Healthy Aging

	Topic Overview
	Health Tools
	Normal Aging
	Physical Vitality
	Emotional and Mental Vitality
	Sexual Vitality
	Getting the Nutrition You Need
	Getting the Medical Care You Need
	Other Places To Get Help
	Related Information
	References
	Credits

What is healthy aging?

Getting older is a natural part of life. How you will feel as you get older depends on many things, including what health problems run in your family and the choices you make. If you take good care of your body and learn positive ways to deal with stress now, you can slow down or even prevent problems that often come with getting older.

It’s never too early or too late to change bad habits and start good ones. No matter when you start, a healthy lifestyle can make a difference in how you feel and what you can do.

What determines how healthy you will be as you get older?

The changes you'll go through as you get older depend on a number of things. One is your family history (genetics). If your family members have diseases or ongoing (chronic) health problems like high blood pressure or diabetes, then you may have a greater chance of having those problems yourself. But just because your risk is higher, it doesn't mean you will definitely have the same problems. In fact, the lifestyle choices you make can help reduce your chances of getting illnesses that run in your family. And even if you do get a family illness, choosing to exercise, eat right, and learning to deal with stress can keep the illness from destroying your ability to enjoy your golden years.

What kinds of changes should you expect as you age?

Changes as you get older are usually gradual. Certain physical changes are common. Your metabolism (how fast your body can burn calories) slows over time, which means that your body needs less food energy than before. Also, most people start needing reading glasses between ages 40 and 50, and many have some hearing loss later in life. Starting in your 50s, bone aging increases. Also starting around age 50, you may notice changes in sexual function—it's normal to have a slower sexual response.

Most vital organs gradually become less efficient with age. The kidneys are less able to keep enough water in your body. And the heart can start to show signs of wear and tear caused by years of eating the wrong foods and not exercising. So as you get older, it’s important to exercise, drink plenty of water, and eat the right foods. Doing these things will help your body work well for a longer period of time.

What do you need to do to feel your best as you age?

One of the most important things you can do for your health at any age is exercise. Exercise keeps your body strong, and it helps with how you feel. People who stay active are less likely to get depressed. Exercise can be anything from walking to gardening to working out at the gym. The important thing is to get moving at least 30 minutes every day. No matter what your age or condition, there is a type of exercise that's right for you.

Your mental and emotional health are also important. Protect or improve your emotional health by staying in touch with friends, family, and the community. People who feel connected to others are more likely to thrive than those who are not. And try to keep stress at a minimum. In addition to getting regular exercise, you can take charge of how stress affects you by taking 20 minutes a day to just relax.

Protect or improve your memory and mental sharpness by keeping your brain active through learning, doing crossword puzzles, or playing cards or strategy games. Depression can be a serious problem for older adults. If you think you may be depressed, seek help—antidepressant medicine and counseling can help treat depression.

Other good health habits can help you stay at your best:

• Eat a healthy, balanced diet. Avoid salty foods and foods with a lot of fat in them, such as fried foods.
• Remember that sexually transmitted diseases can affect anyone at any age, so safe sex is a must.
• If you smoke, try to quit.
• Don't abuse alcohol or drugs.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

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	Walking for wellness

As your body ages, you can expect it to undergo gradual changes, at its own pace. How your body ages depends in part on your family (genetic) patterns of aging. However, your lifestyle choices have a more powerful impact on how well your body ages. Fortunately, you can control your lifestyle choices.

The following are normal signs of aging. Some of these changes may apply to you; others may not. A healthy lifestyle may slow many of these effects of aging.

Skin. With age, the skin becomes less elastic and more lined and wrinkled; fingernail growth also slows. The oil glands gradually produce less oil, making the skin drier than before. You can slow skin aging by using moisturizer and protecting the skin from the sun with sunscreen and sun-protective clothing.

Hair. It's normal for hair to gradually thin on the scalp, pubic area, and armpits. As hair pigment cells decline in number, gray hair growth increases.

