loads needed to build bone mass, but it can increase balance and coordination—and make you more likely to catch yourself before you topple.

NIH-funded researchers are looking for better ways to tell how strong your bones are, and how high your chances are of breaking a bone. For now, though, the DXA test is the best measure, and many seniors, even older women, don’t get it, Ensrud says. If you’re concerned about your bone health, she adds, “Ask your health care provider about the possibility of a bone density test.”

Prevent Falls To Protect Bones

To prevent falls at home:

• Keep rooms free of clutter, especially on floors.
• Don’t walk in socks, stockings, or slippers.
• Be sure rugs have skid-proof backs or are tacked to the floor.
• Keep a flashlight next to your bed to guide you in the dark.

Exercises to improve balance:

• Stand on one leg at a time for a minute. Slowly increase the time. Try to balance with your eyes closed or without holding on.
• Stand on your toes for a count of 10, and then rock back on your heels for a count of 10.
• Move your hips in a big circle to the left, and then to the right. Do not move your shoulders or feet. Repeat five times.

Although atrophy due to disuse can often be reversed with exercise, muscle atrophy with age, referred to as sarcopenia, is irreversible. This is a primary reason why even highly trained athletes succumb to declining performance with age. This decline is noticeable in athletes whose sports require strength and powerful movements, such as sprinting, whereas the effects of age are less noticeable in endurance athletes such as marathon runners or long-distance cyclists. As muscles age, muscle fibers die, and they are replaced by connective tissue and adipose tissue (image). Because those tissues cannot contract and generate force as muscle can, muscles lose the ability to produce powerful contractions. The decline in muscle mass causes a loss of strength, including the strength required for posture and mobility. This may be caused by a reduction in FG fibers that hydrolyze ATP quickly to produce short, powerful contractions. Muscles in older people sometimes possess greater numbers of SO fibers, which are responsible for longer contractions and do not produce powerful movements.

There may also be a reduction in the size of motor units, resulting in fewer fibers being stimulated and less muscle tension being produced.

Sarcopenia can be delayed to some extent by exercise, as training adds structural proteins and causes cellular changes that can offset the effects of atrophy. Increased exercise can produce greater numbers of cellular mitochondria, increase capillary density, and increase the mass and strength of connective tissue. The effects of age-related atrophy are especially pronounced in people who are sedentary, as the loss of muscle cells is displayed as functional impairments such as trouble with locomotion, balance, and posture. This can lead to a decrease in quality of life and medical problems, such as joint problems because the muscles that stabilize bones and joints are weakened. Problems with locomotion and balance can also cause various injuries due to falls.

Tissues of all types are vulnerable to injury and, inevitably, aging. In the former case, understanding how tissues respond to damage can guide strategies to aid repair. In the latter case, understanding the impact of aging can help in the search for ways to diminish its effects.

Tissue Injury and Repair

Inflammation is the standard, initial response of the body to injury. Whether biological, chemical, physical, or radiation burns, all injuries lead to the same sequence of physiological events. Inflammation limits the extent of injury, partially or fully eliminates the cause of injury, and initiates repair and regeneration of damaged tissue. Necrosis, or accidental cell death, causes inflammation. Apoptosis is programmed cell death, a normal step-by-step process that destroys cells no longer needed by the body. By mechanisms still under investigation, apoptosis does not initiate the inflammatory response. Acute inflammation resolves over time by the healing of tissue. If inflammation persists, it becomes chronic and leads to diseased conditions. Arthritis and tuberculosis are examples of chronic inflammation. The suffix “-itis” denotes inflammation of a specific organ or type, for example, peritonitis is the inflammation of the peritoneum, and meningitis refers to the inflammation of the meninges, the tough membranes that surround the central nervous system

The four cardinal signs of inflammation—redness, swelling, pain, and local heat—were first recorded in antiquity. Cornelius Celsus is credited with documenting these signs during the days of the Roman Empire, as early as the first century AD. A fifth sign, loss of function, may also accompany inflammation.

Upon tissue injury, damaged cells release inflammatory chemical signals that evoke local vasodilation, the widening of the blood vessels. Increased blood flow results in apparent redness and heat. In response to injury, mast cells present in tissue degranulate, releasing the potent vasodilator histamine. Increased blood flow and inflammatory mediators recruit white blood cells to the site of inflammation. The endothelium lining the local blood vessel becomes “leaky” under the influence of histamine and other inflammatory mediators allowing neutrophils, macrophages, and fluid to move from the blood into the interstitial tissue spaces. The excess liquid in tissue causes swelling, more properly called edema. The swollen tissues squeezing pain receptors cause the sensation of pain. Prostaglandins released from injured cells also activate pain neurons. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain because they inhibit the synthesis of prostaglandins. High levels of NSAIDs reduce inflammation. Antihistamines decrease allergies by blocking histamine receptors and as a result the histamine response.

After containment of an injury, the tissue repair phase starts with removal of toxins and waste products. Clotting (coagulation) reduces blood loss from damaged blood vessels and forms a network of fibrin proteins that trap blood cells and bind the edges of the wound together. A scab forms when the clot dries, reducing the risk of infection. Sometimes a mixture of dead leukocytes and fluid called pus accumulates in the wound. As healing progresses, fibroblasts from the surrounding connective tissues replace the collagen and extracellular material lost by the injury. Angiogenesis, the growth of new blood vessels, results in vascularization of the new tissue known as granulation tissue. The clot retracts pulling the edges of the wound together, and it slowly dissolves as the tissue is repaired. When a large amount of granulation tissue forms and capillaries disappear, a pale scar is often visible in the healed area. A primary union describes the healing of a wound where the edges are close together. When there is a gaping wound, it takes longer to refill the area with cells and collagen. The process called secondary union occurs as the edges of the wound are pulled together by what is called wound contraction. When a wound is more than one quarter of an inch deep, sutures (stitches) are recommended to promote a primary union and avoid the formation of a disfiguring scar. Regeneration is the addition of new cells of the same type as the ones that were injured.

Tissue Healing During wound repair, collagen fibers are laid down randomly by fibroblasts that move into repair the area.

Homeostatic Imbalances

Tissues and Cancer
Cancer is a generic term for many diseases in which cells escape regulatory signals. Uncontrolled growth, invasion into adjacent tissues, and colonization of other organs, if not treated early enough, are its hallmarks. Health suffers when tumors “rob” blood supply from the “normal” organs.

A mutation is defined as a permanent change in the DNA of a cell. Epigenetic modifications, changes that do not affect the code of the DNA but alter how the DNA is decoded, are also known to generate abnormal cells. Alterations in the genetic material may be caused by environmental agents, infectious agents, or errors in the replication of DNA that accumulate with age. Many mutations do not cause any noticeable change in the functions of a cell. However, if the modification affects key proteins that have an impact on the cell’s ability to proliferate in an orderly fashion, the cell starts to divide abnormally. As changes in cells accumulate, they lose their ability to form regular tissues. A tumor, a mass of cells displaying abnormal architecture, forms in the tissue. Many tumors are benign, meaning they do not metastasize nor cause disease. A tumor becomes malignant, or cancerous, when it breaches the confines of its tissue, promotes angiogenesis, attracts the growth of capillaries, and metastasizes to other organs (image). The specific names of cancers reflect the tissue of origin. Cancers derived from epithelial cells are referred to as carcinomas. Cancer in myeloid tissue or blood cells form myelomas. Leukemias are cancers of white blood cells, whereas sarcomas derive from connective tissue. Cells in tumors differ both in structure and function. Some cells, called cancer stem cells, appear to be a subtype of cell responsible for uncontrolled growth. Recent research shows that contrary to what was previously assumed, tumors are not disorganized masses of cells, but have their own structures.

Cancer treatments vary depending on the disease’s type and stage. Traditional approaches, including surgery, radiation, chemotherapy, and hormonal therapy, aim to remove or kill rapidly dividing cancer cells, but these strategies have their limitations. Depending on a tumor’s location, for example, cancer surgeons may be unable to remove it. Radiation and chemotherapy are difficult, and it is often impossible to target only the cancer cells. The treatments inevitably destroy healthy tissue as well. To address this, researchers are working on pharmaceuticals that can target specific proteins implicated in cancer-associated molecular pathways.

People age 65 and older are much more likely than younger people to suffer a heart attack, to have a stroke, or to develop coronary heart disease (commonly called heart disease) and heart failure. Heart disease is also a major cause of disability, limiting the activity and eroding the quality of life of millions of older people.

Aging can cause changes in the heart and blood vessels. For example, as you get older, your heart can't beat as fast during physical activity or times of stress as it did when you were younger. However, the number of heartbeats per minute (heart rate) at rest does not change significantly with normal aging.

Changes that happen with age may increase a person's risk of heart disease. A major cause of heart disease is the buildup of fatty deposits in the walls of arteries over many years. The good news is there are things you can do to delay, lower, or possibly avoid or reverse your risk.

The most common aging change is increased stiffness of the large arteries, called arteriosclerosis (ahr-teer-ee-o-skluh-roh-sis), or hardening of the arteries. This causes high blood pressure, or hypertension, which becomes more common as we age.

High blood pressure and other risk factors, including advancing age, increase the risk of developing atherosclerosis (ath-uh-roh-skluh-roh-sis). Because there are several modifiable risk factors for atherosclerosis, it is not necessarily a normal part of aging. Plaque builds up inside the walls of your arteries and, over time, hardens and narrows your arteries, which limits the flow of oxygen-rich blood to your organs and other parts of your body. Oxygen and blood nutrients are supplied to the heart muscle through the coronary arteries. Heart disease develops when plaque builds up in the coronary arteries, reducing blood flow to your heart muscle. Over time, the heart muscle can become weakened and/or damaged, resulting in heart failure. Heart damage can be caused by heart attacks, long-standing hypertension and diabetes, and chronic heavy alcohol use.

Age can cause other changes to the heart. For example:

• There are age-related changes in the electrical system that can lead to arrhythmias—a rapid, slowed, or irregular heartbeat—and/or the need for a pacemaker. Valves—the one-way, door-like parts that open and close to control blood flow between the chambers of your heart—may become thicker and stiffer. Stiffer valves can limit the flow of blood out of the heart and become leaky, both of which can cause fluid to build up in the lungs or in the body (legs, feet, and abdomen).
• The chambers of your heart may increase in size. The heart wall thickens, so the amount of blood that a chamber can hold may decrease despite the increased overall heart size. The heart may fill more slowly. Long-standing hypertension is the main cause of increased thickness of the heart wall, which can increase the risk of atrial fibrillation, a common heart rhythm problem in older people.
• With increasing age, people become more sensitive to salt, which may cause an increase in blood pressure and/or ankle or foot swelling (edema).

Other factors, such as thyroid disease or chemotherapy, may also weaken the heart muscle. Things you can't control, like your family history, might increase your risk of heart disease. But, leading a heart-healthy lifestyle might help you avoid or delay serious illness.

Her age is 53. But her heart is 75 years old because she smokes and has uncontrolled high blood pressure. She’s not alone because most American adults have a heart that is older than their actual age. One way to understand your risk for a heart attack or stroke is to learn your “heart age.” Heart age is the age of your heart and blood vessels as a result of your risk factors for heart attack and stroke. There are some things that put you at risk for a heart attack or stroke that you cannot change such as getting older or your family history; yet there are many others that you can change. If you smoke or have high blood pressure, your heart age will be much higher than your actual age. The most common reasons for a higher heart age that can be changed or managed are: high blood pressure, high cholesterol, smoking, obesity, unhealthy diet, physical inactivity, and diabetes. At any age, you can make your heart younger by making changes that reduce your risk. Even if you haven’t had a heart attack or stroke, most US adults have a heart age older than their actual age placing them at greater risk of having one.

What you can do:

• Learn your heart age and how to improve it.
• Start by choosing a risk factor or two that you’re ready to change, like smoking or high blood pressure, and focus on improving them first.
• Work with your doctor to make heart healthy choices for a lower heart age.
• Take action at any age to lower your heart age and keep it low over time.

US adults have hearts 7 years older than they should be.

Though there are other ways of looking at your risk for having a heart attack or stroke, heart age is an easy way for us to talk about it. You want a heart age that is the same or younger than your actual age. Using information from the Framingham Heart Study and data collected from every US state, CDC projections show that around 69 million US adults that haven’t had a heart attack or stroke, have a heart age that is 5 or more years older than their actual age. That’s about the number of people living in the 130 largest US cities combined. One in 2 men and 2 in 5 women have heart ages 5 or more years older than their actual age, with the average being 7 years older.

Having an ideal blood pressure (less than 120/80) lowers your heart age.

Depression is a true and treatable medical condition, not a normal part of aging. However older adults are at an increased risk for experiencing depression. If you are concerned about a loved one, offer to go with him or her to see a health care provider to be diagnosed and treated.

Depression is not just having “the blues” or the emotions we feel when grieving the loss of a loved one. It is a true medical condition that is treatable, like diabetes or hypertension.

How Do I Know if it’s Depression

Someone who is depressed has feelings of sadness or anxiety that last for weeks at a time. He or she may also experience–

• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Insomnia, early–morning wakefulness, or excessive sleeping
• Overeating or appetite loss
• Thoughts of suicide, suicide attempts
• Persistent aches or pains, headaches, cramps, or digestive problems that do not get better, even with treatment

How is Depression Different for Older Adults

• Older adults are at increased risk. We know that about 80% of older adults have at least one chronic health condition, and 50% have two or more. Depression is more common in people who also have other illnesses (such as heart disease or cancer) or whose function becomes limited.
• Older adults are often misdiagnosed and undertreated. Healthcare providers may mistake an older adult’s symptoms of depression as just a natural reaction to illness or the life changes that may occur as we age, and therefore not see the depression as something to be treated. Older adults themselves often share this belief and do not seek help because they don’t understand that they could feel better with appropriate treatment.

How Many Older Adults are Depressed

The good news is that the majority of older adults are not depressed. Some estimates of major depression in older people living in the community range from less than 1% to about 5% but rise to 13.5% in those who require home healthcare and to 11.5% in older hospitalized patients.

How Do I Find Help

Most older adults see an improvement in their symptoms when treated with antidepression drugs, psychotherapy, or a combination of both. If you are concerned about a loved one being depressed, offer to go with him or her to see a health care provider to be diagnosed and treated.

If you or someone you care about is in crisis, please seek help immediately.

• Call 911
• Visit a nearby emergency department or your health care provider’s office
• Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor

Healthy teeth and gums make it easy for you to eat well and enjoy good food. Several problems can affect the health of your mouth, but good care should keep your teeth and gums strong as you age.

Tooth Decay

Teeth are covered in a hard, outer coating called enamel. Every day, a thin film of bacteria called dental plaque builds up on your teeth. The bacteria in plaque produce acids that can harm enamel and cause cavities. Brushing and flossing your teeth can prevent decay, but once a cavity forms, to avoid further damage, a dentist must fix it with a filling.

Use fluoride toothpaste to protect your teeth from decay. If you are at a higher risk for tooth decay (for example, if you have a dry mouth because of a condition you have or medicines you take), you might need more fluoride. Your dentist or dental hygienist may give you a fluoride treatment during an office visit or may tell you to use a fluoride gel or mouth rinse at home.

Gum Disease

Gum disease begins when plaque builds up along and under your gum line. Plaque causes an infection that hurts the gum and bone that hold your teeth in place. A mild form of gum disease may make your gums red, tender, and more likely to bleed. This problem, called gingivitis, can often be fixed by brushing and flossing every day.

A more severe form of gum disease, called periodontitis, must be treated by a dentist. If not treated, this infection can lead to sore, bleeding gums, painful chewing problems, and even tooth loss.

To prevent gum disease:

• Brush your teeth twice a day with fluoride toothpaste.
• Floss regularly.
• Visit your dentist routinely for a checkup and cleaning. Tell the dentist about any medical conditions you have and medications you take.
• Eat a well-balanced diet.
• Quit smoking. Smoking increases your risk for gum disease.

How to Clean Your Teeth and Gums

There is a right way to brush and floss your teeth. Every day:

• Gently brush your teeth on all sides with a soft-bristle brush and fluoride toothpaste. Replace your toothbrush every 3 to 4 months.
• Use small circular motions and short back-and-forth strokes.
• Brush carefully and gently along your gum line.
• Lightly brush your tongue or use a tongue scraper to help keep your mouth clean.
• Clean between your teeth with dental floss, prethreaded flossers, a water flosser, or a similar product. This removes plaque and leftover food that a toothbrush can't reach.
• Rinse after you floss.

People with arthritis or other conditions that limit hand motion may find it hard to hold and use a toothbrush. Some helpful tips are:

• Use an electric or battery-operated toothbrush.
• Buy a toothbrush with a larger handle.
• Attach the toothbrush handle to your hand with a wide elastic band.

See your dentist if brushing or flossing causes your gums to bleed or hurts your mouth. If you have trouble flossing, a floss holder may help. Ask your dentist to show you the right way to floss.

Dentures

Sometimes, false teeth (dentures) are needed to replace badly damaged teeth or teeth lost because of gum disease. Partial dentures may be used to fill in one or more missing teeth. Dentures may feel strange at first. In the beginning, your dentist may want to see you often to make sure the dentures fit. Over time, your gums will change shape, and your dentures may need to be adjusted or replaced. Be sure to let your dentist handle these adjustments.