Height. By age 80, it's common to have lost as much as 2 in. (5.1 cm) in height. This is often related to normal changes in posture and compression of joints, spinal bones, and spinal discs.

Hearing. Over time, changes in the ear make high-frequency sounds harder to hear and changes in tone and speech less clear. These changes tend to accelerate after age 55.

Vision. Most people in their 40s develop a need for reading glasses as the lens becomes less flexible. It's also normal for night vision and visual sharpness to decline, while glare increasingly interferes with clear vision in the later years.

Bones. Throughout adulthood, bones gradually lose some of their mineral content, becoming less dense and strong. In women, bone loss increases after menopause. You can slow natural bone loss and reduce your risk of osteoporosis by getting regular, weight-bearing exercise (such as walking), taking daily calcium and vitamin D, and avoiding lifestyle choices that weaken bones (such as too much caffeine or carbonated beverages). Your health professional may also recommend a bone-protecting medication. For more information, see the topic Osteoporosis.

Metabolism and body composition. Over time, the body typically needs less energy, and your metabolism slows. Hormone changes in the aging body result in a shift to more body fat and less muscle mass. The best approach to managing these changes is to take in fewer calories while keeping up or increasing your physical activity. Strength training is an especially good way to build or keep your muscle mass.

Brain and nervous system. Starting in the third decade of life, the brain's weight, the size of its nerve network, and its blood flow decrease. But the brain adapts to these changes, growing new patterns of nerve endings. Memory changes are a normal part of the aging process—it's common to have less recall of recent memories and to be slower remembering names and details. You can help keep your brain sharp with regular social activity; "mental exercise," such as doing crossword puzzles and reading; and physical activity, which increases blood and oxygen flow to the brain.

Heart and blood circulation. The heart naturally becomes less efficient as it ages, and your heart has to work a little harder than it once did during activity. This makes the heart muscle a little larger. You'll notice a gradual decline in your energy or endurance from one decade to the next.

Lungs. In inactive people, the lungs become less efficient over time, supplying the body with less oxygen. Regular physical activity plays a key role in keeping your lungs strong.

Kidneys. With advancing age, the kidneys decline in size and function. They don't clear wastes and some medications from the blood as quickly and don't help the body handle dehydration as well as in the past. This makes it increasingly important that you minimize the toxins, alcohol, and unnecessary medication that you take in, and that you drink plenty of water.

Sexual function. Men and women produce lower levels of hormones starting in their 50s. Men produce less sperm, and their sexual response time slows, though the male sex drive doesn't lessen. Women stop ovulating and have a number of menopausal changes linked to lower estrogen production. For more information, see the Sexual Vitality section of this topic, and see the topic Menopause and Perimenopause.

Physical activity builds physical vitality. With every year of your life, you have more to gain from being physically active; as your age-related risks of chronic disease increase, regular exercise generally slows that trend. Some research suggests that the heart and blood vessel (cardiovascular) benefits you get from physical activity may also help your brain stay healthy.¹ In fact, you're even more likely to notice the benefits of regular exercise if you already have a chronic condition, such as depression, coronary artery disease, or diabetes.

What are the benefits of being physically active?

On a daily basis, being physically active improves your quality of life by improving your:

• Energy level.
• Mental sharpness.
• Mood (regular aerobic exercise can help manage depression, anxiety, and stress).
• Balance, strength, and flexibility, which are key to preventing injuries and falls.
• Odds against chronic illness. Physical activity also often helps manage chronic illness with fewer medications.

As you get older, an inactive lifestyle increases your risk of chronic disease. Conversely, getting regular aerobic exercise is one of your best defenses against chronic diseases such as:

• Coronary artery disease.
• Osteoarthritis.
• High blood pressure.
• Obesity.
• Osteoporosis (weight-bearing exercise is necessary).
• Type 2 diabetes.
• Chronic obstructive pulmonary disease (COPD).
• Cancer.

If you already have a chronic disease, becoming physically active may decrease your need for medication to treat or control it.

I'm not physically active right now—how do I start?