Be careful when wearing dentures because it may be harder for you to feel hot foods and drinks or notice bones in your food. When learning to eat with dentures, it may be easier if you:

• Start with soft, non-sticky food.
• Cut your food into small pieces.
• Chew slowly using both sides of your mouth.

Keep your dentures clean and free from food that can cause stains or bad breath. Avoid small crunchy foods that can get trapped under the dentures and hurt your gums. Brush dentures every day with a denture-care product, and soak them in water or a denture-cleansing liquid at night. Be sure to leave them out of your mouth while you sleep to prevent swollen gums.

Dry Mouth

Dry mouth happens when you don't have enough saliva, or spit, to keep your mouth wet. It can make it hard to eat, swallow, taste, and even speak. Dry mouth can increase your risk of tooth decay, fungal infections of the mouth, and cavities. Many common medicines can cause this problem. For example, medicines for high blood pressure, depression, and bladder-control issues often cause dry mouth.

There are things you can do that may help. Try sipping water or sugarless drinks. Don't smoke, and avoid alcohol, caffeine, soft drinks, and acidic fruit juices. Avoid spicy or salty foods. Sugarless hard candy or sugarless gum that is a little tart may help. Your dentist or doctor might suggest using artificial saliva to keep your mouth wet.

Oral Cancer

Oral cancer can start in any part of the mouth or throat, including the tongue. It is more likely to happen in people over age 40. A dental checkup is a good time for your dentist to look for signs of oral cancer. Pain is not usually an early symptom of the disease. Treatment works best before the disease spreads. Even if you have lost all your natural teeth, you should still see your dentist for regular oral cancer exams.

You can lower your risk of getting oral cancer in a few ways:

• Do not use tobacco products, such as cigarettes, chewing tobacco, snuff, pipes, or cigars.
• If you drink alcohol, do so only in moderation.
• Use lip balm with sunscreen.
• Electronic cigarettes (e-cigarettes) are relatively new, and scientists are still learning about their long-term health effects. However, we do know e-cigarette vapor contains cancer-causing chemicals.

All systems in the body accumulate subtle and some not-so-subtle changes as a person ages. Among these changes are reductions in cell division, metabolic activity, blood circulation, hormonal levels, and muscle strength. In the skin, these changes are reflected in decreased mitosis in the stratum basale, leading to a thinner epidermis. The dermis, which is responsible for the elasticity and resilience of the skin, exhibits a reduced ability to regenerate, which leads to slower wound healing. The hypodermis, with its fat stores, loses structure due to the reduction and redistribution of fat, which in turn contributes to the thinning and sagging of skin.

The accessory structures also have lowered activity, generating thinner hair and nails, and reduced amounts of sebum and sweat. A reduced sweating ability can cause some elderly to be intolerant to extreme heat. Other cells in the skin, such as melanocytes and dendritic cells, also become less active, leading to a paler skin tone and lowered immunity. Wrinkling of the skin occurs due to breakdown of its structure, which results from decreased collagen and elastin production in the dermis, weakening of muscles lying under the skin, and the inability of the skin to retain adequate moisture.

Many anti-aging products can be found in stores today. In general, these products try to rehydrate the skin and thereby fill out the wrinkles, and some stimulate skin growth using hormones and growth factors. Additionally, invasive techniques include collagen injections to plump the tissue and injections of BOTOX^® (the name brand of the botulinum neurotoxin) that paralyze the muscles that crease the skin and cause wrinkling.

Vision problems are often considered a normal part of aging, but they don’t have to be.

US adults aged 40 and older are at greatest risk for eye diseases. About 6.5 million in that age group have vision impairment, including nearly 1 million who are blind. This number is expected to double in the coming years as the US population ages.

Regular dilated eye exams are key to early detection and treatment to improve and preserve your vision now and in the future.

Age-Related Eye Diseases

Some vision impairment, such as refractive errors (problems with focus), are a normal part of aging. Presbyopia, or nearsightedness, is a common refractive error that affects older adults, usually starting around age 45. Presbyopia makes it hard to focus up close but can easily be corrected with glasses or contact lenses.

The major causes of vision impairment and blindness in older adults are age-related eye diseasesexternal icon such as glaucoma, cataracts, and age-related macular degeneration (AMD). Your risk for developing age-related eye diseases significantly increases after age 65.

• Glaucoma—a group of diseases that damages a nerve in the back of your eye called the optic nerve. Glaucoma can affect one or both of your eyes.
• Cataracts—a clouding of your eye’s lens that affects over 24 million people in the United States.
• AMD—a slow breakdown of the light-sensitive tissue in your eye, causing loss of your central vision.

The most common cause of vision impairment among adults over 40 is diabetic retinopathy—a common complication of diabetes. One in three adults over 40 with diabetes will develop diabetic retinopathy. If you have diabetes, understand your risk and learn how to protect your vision and eye health.

Finding and treating these eye problems early is important to preventing vision impairment.

Aging and Vision Impairment Risks

Chronic health conditions like diabetes, heart disease, and arthritis are more common among older people with vision impairment than those without it.

Older adults with vision impairment also have a higher risk for:

• Falls and injuries.
• Social isolation.
• Depression.
• Reduced quality of life and daily functioning.
• Trouble following instructions related to health and medicines.

Thinking of your vision health as a part of your overall health can help you take steps to prevent these related problems.

Low Vision and Aging

Low vision is a problem that makes it hard to do everyday activities. It can’t be fixed with glasses, contact lenses, or other standard treatments like medicine or surgery. You may have low vision if you can’t see well enough to do things like:

• Read.
• Drive.
• Recognize people’s faces.
• Tell colors apart.
• See your television or computer screen clearly.

Aging does not cause low vision on its own, but the condition is more common in people over 50.

If you have low vision, ask your eye doctor about vision rehabilitation services and devices that can help you make the most of your eyesight. You can also seek out reurces for low vision in your area to help you manage your vision loss.

What You Can Do

Follow these simple steps to reduce your risk for vision impairment:

• Get a regular eye exam for early detection and treatment of eye problems.
• Eat a healthy diet that includes dark leafy greens like spinach, kale, and collard greens, which are high in antioxidants.
• Quit smoking or don’t start—an important way to prevent AMD and other common eye diseases.
• Know your family history. Some eye diseases run in families, and early treatment is often the most effecti

Many people want and need to be close to others as they grow older. For some, this includes the desire to continue an active, satisfying sex life. With aging, that may mean adapting sexual activity to accommodate physical, health, and other changes.

There are many different ways to have sex and be intimate—alone or with a partner. The expression of your sexuality could include many types of touch or stimulation. Some adults may choose not to engage in sexual activity, and that’s also normal.

Here, we explore some of the common problems older adults may face with sex.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes sometimes affect the ability to have and enjoy sex.

A woman may notice changes in her vagina. As a woman ages, her vagina can shorten and narrow. Her vaginal walls can become thinner and a little stiffer. Most women will have less vaginal lubrication, and it may take more time for the vagina to naturally lubricate itself. These changes could make certain types of sexual activity, such as vaginal penetration, painful or less desirable. If vaginal dryness is an issue, using water-based lubricating jelly or lubricated condoms may be more comfortable. If a woman is using hormone therapy to treat hot flashes or other menopausal symptoms, she may want to have sex more often than she did before hormone therapy.

As men get older, impotence (also called erectile dysfunction, or ED) becomes more common. ED is the loss of ability to have and keep an erection. ED may cause a man to take longer to have an erection. His erection may not be as firm or as large as it used to be. The loss of erection after orgasm may happen more quickly, or it may take longer before another erection is possible. ED is not a problem if it happens every now and then, but if it occurs often, talk with your doctor.

Talk with your partner about these changes and how you are feeling. Your doctor may have suggestions to help make sex easier.

What Causes Sexual Problems?

Some illnesses, disabilities, medicines, and surgeries can affect your ability to have and enjoy sex.

Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable. Exercise, drugs, and possibly joint replacement surgery may help relieve this pain. Rest, warm baths, and changing the position or timing of sexual activity can be helpful.

Chronic pain. Pain can interfere with intimacy between older people. Chronic pain does not have to be part of growing older and can often be treated. But, some pain medicines can interfere with sexual function. Always talk with your doctor if you have side effects from any medication.

Dementia. Some people with dementia show increased interest in sex and physical closeness, but they may not be able to judge what is appropriate sexual behavior. Those with severe dementia may not recognize their spouse or partner, but they still desire sexual contact and may seek it with someone else. It can be confusing and difficult to know how to handle this situation. Here, too, talking with a doctor, nurse, or social worker with training in dementia care may be helpful.

Diabetes. This is one of the illnesses that can cause ED in some men. In most cases, medical treatment can help. Less is known about how diabetes affects sexuality in older women. Women with diabetes are more likely to have vaginal yeast infections, which can cause itching and irritation and make sex uncomfortable or undesirable. Yeast infections can be treated.