If you've been inactive for awhile, you don't necessarily have to set your sights on becoming athletic—your first goal is to simply start moving more each day. Before you do, though, get off to a smart start by seeing your health professional for a full physical examination. Then you can follow his or her recommendations as well as these guidelines for becoming more physically active.

• Add more movement to your daily routine. For example, put away the TV remote control, park farther from building entrances, and take stairs instead of elevators. Walk a lap or two around your house or apartment, then down the street or around a nearby park. Buy a pedometer and gradually increase the number of steps you take each day.
• Start with small, short-term goals. It's easiest to stick to something new when you have early, frequent successes. For example, make a plan to walk for 10 minutes a day, 3 days a week, for 2 weeks.
• Buddy up with a friend. There's no better way to stay on track with exercise than with a buddy you look forward to seeing, who also counts on you (especially on days when you could easily find an excuse not to exercise).
• Change the way you think about yourself—start thinking, dressing, and eating like the active, vital person you plan to be.
• Make physical fitness a habit with such simple tasks as writing exercise into your weekly calendar.

Walking for wellness

After a few weeks of regular physical activity, you will probably feel better than before. When you're ready for more, add some variety to your activity schedule with new ways to build flexibility, aerobic fitness, and muscle strength. Over time, aim for the U.S. Surgeon General's recommendation that you have at least 30 minutes of moderate physical activity (walking, bicycling, yard work) most or all days of the week.²

• Flexibility is increasingly important as age-related stiffness becomes a normal part of your daily life. A daily stretching or yoga routine can greatly improve your ease of movement. To help prevent injury, it's important to stretch before and after any activity that uses your joints and muscles for more than a few minutes.
• Aerobic fitness conditions your heart and lungs. Aerobic (oxygen-using) exercise is any activity that gets your heart pumping faster than when you're at rest, circulating more oxygen-carrying blood throughout your body. All kinds of daily activities can be aerobic, ranging from housecleaning, yard work, or pushing a child on a swing to walking, bicycling, or playing tennis. On most days, try to do at least 30 minutes of aerobic activity.
• Muscle strengthening includes building more powerful muscles and increasing how long you can use them (endurance). Weight lifting builds stronger muscles and strengthens bones, while pushups build endurance. No matter what your age and whether you've done it before, you can gain great benefit from strength training. As you age, muscle strengthening plays an increasingly big part in healthy weight control, because muscle is the primary cell type that uses calories. Muscle strengthening is also key to improving or preventing balance problems, falls, and therefore bone fractures. The U.S. Surgeon General recommends doing strengthening exercise at least 2 times each week.²

For more information, see the topic Fitness.

I'm already physically active. Is there anything more I should be doing?

Even if you're happy with your fitness routine, it's a good idea to periodically stop, think, and rework your activities and goals. As age-related issues gradually enter into your fitness equation, keep the following factors in mind.

• Beyond age 60, it's important to spend as much time building strength and flexibility as you spend on aerobic fitness. Strength and flexibility help your body better handle the age-related changes, including loss of muscle and problems with balance. To maintain or improve your balance and resilience, include stretching, muscle strengthening, and such balance-building activities as yoga or tai chi in your weekly routine.
• It's normal to have to gradually adjust your expectations of how far you can push your body. If you're used to pushing yourself, accept your body's changes and tend toward moderation.
• Cross-training, or including different activities in your activity calendar, helps you build better overall fitness and helps prevent injury from overuse.
• Replacing a "lost" activity is a key to staying active. For instance, if you can no longer run, you might try walking, biking, and/or swimming.
• Injury generally takes longer to recover from as you age. If you are injured, allow your injury time to heal—yet keep the rest of your body moving! You can choose from a list of alternate activities, such as swimming, water aerobics, biking, walking, yoga, Pilates, or rowing.
• To prevent injury, start a new activity gradually, avoid overusing your body, and stretch often.

Emotional and mental vitality are closely tied to physical vitality—just as your mind has powerful effects on your body, so your physical state affects how you feel and think. Social contact can also make a big difference in how you feel.