Heart disease. Narrowing and hardening of the arteries can change blood vessels so that blood does not flow freely. As a result, men and women may have problems with orgasms. For both men and women, it may take longer to become aroused, and for some men, it may be difficult to have or maintain an erection. People who have had a heart attack, or their partners, may be afraid that having sex will cause another attack. Even though sexual activity is generally safe, always follow your doctor’s advice. If your heart problems get worse and you have chest pain or shortness of breath even while resting, your doctor may want to change your treatment plan.

Incontinence. Loss of bladder control or leaking of urine is more common as people, especially women, grow older. Extra pressure on the belly during sex can cause loss of urine. This can be helped by changing positions or by emptying the bladder before and after sex. The good news is that incontinence can usually be treated.

Stroke. The ability to have sex is sometimes affected by a stroke. A change in positions or medical devices may help people with ongoing weakness or paralysis to have sex. Some people with paralysis from the waist down are still able to experience orgasm and pleasure.

Depression. Lack of interest in activities you used to enjoy, such as intimacy and sexual activity, can be a symptom of depression. It’s sometimes hard to know if you’re depressed. Talk with your doctor. Depression can be treated.

Surgery. Many of us worry about having any kind of surgery—it may be even more troubling when the breasts or genital area are involved. Most people do return to the kind of sex life they enjoyed before surgery.

Hysterectomy is surgery to remove a woman’s uterus because of pain, bleeding, fibroids, or other reasons. Often, when an older woman has a hysterectomy, the ovaries are also removed. Deciding whether to have this surgery can leave both women and their partners worried about their future sex life. If you’re concerned about any changes you might experience with a hysterectomy, talk with your gynecologist or surgeon.

Mastectomy is surgery to remove all or part of a woman’s breast because of breast cancer. This surgery may cause some women to lose their sexual interest, or it may leave them feeling less desirable or attractive to their partners. In addition to talking with your doctor, sometimes it is useful to talk with other women who have had this surgery. Programs like the American Cancer Society’s “Reach to Recovery” can be helpful for both women and men. If you want your breast rebuilt (reconstruction), talk to your cancer doctor or surgeon.

Prostatectomy is surgery that removes all or part of a man’s prostate because of cancer or an enlarged prostate. It may cause urinary incontinence or ED. If you need this operation, talk with your doctor before surgery about your concerns.

Medications. Some drugs can cause sexual problems. These include some blood pressure medicines, antihistamines, antidepressants, tranquilizers, Parkinson’s disease or cancer medications, appetite suppressants, drugs for mental problems, and ulcer drugs. Some can lead to ED or make it hard for men to ejaculate. Some drugs can reduce a woman’s sexual desire or cause vaginal dryness or difficulty with arousal and orgasm. Check with your doctor to see if there is a different drug without this side effect.

Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.

Am I Too Old to Worry About Safe Sex?

Age does not protect you from sexually transmitted diseases. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.

Almost anyone who is sexually active is also at risk of being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. You are at risk for HIV/AIDS if you or your partner has more than one sexual partner, if you are having unprotected sex, or if either you or your partner is sharing needles. To protect yourself, always use a condom during sex that involves vaginal or anal penetration.

A man needs to have a full erection before putting on a condom.

Talk with your doctor about ways to protect yourself from all sexually transmitted diseases and infections. Go for regular checkups and testing. Talk with your partner. You are never too old to be at risk.

Can Emotions Play a Part?

Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do and what you want to do. Many older couples find greater satisfaction in their sex lives than they did when they were younger. In many cases, they have fewer distractions, more time and privacy, no worries about getting pregnant, and greater intimacy with a lifelong partner.

As we age, our bodies change, including our weight, skin, and muscle tone, and some older adults don’t feel as comfortable in their aging bodies. Older adults, men and women alike, may worry that their partners will no longer find them attractive. Aging-related sexual problems like the ones listed above can cause stress and worry. This worry can get in the way of enjoying a fulfilling sex life.

Older couples face the same daily stresses that affect people of any age. They may also have the added concerns of illness, retirement, and lifestyle changes, all of which may lead to sexual difficulties. Talk openly with your partner, and try not to blame yourself or your partner. You may also find it helpful to talk with a therapist, either alone or with your partner. Some therapists have special training in helping with sexual problems. If you sense changes in your partner’s attitude toward sex, don’t assume they are no longer interested in you or in an active sex life. Talk about it. Many of the things that cause sexual problems in older adults can be helped.

What Can I Do?

There are things you can do on your own for an active and enjoyable sex life. If you have a long-term partner, take time to enjoy each other and to understand the changes you both are facing.

Don’t be afraid to talk with your doctor if you have a problem that affects your sex life. He or she may be able to suggest a treatment. For example, the most common sexual difficulty of older women is painful intercourse caused by vaginal dryness. Your doctor or a pharmacist can suggest over-the-counter vaginal lubricants or moisturizers to use. Water-based lubricants are helpful when needed to make sex more comfortable. Moisturizers are used on a regular basis, every 2 or 3 days. Or, your doctor might suggest a form of vaginal estrogen.

If ED is the problem, it can often be managed and perhaps even reversed with medication or other treatments. There are pills that can help. They should not be used by men taking medicines containing nitrates, such as nitroglycerin. The pills do have possible side effects. Be wary of any dietary or herbal supplements promising to treat ED. Always talk to your doctor before taking any herb or supplement.

Physical problems can change your sex life as you get older. If you are single, dating and meeting new people may be easier later in life when you’re more sure of yourself and what you want. If you’re in a relationship, you and your partner may discover new ways to be together as you get older. Talk to your partner or partners about your needs. You may find that affection—hugging, kissing, touching, and spending time together—can be just what you need, or a path to greater intimacy and sex.

Many older adults are turning to complementary and integrative health approaches to promote health and well-being. Mind and body practices, in particular, including relaxation techniques and meditative exercise forms such as yoga, tai chi, and qi gong are being used by older Americans, both for fitness and relaxation, and because of perceived health benefits. A number of reviews of the scientific literature point to the potential benefit of mind and body approaches for symptom management, particularly for pain. Check out what the science says about mind and body practices for these 4 common aging-related conditions:

1. Osteoarthritis. Practicing tai chi—a traditional Chinese form of exercise—may be helpful for managing osteoarthritis of the knee. Guidelines issued by the American College of Rheumatology conditionally recommend tai chi, along with other non-drug approaches, for this condition.

2. Menopausal symptoms. Overall, there is scientific evidence suggesting that some mind and body approaches, such as yoga, tai chi, and meditation may provide some relief from common menopausal symptoms.

3. Sleep problems. Using relaxation techniques, (e.g., progressive relaxation, guided imagery, biofeedback, self-hypnosis, and deep breathing exercises) before bedtime can be helpful components of a successful sleep regimen.

4. Shingles. Tai chi may help older adults avoid getting shingles by increasing immunity to varicella-zoster virus and boosting the immune response to varicella vaccine in older people. While there have only been a few studies on the effects of tai chi on immunity to varicella, the results so far have been promising.

These mind and body practices are generally considered safe for healthy people when they’re performed appropriately. If you have any health problems, talk with both your health care provider and the complementary health practitioner/instructor before starting to use a mind and body practice. For information about natural products for common aging-related conditions, check out these tips.

Some people love it, some people hate it, but regardless of your personal feelings, exercise and physical activity are good for you—period. In fact, exercise and physical activity are considered a cornerstone of almost every healthy aging program. Scientific evidence suggests that people who exercise regularly not only live longer, they live better. And, being physically active—doing everyday activities that keep your body moving, such as gardening, walking the dog, and taking the stairs instead of the elevator—can help you continue to do the things you enjoy and stay independent as you age.

Specifically, regular exercise and physical activity can reduce your risk of developing some diseases and disabilities that often occur with aging. For instance, balance exercises help prevent falls, a major cause of disability in older adults. Strength exercises build muscles and reduce the risk of osteoporosis. Flexibility or stretching exercises help keep your body limber and give you the freedom of movement you need to do everyday activities.

Exercise may even be an effective treatment for certain chronic conditions. People with arthritis, high blood pressure, or diabetes can benefit from regular exercise. Heart disease, a problem for many older adults, may also be alleviated by exercise. Scientists have long known that regular exercise causes certain changes in the hearts of younger people. These changes, which include lowering resting heart rate and increasing stroke volume (the amount of blood pumped with each heartbeat), make the heart a better pump.

Evidence now suggests that people who begin exercise training in later life, for instance in their 60s and 70s, can also experience improved heart function. In one study, researchers with the Baltimore Longitudinal Study of Aging (BLSA) observed a decreased risk of a coronary event, like a heart attack, in older male BLSA participants who took part in high-intensity, leisure-time physical activities like lap swimming or running.

In addition to benefits for the heart, studies show that exercise helps breathlessness and fatigue in older people. Endurance exercises—activities that increase your breathing and heart rate, such as dancing, walking, swimming, or bicycling—increase your stamina and improve the health of your lungs and circulatory system as well as your heart.

There are many ways to be active. You can be active in short spurts throughout the day, or you can set aside specific times of the day or specific days of the week to exercise. Many physical activities, such as brisk walking or raking leaves, are free or low-cost and do not require special equipment.

Weight is a very complex issue. For older people, the health problems associated with obesity may take a back seat to problems associated with body composition (fat-to-muscle ratio) and location of fat (hip or waist) on the body.

Many health problems are connected to being overweight or obese. People who are overweight or obese are at greater risk for type 2 diabetes, high blood pressure, heart disease, stroke, some types of cancer, sleep apnea, and osteoarthritis. But data show that for older adults, thinner is not always healthier, either. In one study, researchers found that older adults who are thin (a body-mass index or BMI of less than 19) have a higher mortality rate compared with those who are obese or of normal weight. In another study, women with low BMI had an increased risk of mortality. Being, or becoming, thin as an older adult can be a symptom of disease or an indication of developing frailty. Those are possible reasons why some scientists think maintaining a higher BMI may not necessarily be bad as we age.

Body-fat distribution, specifically waist circumference and waist-to-hip ratio, can also be a serious problem for older adults. We know that the "pear" shape, with body fat in peripheral areas such as the hips and thighs, is generally healthier than the "apple" shape, with fat around the waist. Being apple-shaped can increase risk for heart disease and possibly breast cancer. With age, the pattern for body fat can shift from safer peripheral areas to the abdominal area of the body. BLSA researchers examined 547 men and women over a 5-year period to observe body measurement changes. They found that men predominantly shifted in waist size, while women showed nearly equal changes in waist and hip measurements. The men developed a more dangerous body-fat distribution, even though women carried more total body fat. This may help explain why men generally have a higher incidence of certain diseases and a shorter lifespan.

So, is there a "normal" weight range or pattern for healthy aging? For older adults, one size does not fit all. Although we have learned a lot about patterns of weight and aging, watching your weight as you age is very much an individual matter. Talk with your doctor about any weight concerns, including decisions to lose weight or any unexplained weight changes.

Food has been shown to be an important part of how people age. In one study, scientists investigated how dietary patterns influenced changes in BMI and waist circumference, which are risk factors for many diseases. Scientists grouped participants into clusters based on which foods contributed to the greatest proportion of calories they consumed. Participants who had a "meat and potatoes" eating pattern had a greater annual increase in BMI, and participants in the "white-bread" pattern had a greater increase in waist circumference compared with those in the "healthy" cluster. "Healthy" eaters had the highest intake of foods like high-fiber cereal, low-fat dairy, fruit, nonwhite bread, whole grains, beans and legumes, and vegetables, and low intake of red and processed meat, fast food, and soda. This same group had the smallest gains in BMI and waist circumference.

Scientists think there are likely many factors that contribute to the relationship between diet and changes in BMI and waist circumference. One factor may involve the glycemic index value (sometimes called glycemic load) of food. Foods with a low glycemic index value (such as most vegetables and fruits and high-fiber, grainy breads) decrease hunger but have little effect on blood sugar and therefore are healthier. Foods like white bread have a high glycemic index value and tend to cause the highest rise in blood sugar.

Another focus of research is the relationship between physical problems and micronutrient or vitamin deficiency. Low concentrations of micronutrients or vitamins in the blood are often caused by poor nutrition. Not eating enough fruits and vegetables can lead to a low carotenoid concentration, which is associated with a heightened risk of skeletal muscle decline among older adults. Low concentrations of vitamin E in older adults, especially in older women, is correlated with a decline in physical function. Compared with other older adults, those with low vitamin D levels had poorer results on two physical performance tests. Women with a low vitamin D concentration were more likely to experience back pain. These studies support the takeaway message: the nutrients you get from eating well can help keep muscles, bones, organs, and other parts of the body strong throughout life.

So, eating well is not just about your weight. It can also help protect you from certain health problems that occur more frequently among older adults. And, eating unhealthy foods can increase your risk for some diseases. If you are concerned about what you eat, talk with your doctor about ways you can make better food choices.

As you age, you may notice you have less muscle and energy and more fat. Carrying those extra pounds may be harming your health. It’s easy to be confused by advice about diet and exercise, but they’re key to avoiding weight gain as you get older. As you move through your 30s, 40s, 50s, and beyond, you can take steps to help fight the flab that can come with age.

Your metabolism changes as you get older. You burn fewer calories and break down foods differently. You also lose lean muscle. Unless you exercise more and adjust your diet, the pounds can add up. Middle-age spread can quickly become middle-age sprawl.

“At some point, everyone loses muscle mass as they get older and gains abdominal fat,” says NIH’s Dr. Mark Mattson, an expert on aging and exercise. The so-called couch-potato lifestyle is the main culprit behind middle-age spread. “Over-eating and leading a sedentary lifestyle can speed up age-related changes in metabolism,” Mattson says.

One key player in age-related changes is a chemical called leptin, which helps your brain tell you to stop eating. Leptin signals don’t work as well as you get older, so you might continue to feel hungry even after you’ve eaten. Obesity makes leptin even less effective.

“There’s a reward part to everything you eat,” says Dr. Josephine M. Egan, an NIH expert on diabetes and aging. “You get the taste of the food. You feel good. Normal-weight people will satisfy cravings by having a small amount of what they crave.” As both the years and the pounds add up, however, you may need to eat more of what you crave to get the same pleasant sensation.

Both aging and obesity can also bring changes to the way your body processes glucose—the sugar your body makes from food and uses for energy. These changes can lead to diabetes, which raises your risk for heart disease, blindness, amputations, and other conditions.

“Obesity increases the risk, and reduces the age of onset, for many diseases of aging,” Mattson says. “Over the long-term, even our brains are affected. Emerging evidence suggests that long-standing diabetes and obesity can lead to changes in brain cells that make them vulnerable to aging.”

As you move beyond your 50s, you’ll probably need fewer calories. But it’s also important to maintain proper nutrition, so don’t skimp on healthy foods. Weighing too little and weighing too much are each linked to poor health, especially in older people.

Exercise and moving are also important. “It doesn’t matter what your age is; physical activity is good for you,” says Egan. Be sure to talk with your health care provider about safe ways to adjust your activity patterns as you get older. If you have a specific health issue that you’re concerned about—such as arthritis or a recent surgery—ask for tips to help you exercise safely. Work together to choose activities that are best for you.

Focusing on physical activity and healthy eating are the keys to avoiding middle-age spread and the health problems that can come with it.

Small Steps to Healthy Aging

• Commit to a healthy diet.
• Limit snacking.
• Drink plenty of water.
• Move more. Take the stairs and add walking breaks to your day.
• Get plenty of sleep.
• Limit alcohol use. Alcohol is high in calories and may worsen health conditions common among older adults.
• Avoid tobacco products.

Sure, engaging in your favorite activities can be fun or relaxing, but did you know that doing what you like to do may actually be good for your health? It's true. Research studies show that people who are sociable, generous, and goal-oriented report higher levels of happiness and lower levels of depression than other people.

People who are involved in hobbies and social and leisure activities may be at lower risk for some health problems. For example, one study followed participants for up to 21 years and linked leisure activities like reading, playing board games, playing musical instruments, and dancing with a lower risk for dementia. In another study, older adults who participated in social activities (for example, played games, belonged to social groups, attended local events, or traveled) or productive activities (for example, had paid or unpaid jobs, cooked, or gardened) lived longer than people who did not report taking part in these types of activities.

Other studies have found that older adults who participate in what they see as meaningful activities, like volunteering in their community, reported feeling healthier and happier.

Keeping Engaged Socially is good for your health!

We are not talking about your marital status. We mean, do you participate in activities that connect you with other people? As people get older, their social lives oftentimes slow down for a variety of reasons. When it is unwanted, this can lead to loneliness and isolation. Research has shown that for older adults, staying engaged in enjoyable activities is associated with better physical and mental health. As we age, being involved with others is strongly associated with better brain function. So it is not only fun, it is good for you! You might not have ever imagined that while you were singing in the church choir, or meeting with your book club, or volunteering at the animal shelter that you were actually improving your brain health!

In addition, research has shown that learning a new activity for older people can provide some “insurance” against memory loss. However, it cannot prevent progressive diseases like Alzheimer’s and other dementias.

There are many ways to get involved in your local community. Some to consider include:

Go back to school—audit a class at a local college or take a class related to a hobby.