Replacing a "lost" activity is a key to staying active and feeling good about yourself. For instance, if you can no longer run, you might try walking, biking, and/or swimming. And if your favorite activity was dancing, you might try something else that combines social and physical activity, such as joining a water aerobics class. Replacing lost activities can help you keep a positive attitude and sense of well-being over time, even if aging and changes in your health mean you can not do all the things you used to do.³

Physical activity. Protect or improve your emotional and cognitive health with regular physical activity. While exercise produces chemicals in the body that promote emotional well-being, inactivity can worsen depression, anxiety, and stress. For example, one study suggests that older women who walk regularly have more mental sharpness than those who don't.⁴ Another study showed that regular exercise 3 or more times per week delayed the beginning of dementia and Alzheimer's disease.⁵

Social activity. Protect or improve your emotional health by staying in touch with friends, family, and the greater community. Whether physically healthy or ill, people who feel connected to others are more likely to thrive than those who are socially isolated.⁶ Volunteering in your community and sharing your wisdom and talents with others is a gratifying and meaningful way to enrich your life. In fact, older adults who regularly volunteer even a small amount of time generally have a greater sense of well-being than those who don't.⁷

Mental activity. Protect or improve your memory and mental sharpness by:

• Challenging your intellect on a daily basis. Read, learn a new musical instrument or language, do crossword puzzles, play games of strategy with others. Just like an active body, an active brain continues to develop and thrive, while an inactive brain loses its power over time.
• Helping your memory along. Write down dates, names, and other important information that you easily forget. Use routine and repetition—keep daily items such as keys and eyeglasses in a specific place; when you learn a new name, repeat it out loud in conversation or to yourself several times to commit it to memory. (No matter what your age, having too much on your mind can interfere with your memory of new information. And as you age, it is normal to take longer to retrieve new information from your memory banks.)
• Preventing depression, which is a common yet treatable cause of cognitive decline in older people. In addition to getting regular exercise and social contact, avoid the depressant effect of alcohol and sedative use, eat a healthy diet, and include meaningful activity in your daily life (such as learning, creating, working, volunteering). If depression strikes, seek professional help—antidepressant medication and/or counseling are effective treatments for depression. For more information, see the topic Depression. If you find that a physical condition or disability is making your depressed mood worse, get the medical treatment you need.
• Not smoking. Cigarette smoking may speed mental decline; this connection was recently identified in a large study comparing smokers and nonsmokers age 65 and over.⁸

Stress reduction and relaxation techniques. Too much life stress can take a toll on your body, your mind, and the people who are closest to you. In addition to getting regular exercise, you can take charge of how stress affects you by taking 20 minutes per day for relaxation time.

• Meditation focuses your attention and helps calm both mind and body. Daily meditation is used for managing a spectrum of physical and emotional conditions, including high blood pressure, anxiety, depression, and chronic pain.
• The body responds to stress with muscle tension, which can cause pain or discomfort. Progressive muscle relaxation reduces muscle tension and general anxiety and may help you get to sleep.
• The way you breathe affects your whole body. Try breathing exercises for relaxation. Full, deep breathing is a good way to reduce tension, feel relaxed, and reduce stress.

Positive thinking. Positive thinking may help you live a longer, happier life. However, even if you tend to be an optimist, there are times when it takes extra effort to frame your life positively. Take the following steps to harness the power of positive thinking in your daily life.

• Create positive expectations of yourself, your health, and life in general. When you catch yourself using negative self-talk or predicting a bad outcome, stop. Reframe your thought into a positive one, and speak it out loud or write it down. This type of thinking can help you best recover from surgery, cancer, and other life crises.
• Open yourself to humor, friendship, and love. Go out of your way to find reasons to laugh and to spend time with people you enjoy.
• Appeal to a higher power, if it suits you. Whether it be through your faith in a loving, all-powerful God or your connection with nature or a collective unconscious, your sense of spiritual wellness can help you through personal trials and enhance your joy in living.