• Participate in sports—whether tai chi or tennis, there’s something for every interest and ability.
• Head outdoors—join a walking, hiking, or bird watching group.
• Make music—join a choir or band or take lessons.
• Get involved—participate with a church, temple, or other religious organization.
• Read, join, participate, or start a book club.
• Volunteer for a cause or group you’re passionate about.
• Take classes at a gym.
• Find (or start!) a group that fits your passion —whether it’s knitting or carpentry.
• Indulge your creativity —stage a play with friends, create a themed-dining dinner club, or take an art class.

"The stairs are getting so hard to climb.

"Since my wife died, I just open a can of soup for dinner.

"I've lived here 40 years. No other place will seem like home.

These are common issues for older people. You may share the often-heard wish—"I want to stay in my own home!" The good news is that with the right help you might be able to do just that. Staying in your own home as you get older is called "aging in place." This article contains suggestions to help you find the help you need to continue to live independently.

How to plan ahead to age in place

Planning ahead is hard because you never know how your needs might change. The first step is to think about the kinds of help you might want in the near future. Maybe you live alone, so there is no one living in your home who is available to help you. Maybe you don't need help right now, but you live with a spouse or family member who does. Everyone has a different situation.

One way to begin planning is to look at any illnesses, like diabetes or emphysema, that you or your spouse might have. Talk with your doctor about how these health problems could make it hard for someone to get around or take care of him- or herself in the future. If you're a caregiver for an older adult, learn how you can get them the support they need to stay in their own home.

What support can help me age at home?

You can get almost any type of help you want in your home — often for a cost. You can get more information on many of the services listed here from your local Area Agency on Aging, local and state offices on aging or social services, tribal organization, or nearby senior center.

Personal care. Is bathing, washing your hair, or dressing getting harder to do? Maybe a relative or friend could help. Or, you could hire a trained aide for a short time each day.

Household chores. Do you need help with chores like housecleaning, yard work, grocery shopping, or laundry? Some grocery stores and drug stores will take your order over the phone and bring the items to your home. There are cleaning and yard services you can hire, or maybe someone you know has a housekeeper or gardener to suggest. Some housekeepers will help with laundry. Some drycleaners will pick up and deliver your clothes.

Meals. Worried that you might not be eating nutritious meals or tired of eating alone? Sometimes you could share cooking with a friend or have a potluck dinner with a group of friends. Find out if meals are served at a nearby senior center or house of worship. Eating out may give you a chance to visit with others. Is it hard for you to get out? Ask someone to bring you a healthy meal a few times a week. Meal delivery programs bring hot meals into your home; some of these programs are free or low-cost.

Money management. Do you worry about paying bills late or not at all? Are health insurance forms confusing? Maybe you can get help with these tasks. Ask a trusted relative to lend a hand. Volunteers, financial counselors, or geriatric care managers can also help. Just make sure you get the referral from a trustworthy source, like your local Area Agency on Aging. If you use a computer, you could pay your bills online. Check with your bank about this option. Some people have regular bills, like utilities and rent or mortgage, paid automatically from their checking account.

Be careful to avoid money scams. Never give your Social Security number, bank or credit card numbers, or other sensitive information to someone on the phone (unless you placed the call) or in response to an email. Always check all bills, including utility bills, for charges you do not recognize.

Even though you might not need it now, think about giving someone you trust permission to discuss your bills with creditors or your Social Security or Medicare benefits with those agencies. Learn more about legal and financial planning for older adults.

Health care. Do you forget to take your medicine? There are devices available to remind you when it is time for your next dose. Special pill boxes allow you or someone else to set out your pills for an entire week. Have you just gotten out of the hospital and still need nursing care at home for a short time? The hospital discharge planner can help you make arrangements, and Medicare might pay for a home health aide to come to your home.

If you can't remember what the doctor told you to do, try to have someone go to your doctor visits with you. Ask them to write down everything you are supposed to do or, if you are by yourself, ask the doctor to put all recommendations in writing.

Common concerns about aging in place

If staying in your home is important to you, you may still have concerns about safety, getting around, or other activities of daily life. Find suggestions below to help you think about some of these worries.

Getting around — at home and in town. Are you having trouble walking? Perhaps a walker would help. If you need more, think about getting an electric chair or scooter. These are sometimes covered by Medicare. Do you need someone to go with you to the doctor or shopping? Volunteer escort services may be available. If you are no longer driving a car, find out if there are free or low-cost public transportation and taxis in your area. Maybe a relative, friend, or neighbor would take you along when they go on errands or do yours for you. To learn about resources in your community, contact Eldercare Locator at 800-677-1116 (toll-free) or https://eldercare.acl.gov.

Finding activities and friends. Are you bored staying at home? Your local senior center offers a variety of activities. You might see friends there and meet new people too. Is it hard for you to leave your home? Maybe you would enjoy visits from someone. Volunteers are sometimes available to stop by or call once a week. They can just keep you company, or you can talk about any problems you are having. Call your local Area Agency on Aging to see if they are available near you.

Safety concerns. Are you worried about crime in your neighborhood, physical abuse, or losing money as a result of a scam? Talk to the staff at your local Area Agency on Aging. If you live alone, are you afraid of becoming sick with no one around to help? You might want to get an emergency alert system. You just push a special button that you wear, and emergency medical personnel are called. There is typically a monthly fee for this service.

Housing concerns. Would a few changes make your home easier and safer to live in? Think about things like a ramp at the front door, grab bars in the tub or shower, nonskid floors, more comfortable handles on doors or faucets, and better insulation. Sound expensive? You might be able to get help paying for these changes. Check with your local Area Agency on Aging, state housing finance agency, welfare department, community development groups, or the federal government.

Getting help during the day. Do you need care but live with someone who can't stay with you during the day? For example, maybe they work. Adult day care outside the home is sometimes available for older people who need help caring for themselves. The day care center can pick you up and bring you home. If your caretaker needs to get away overnight, there are places that provide temporary respite care.

Resources to help you age in place

Here are some resources to start with:

Reach out to people you know. Family, friends, and neighbors are the biggest source of help for many older people. Talk with those close to you about the best way to get what you need. If you are physically able, think about trading services with a friend or neighbor. One could do the grocery shopping, and the other could cook dinner, for example.

Learn about community and local government resources. Learn about the services in your community. Health care providers and social workers may have suggestions. The local Area Agency on Aging, local and state offices on aging or social services, and your tribal organization may have lists of services. If you belong to a religious group, talk with the clergy, or check with its local office about any senior services they offer.

Talk to geriatric care managers. These specially trained professionals can help find resources to make your daily life easier. They will work with you to form a long-term care plan and find the services you need. Geriatric care managers can be helpful when family members live far apart. Learn more about geriatric care managers.

Look into Federal Government sources. The federal government offers many resources for seniors. Longtermcare.gov, from the Administration for Community Living, is a good place to start.

How much will it cost to age in place?

An important part of planning is thinking about how you are going to pay for the help you need. Some things you want may cost a lot. Others may be free. Some might be covered by Medicare or other health insurance. Some may not. Check with your insurance provider(s). It's possible that paying for a few services out of pocket could cost less than moving into an independent living, assisted living, or long-term care facility. And you will have your wish of still living on your own. Resources like Benefits.gov and BenefitsCheckUp® can help you find out about possible benefits you might qualify for.

Are you eligible for benefits from the U.S. Department of Veterans Affairs (VA)? The VA sometimes provides medical care in your home. In some areas, they offer homemaker/ home health aide services, adult day health care, and hospice. To learn more, visit www.va.gov, call the VA Health Care Benefits number, 877-222-8387 (toll-free), or contact the VA medical center nearest you.

As we grow older, we are more likely to be diagnosed with one or more chronic ailments. These ailments include life-threatening diseases such as cardiovascular disease, diabetes, and cancer, as well as debilitating conditions like arthritis, fatigue, and frailty. These ailments rob us of our quality of life. The question is: How does the aging process affect the disease process and susceptibility—and vice versa?

Over the years, researchers studying the basic science of aging have sought to answer this question, but their work was confined primarily to investigations of the specific activities and mechanisms that contribute to the aging process, and not as much on the effects of the aging process on various diseases. While aging itself isn't a disease, the aging process represents a major risk factor for several chronic diseases and conditions, including frailty and lack of resilience.

Geroscience takes a different approach, seeking to understand the genetic, molecular, and cellular mechanisms that make aging a major risk factor and driver of common chronic conditions and diseases of older people.

Future research directions

People are living longer today because of progress in medical care. But many people suffer from debilitating conditions because research has focused on curing life-threatening diseases such as cancer and cardiovascular disease. For the growing population of older adults, geroscience may provide novel preventive or diagnostic measures that can reduce the burden of age-related disease and disability.

Resilience at the molecular, cellular, and systems levels is one key to these types of studies. Some diseases can speed the loss of function and resilience associated with aging, leading to increased susceptibility to further disease and disability. By exploring accurate and predictive measurements of resilience, researchers hope to discover how these measures can be adapted to benefit people.