Because sexuality tends to be a private matter, it's likely that you've heard less about sexual change than any other element of aging. Fortunately, the news is good—for most healthy adults, pleasure and interest don't diminish with age. Most people are sexual throughout their lives, with or without a partner, and some feel greater sexual freedom in their later years. On the other hand, some men and women are content to be sexually inactive.

Around age 50, men and women typically begin to notice changes in their sexual drive, sexual response, or both. Like so many other physical changes that evolve over time, these aren't signs that you are losing your sexuality. Rather, these changes are simply something to adjust to and discuss openly with your partner and/or health professional.

Normal sexual changes in men

As you age beyond your 50s, you may find that:

• Male sex drive is minimally affected by age (although health problems, certain medications, or relationship stress can lower sex drive).
• Erections become less firm and tend to take more time than when you were younger.
• You may be able to delay ejaculation for longer than when you were younger.

Normal sexual changes in women

After menopause, estrogen and androgen levels drop, causing physical changes. You may find that:

• It can take longer to become sexually excited.
• Your skin may be more sensitive and easily irritated when caressed.
• Intercourse may be painful because of thinning vaginal walls (regular sex often helps prevent this from becoming severe). If a water-based lubricant (such as Astroglide or Replens) isn't enough, talk to your health professional about vaginal estrogen cream, which reverses thinning and sensitivity. For more information, see the topic Menopause and Perimenopause.
• You are less interested in sex.

If you have noticed sexual changes that don't seem to be linked to normal aging, talk to your health professional. There are a number of medications that can cause sexual problems, as well as health conditions that can cause sexual problems.

Adjusting to age-related sexual changes

With a little experimentation and patience, you can adjust to sexual changes and satisfy your sexual and intimacy needs. If you think your sexual interest might be affected by a medication or health problem, work with your health professional to correct or treat it. Talk with your partner about any misgivings you might have so you can handle them together.

With your partner, take your time to set a relaxed mood and engage in foreplay. Use a lubricant if vaginal dryness or irritation is a barrier to enjoying sex. If you drink alcohol, remember that a small amount may relax you and increase your responsiveness, but too much alcohol is likely to work against you.

Sexually transmitted diseases (STDs) are a risk no matter what age you are. Unless you and your partner have recently been tested or you are 100% sure that you both have been monogamous for many years without infection, make sure that you practice safe sex to prevent STDs.

As you get older, good nutrition plays an increasingly important role in how well you age. Eating a low-salt, low-fat diet with plenty of fruits, vegetables, and fiber can actually reduce your age-related risks of heart disease, diabetes, stroke, osteoporosis, and other chronic diseases. By eating a wide variety of foods, you can pretty easily get what your body needs, including:

• Protein, which is needed to maintain and rebuild muscles. You can get low-fat, quality protein from poultry, fish, eggs or egg substitutes, soy, and limited amounts of nuts and low-fat meat and dairy.
• Carbohydrate, which is the body's preferred source of energy. There are two main sources of dietary carbohydrates: simple sugars, such as sucrose (the refined white sugar added to sweets and desserts), fructose (the sugar contained in fruit), and lactose (milk sugar); and complex carbohydrates, which come from vegetables and grains. Unlike refined sugars, fruits contain vitamins and fiber, dairy products contain nutrients such as calcium and vitamin D, and complex carbohydrates contain vitamins, minerals, and fiber. Get most of your carbohydrate calories from vegetables, grains, and fruits, and try to replace fat calories with complex carbohydrates in your diet.
• Fat, which also provides energy. To help keep your blood cholesterol levels low, get most of your limited fat intake from the polyunsaturated fats (as in liquid corn oil or soybean oil) and monounsaturated fats (in olive oil, avocados, and nuts). Limit saturated fats (beef, pork, veal, butter, shortening, and cheese). You can do this by eating these foods less often, having smaller servings, choosing less fatty cuts of meat, and by using stronger tasting cheeses so you can use just a little and still get the cheese flavor. Try to avoid the trans fats (hydrogenated fats) found in stick margarine and in many processed foods such as crackers and cookies. Trans fats are now shown on the nutrition facts labels found on most packaged foods.
• Water, to replace water lost through activity. Because your kidneys gradually become less efficient at keeping your body hydrated, make a conscious effort to get six to eight 8 fl oz (0.2 L) glasses of water per day.

As you take a look at your daily diet, remember that as you age:

• Your body's daily energy needs slowly decrease. You therefore need fewer calories per day than when you were younger. Your health professional or a registered dietitian (RD) can help you calculate your ideal calorie intake.
• Natural hormone changes make your body prone to producing more body fat (especially around your middle) and less muscle. You therefore need less fat and plenty of protein in your diet, combined with increased activity and muscle strengthening (muscle cells are the major calorie burners in your body).
• Your bones lose mineral content more rapidly than before, especially if you are a postmenopausal woman, because lower estrogen increases bone loss. As a result, you need plenty of daily calcium to help prevent osteoporosis. (Your health professional may have additional treatment recommendations, including a calcium supplement and/or medication.)

Simply put, the best way to reach and maintain a healthy weight as you age is to take in fewer calories than you needed in your youth and to make sure that most of what you eat is nutritious and low in fat and processed sugar. Avoid saturated fats and trans fats. These are harmful to your blood vessels and increase your risk for developing hardening of the arteries (atherosclerosis). And they can affect your cholesterol and increase your risk of heart disease. Saturated fats are found mostly in foods that come from animals, such as beef, pork, veal, butter, and cheese. Trans fats are found in the shortening in many cookies and crackers, in fried fast foods, and in stick margarine. Also consider how other food choices can improve or worsen your cholesterol levels.

For more information on nutrition, see the topic Healthy Eating.

Help for managing underweight or poor nutrition

People who are underweight have low reserves for bouncing back after an illness or injury. In the later years, this can lead to permanent ill health or disability. If you have trouble keeping your weight up, it's critical that you take special measures to build your weight, energy, and resilience. Every day, follow your health professional's recommendations and:

• Eat three meals plus three snacks, and never miss a meal.
• Choose higher-calorie foods from each food group, such as whole milk instead of skim milk. However, try to keep your overall saturated fat intake low—high cholesterol can affect anyone.
• Eat the highest-calorie foods in a meal first.
• Use liquid supplements, such as Ensure or Boost, between meals.

If you are having trouble getting the food you need because of transportation, financial, or health problems, ask your health professional about local meal programs. Most communities have Meals on Wheels programs that can deliver food to your door, as well as meals at churches and community centers that can nourish your needs for both food and social time.

Medical prevention, regular checkups, and prompt treatment play a key role in your quality of life as you age.

Prevention

Whereas your grandparents' generation had few protections from life-threatening conditions, you now have the advantage of immunizations and regular screenings. To maximize your odds of living a longer, higher-quality life, make sure you get all screenings and immunizations that are recommended for all people over age 50:

• Preventive health screenings for both men and women include blood pressure checks, cholesterol screening, colorectal cancer screening, hearing and vision tests, and dental examinations. Men may also be advised to have an annual prostate check, which may include a digital rectal examination and/or a blood test. Women are advised to also have a regular breast examination and mammogram as well as a pelvic exam and Pap test. For detailed information on these and other recommended health screenings, see the topic Early Disease Detection. There are sections in the topic for people ages 50 to 64, and people over 65 years old.
• The recommended immunizations includes tetanus boosters, yearly influenza (flu) shot, and pneumococcal vaccine. For detailed information on these and other recommended immunizations, see the topic Immunizations. There is a section in the topic about immunizations for adults.

Managing your health care

Be an informed health care consumer. When concerned about a medical condition, read as much as you can about it and its possible treatments. Make a list of unanswered questions and talk to your health professional about them. Explore all treatment options before deciding how to treat a problem, and get at least one second opinion if you're considering a surgery, medication with dangerous side effects, or experimental treatment. For more information, see the topic Making Wise Health Decisions.