Investigators also seek to determine how particular chronic diseases affect not only the primary organ involved in a disease, but also, how additional organs and systems may be impaired. In Alzheimer's disease, for example, studies focus on what happens in the brain—the primary affected organ—while researchers also look at the bones, vascular system, and overall metabolism. Such studies provide a more holistic view of individual diseases and conditions, which could lead to interventions on a number of levels. For any chronic disease or lost function that increases with age, geroscience proposes that slowing the rate of aging will improve health.

The ultimate goal of geroscience is to accelerate research into the basic mechanisms driving aging, which could lead to improved clinical interventions. Toward that goal, the GSIG remains focused on discovering the basic biology at the intersection among aging, chronic disease, frailty, and resilience. Basic biology renders the process of aging the major risk factor for the age-related decline in health, threatening an increasingly older population.

Want the secret to living a longer and healthier life? Scientists have found ways to prolong the healthy lifespans of worms, mice, and even monkeys. Their work has revealed exciting new clues about the biology of aging. But solid evidence still shows that the best way to boost the chance of living a long and active life is to follow the advice you likely heard from your parents: eat well, exercise regularly, get plenty of sleep, and stay away from bad habits.

People born in the U.S. today can expect to live to an average age of about 79. A century ago, life expectancy was closer to 54. “We’ve had a significant increase in lifespan over the last century,” says Dr. Marie Bernard, deputy director of NIH’s National Institute on Aging. “Now if you make it to age 65, the likelihood that you’ll make it to 85 is very high. And if you make it to 85, the likelihood that you’ll make it to 92 is very high. So people are living longer, and it’s happening across the globe.”

Older people tend to be healthier nowadays, too. Research has shown that healthful behaviors can help you stay active and healthy into your 60s, 70s, and beyond. In fact, a long-term study of Seventh-day Adventists—a religious group with a generally healthy lifestyle—shows that they tend to remain healthier into old age. Their life expectancy is nearly 10 years longer on average than most Americans. The Adventists’ age-enhancing behaviors include regular exercise, a vegetarian diet, avoiding tobacco and alcohol, and maintaining a healthy weight.

“If I had to rank behaviors in terms of priority, I’d say that exercise is the most important thing associated with living longer and healthier,” says Dr. Luigi Ferrucci, an NIH geriatrician who oversees research on aging and health. “Exercise is especially important for lengthening active life expectancy, which is life without disease and without physical and mental/thinking disability.”

Natural changes to the body as we age can lead to a gradual loss of muscle, reduced energy, and achy joints. These changes may make it tempting to move less and sit more. But doing that can raise your risk for disease, disability, and even death. It’s important to work with a doctor to find the types of physical activity that can help you maintain your health and mobility.

Even frail older adults can benefit from regular physical activity. One NIH-funded study included over 600 adults, ages 70 to 89, who were at risk for disability. They were randomly placed in either a moderate exercise program or a comparison group without structured exercise. The exercise group gradually worked up to 150 minutes of weekly activity. This included brisk walking, strength and balance training, and flexibility exercises.

“After more than 2 years, the physical activity group had less disability, and if they became disabled, they were disabled for a shorter time than those in the comparison group,” Bernard explains. “The combination of different types of exercise—aerobic, strength and balance training, and flexibility—is important to healthy aging.” NIH’s Go4Life website has tips to help older adults get and stay active.

Another sure way to improve your chances for a longer, healthier life is to shed excess weight. “Being obese—with a body mass index (BMI) higher than 30—is a risk factor for early death, and it shortens your active life expectancy,” Ferrucci says. BMI is an estimate of your body fat based on your weight and height. Use NIH’s BMI calculator to determine your BMI. Talk with a doctor about reaching a healthy weight.

Studies in animals have found that certain types of dietary changes—such as extremely low-calorie diets—can lead to longer, healthier lives. These studies offer clues to the biological processes that affect healthy aging. But to date, calorie-restricted diets and other dietary changes have had mixed results in extending the healthy lives of people.

“We have indirect evidence that nutritional adjustments can improve active longevity in people, but this is still an area of intense research,” Ferrucci says. “So far, we don’t really have solid evidence about caloric restriction and whether it may have a positive effect on human aging.” Researchers are now studying potential drugs or other approaches that might mimic calorie restriction’s benefits.

Not smoking is another pathway to a longer, healthier life. “There’s no question that smoking is a hard habit to break. But data suggest that from the moment you stop smoking, there are health benefits. So it’s worthwhile making that effort,” Bernard says.

You might think you need good genes to live longer. But genes are only part of the equation for most of us, says Dr. Thomas Perls, an aging expert and director of the New England Centenarian Study at the Boston University School of Medicine. “Research shows that genes account for less than one-third of your chances of surviving to age 85. The vast majority of variation in how old we live to be is due to our health behaviors,” Perls says. “Our genes could get most of us close to the remarkable age of 90 if we lead a healthy lifestyle.”

The influence of genes is stronger, though, for people who live to older ages, such as beyond 95. Perls has been studying people who live to age 100 and up (centenarians) and their families to learn more about the biological, psychological, and social factors that promote healthy aging.

“It seems there’s not a single gene that imparts a strong effect on the ability to get to these older ages,” Perls says. “Instead, it’s the combined effects of probably hundreds of genes, each with weak effects individually, but having the right combination can lead to a very strong effect, especially for living to the oldest ages we study.”

It’s a good idea to be skeptical of claims for a quick fix to aging-related problems. Perls cautions against marketed “anti-aging” measures such as “hormone replacement therapy,” which has little proven benefit for healthy aging and can have severe side effects. “People used to say, ‘the older you get the sicker you get.’ But with common sense, healthy habits such as regular exercise, a healthy weight, avoiding red meat, not smoking, and managing stress, it can be ‘the older you get, the healthier you’ve been,’” Perls says.

The key to healthy aging is to engage fully in life—mentally, physically, and socially. “Transitioning to older years isn’t about sitting in a rocking chair and letting the days slip by,” Bernard says. “Older adults have unique experiences, intellectual capital, and emotional involvement that can be shared with younger generations. This engagement is really key to helping our society move forward.”

Stay Healthy at 50+

• Get moving. Exercise can reduce the risk for age-related diseases and disability.
• Eat a healthy diet.
• Pay attention to weight and shape. Extra weight, especially at the waist or with muscle loss, can raise health risks. Talk to your doctor about weight concerns.
• Don’t smoke or use tobacco.
• Keep your brain active.
• Be good to yourself. Get enough sleep. Stay in touch with family and friends. And surround yourself with people you enjoy.
• Get regular medical checkups.
• Drink only in moderation if you drink alcohol.

It’s a time to celebrate getting older, but caring for your body, mind, mental health, and relationships has health benefits no matter your age.

These science-based tips can help you stay healthy, happy, and independent for years to come.

Get moving

Physical exercise can increase mobility, help prevent falls and fractures, and reduce the risk of some diseases associated with aging. It can also give the brain a boost, which can help with tasks like processing information, learning new things, paying attention, and solving problems.

These kinds of exercise are especially important as you get older:

• Endurance and aerobic exercises such as hiking, biking, dancing, and swimming, which strengthen your heart and lungs and boost circulation
• Strength exercises such as weightlifting, resistance band workouts, and carrying groceries, which keep your muscles strong
• Balance exercises such as tai chi and standing on one foot, which help improve coordination and build strength to reduce the risk of falls and fractures
• Flexibility exercises and stretches, which can help keep you limber and protect you from injuries

Experts recommend aiming for 2.5 hours of physical exercise each week, which is only slightly more than 21 minutes per day. Get more tips for getting (and staying) physically active as you age.

Eat healthy

A diet that includes plenty of nutrients, vitamins, and minerals keeps your brain and body healthy and may reduce your risk of some aging-related diseases.

• Prioritize nutrient-rich foods such as seafood, plant-based proteins like nuts and seeds, and lean (low-fat) meats and poultry.
• Limit foods with unhealthy additives such as added sugars and saturated fats.
• Say “yes” to fruits and vegetables. Research shows that eating five servings of fruits and vegetables every day can reduce your risk of some chronic diseases.
• Watch your portion size. Keep an eye on how much you are eating and talk to your doctor about how many calories are right for you and your lifestyle.

A Mediterranean-style diet―which includes nuts, vegetables, and fish―is one example of a diet that’s good for heart health and may support the brain’s ability to think and remember.

Prioritize your physical health

Small changes add up. Start today for greater health benefits later in life.