Be your own best health advocate. Make it your goal to work in partnership with your health professionals. In general, people who make health decisions with their health professionals are happier with the care they receive and the results they achieve. It's important to share in every decision about your health. The decisions you make influence your overall well-being as well as the quality and cost of your care. Whenever you have a medical appointment:

• Bring your health and medication history with you, as well as a list of questions you want answered during your appointment.
• Make sure you understand your health professional's key points about your health and any possible tests and treatments.
• You can bring along a friend or family member to support you and help you remember key information for later on. This can be especially useful when you're under a lot of physical or emotional stress.

For more information about how to work in partnership with a health professional, see the topics Work Closely With Your Doctor and Smart Decisions: Know Your Options.

Get organized. Feeling organized and in control of your health care can be a challenge, especially when something comes up unexpectedly. Your best approach to managing your health care is to organize now—create a personal medical information file, including an ongoing record of your:

• Health professionals' names and numbers.
• Medications, herbal supplements, and vitamins. For each, include the dosage, who prescribed it and why, and any side effects you have had.
• Any known allergies to medications, foods, or insects (include the type of allergic reaction).
• Immunization record.
• Symptoms, health conditions, and treatments. For each, jot down dates and any details that you might easily forget.
• Exam and test results.
• Emergency medical information, such as pacemaker use or chronic disease diagnosis.
• Insurance policy and payment receipts.

For more information on how to organize your medical information, see the topic Your Home Health Center.

Should you become physically or mentally unable to make your own medical decisions, advance directives such as a living will and a medical power of attorney can ensure that you will get the care you want. A living will states your wishes about your medical care; a medical power of attorney gives a person you choose (your health care agent) the authority to make medical decisions for you if you become unable to make these decisions for yourself. In addition to putting your advance directives in writing, also be sure to clearly communicate your choices to all family members who might be involved in your health care in the future. For information about writing advance directives or selecting a health care agent, see the topics Writing an Advance Directive and Choosing a Health Care Agent.

Online Resources

Organizations

• Better Care at Lower Costs
• Choosing a Health Care Agent
• Dealing With Emergencies
• Early Disease Detection
• Fitness
• Healthwise Self-Care Checklist
• Healthy Eating
• Immunizations
• Making the Most of Your Appointment
• Making Wise Health Decisions
• Menopause and Perimenopause
• Preventing Falls
• Reducing Medication Costs
• Safe Sex
• Smart Decisions: Know Your Options
• Stress Management
• Understanding Lab Test Results
• Work Closely With Your Doctor
• Work in Partnership With Your Health Professional to Prevent Medical Errors
• Writing an Advance Directive
• Your Home Health Center

Citations

1. Colcombe SJ, et al. (2003). Aerobic fitness reduces brain tissue loss in aging humans. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58: M176–M180.

2. U.S. Department of Health and Human Services (1996). A Report of the Surgeon General: Physical Activity and Health—Executive Summary. Available online: http://www.fitness.gov/execsum.htm.

3. Duke J, et al. (2002). Giving up and replacing activities in response to illness. Journal of Gerontology, 57B(4): P367–P376.

4. Yaffe K, et al. (2001). A prospective study of physical activity and cognitive decline in elderly women. Archives of Internal Medicine, 161: 1703–1708.

5. Larson EB, et al. (2006). Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of Internal Medicine, 144(2): 73–81.

6. Cacioppo JT, et al. (2002). Loneliness and health: Potential mechanisms. Psychosomatic Medicine, 64: 407–417.

7. Morrow-Howell N, et al. (2003). Effects of volunteering on the well-being of older adults. Journal of Gerontology, 58B(3): S137–S145.

8. Ott A, et al. (2004). Effect of smoking on global cognitive function in nondemented elderly. Neurology, 62: 920–924.

Other Works Consulted

• Alline KM, Johnson LE (2002). Sexuality. In RJ Ham et al., eds., Primary Care Geriatrics, 4th ed., pp. 427–436. St. Louis: Mosby.