• Drink less alcohol. Alcohol can contribute to health problems, especially as you get older. If you drink, try sticking to one drink a day or less, or stop drinking altogether.
• Prioritize sleep. Aim for seven to nine hours of sleep each night. A bedtime routine and a regular sleep schedule can help develop good sleep hygiene.
• Quit smoking and tobacco use. If you use tobacco, dropping the habit now will help you feel better right away and can add years to your life, even if you’ve been smoking for a long time.
• Keep up on your health care. Make sure to get regular checkups and stay up to date on your health screenings and vaccinations.

Care for your mental health

• Keep your stress in check. Chronic stress can damage the brain and body, including the parts of the brain involved with learning and memory. Strategies like getting regular exercise, meditating, and connecting with friends and family can help you manage stress.
• Speak up if you feel down. If you’re struggling with mental health, don’t be afraid to reach out. Help is available!

Nurture your relationships

No matter your age, feeling lonely and socially isolated can be harmful to your physical, emotional, and cognitive health. Developing and maintaining strong social ties can help you feel more engaged and connected.

Try:

• Volunteering for a local organization.
• Scheduling regular check-ins with friends and family who live far away.
• Connecting with other people in your community. Get to know your neighbors or join a local club.

Engage your mind

Exercising your brain is just as important as exercising your body. Activities that challenge your brain on a regular basis keep your mind active and healthy and may help slow cognitive decline as you get older.

Try:

• Learning something new like a new skill, language, or game.
• Getting out and about―you could visit a museum or try an exercise class.
• Spending time on your hobbies―for example, reading a book, playing the guitar, or cooking a nourishing meal.

Join a clinical study

Scientists are learning new things about the aging process and the best ways to support health, well-being, and healthy aging throughout life. Participating in a clinical research study is a great way to contribute to the scientific process and improve lives. Find out more about clinical research and how to volunteer for studies.

You can take steps to stay healthy and active as you get older. It’s important to:

• Keep your body and mind active
• Choose healthy foods
• Talk to your doctor about any health concerns you have
• Take steps to prevent falls
• Stay safe while driving

Remember, it’s never too late to make healthy changes in your life.

Stay Active

These steps can help you live a healthier life.

Keep your body active.

Staying active as you get older is one of the best things you can do for your health. Regular physical activity can help you:

• Reduce your risk for type 2 diabetes, heart disease, stroke, arthritis, osteoporosis, and some cancers
• Improve your balance and prevent falls
• Stay independent and live on your own longer
• Improve your mood and sleep
• Reduce symptoms of anxiety and depression
• Improve your ability to think, learn, and make decisions

Keep in mind that if you haven’t been active in the past, it’s not too late to start! Talk with your doctor if you have questions about what activities might work best for you.

• Get more tips on staying active as you get older
• Find out how to move your way — with activities you really enjoy
• Read about the benefits of physical activity

Do aerobic activity.

Anything that gets your heart beating faster counts as aerobic activity.

• Aim for 150 minutes of moderate-intensity aerobic activity every week — and break up the time over the week however you want. Try walking, swimming, or doing yard work.
• If you’re just getting started, go slow and do what you can. Even a 5-minute daily walk has real health benefits. Build up to more activity over time.

Get more ideas for aerobic activities you can try.

Do strength, balance, and stretching activities.

Doing different types of physical activity can make it easier to do everyday activities. That's why it's important to:

• Do muscle-strengthening activities 2 or more days a week
• Do exercises to improve your balance, especially if you're at risk of falling
• Do stretching (flexibility) exercises so you can move more easily

If you're doing physical activity outdoors, follow these safety tips. And if you have a health condition, talk with your doctor about the best activities for you.

Eat Healthy

Get ideas for eating healthy.

Eating healthy is always important, no matter how old you are. And it’s never too late to make healthy changes to your diet.

Choose a mix of healthy foods you enjoy from each food group, including:

• Whole fruits — like apples, berries, oranges, mango, and bananas
• Vegetables — like broccoli, sweet potatoes, beets, okra, spinach, peppers, and jicama
• Whole grains — like brown rice, millet, oatmeal, bulgur, and whole-wheat bread
• Proteins — like lean meats and chicken, eggs, seafood, beans and lentils, nuts and seeds, and tofu
• Low-fat or fat-free dairy — like milk, yogurt, cheese, lactose-free dairy, and fortified plant-based alternatives (such as soy milk or soy yogurt)
• Oils — like vegetable oil, olive oil, and oils in foods like seafood, avocado, and nuts

Use these resources to:

• Build a healthy eating routine
• Learn more about healthy eating
• Get more tips and ideas for eating healthy as you get older
• Read more about healthy eating for older adults
• Find healthy recipes from the MyPlate Kitchen

Talk with Your Doctor

Play an active role in your health care.

Your doctor or nurse can help you stay healthy as you get older. Take these steps before and during a visit with your doctor:

• Use our tool to get a list of preventive services recommended for you. Print out the list and take it with you to your next doctor’s appointment.
• Learn about preventive services covered by the Affordable Care Act. Most health insurance plans must cover preventive services like screenings and vaccines at no cost to you.
• Get tips for talking with your doctor or nurse. This can help you get the most out of your medical appointments.
• Tell your doctor or pharmacist if you have questions or concerns about your medicines. Get more tips for using medicines safely.
• If you think you might be depressed, let your doctor know. Depression is treatable — and it’s nothing to be ashamed of. Learn more about depression in older adults.

If you have Medicare, be sure to schedule your Medicare wellness visit every year.

Quit Smoking

If you smoke, quit.

Quitting smoking is one of the most important things you can do for your health. Call 1-800-QUIT-NOW (1-800-784-8669) for free help with quitting. You can also:

• Get more tips for quitting smoking
• Check out the benefits of quitting smoking when you're older

If you have a history of heavy smoking and you smoke now or have quit within the past 15 years, ask your doctor about screening for lung cancer.

Stay Safe

Take steps to prevent falls.

Older adults are at higher risk for serious injuries from falls. Take these steps to lower your risk of falling:

• Use this checklist to make your home safer.
• Do exercises to improve your balance.
• Ask your doctor or pharmacist to review your medicines. Some medicines can make you dizzy or sleepy. Learn more about using medicines safely.
• Get your vision checked every 1 to 2 years. And be sure to get new glasses or contact lenses when your vision changes. Read more about protecting your vision.
• If you're worried that you might have hearing loss, get your hearing checked. Learn more about hearing loss.
• Learn more about lowering your risk of falls.

Make sure you have smoke alarms and carbon monoxide detectors in your home.

Older adults are more likely to be injured or killed in home fires. To stay safe, put smoke alarms on every floor of your home.

Use long-life smoke alarms if possible. These alarms use lithium batteries and last longer than regular smoke alarms. They also have a “hush button” so you can stop them quickly if there’s a false alarm.

If you use regular smoke alarms, replace the batteries at least once a year.

It’s also important to put carbon monoxide detectors in your home. Carbon monoxide is a gas that you can’t see or smell but that can kill you. Carbon monoxide is found in fumes that form when people burn fuel in vehicles, stoves, grills, fireplaces, and furnaces.

Put carbon monoxide detectors on every floor of your home and replace the batteries at least once a year. You can change your smoke alarm and carbon monoxide detector batteries when you change your clocks back from daylight saving time in the fall.

Follow these other tips for using smoke alarms and carbon monoxide detectors:

• Test them once a month by pushing the test button
• Put them on every floor of your home and near places where people sleep
• Don’t forget to put a smoke alarm and a carbon monoxide detector in the basement
• Replace your smoke alarm if it doesn’t work when tested or if it’s more than 10 years old
• Replace your carbon monoxide detector if it doesn’t work when tested or if it’s more than 5 years old
• Dust or vacuum smoke alarms and carbon monoxide detectors when you change the batteries

Get more information about smoke alarms.

Take steps to stay safe while driving.

Getting older doesn’t make you a bad driver. But changes that come with aging can make it harder for you to drive safely. You may have trouble seeing at night or find it harder to react quickly to avoid an accident.

Take steps to stay safe:

• Get your vision and hearing checked regularly
• Always wear your seat belt
• Never use your phone while driving
• Plan your route and drive on streets you know

Read more about older adults and driving.

Keep Your Memory Sharp

Challenge your mind.

Just like physical activity is good for your body, activities that challenge your mind can help keep your brain healthy.

As you get older, it's important to:

• Learn new things — take a class or challenge yourself to read a section of the newspaper that you normally skip
• Connect with other people — try sharing meals with a friend or volunteering at a local school
• Keep moving — joining a hiking club, trying a dance class, or taking up other active hobbies can benefit not only your physical health but also your brain

If you're forgetting things more often than usual and it’s getting in the way of doing everyday activities, talk with your doctor or nurse. Learn more about memory problems.

Caregiver Support

Get support if you're a caregiver.

A caregiver is someone who helps a family member, friend, or neighbor who is sick or has a disability.

Caregiving can be stressful — that’s why it’s important to make time to care for yourself, too. Learn how to get support if you’re a caregiver.