Many factors can affect your weight, including your genes, age, sex, lifestyle, family habits, culture, sleep, and even where you live and work. Some of these factors can make it hard to maintain or achieve a healthy weight. Regardless, following a nutritious eating pattern and exercising regularly can help keep your body as healthy as possible as you age. Read on to learn why weight may change as you get older, why it’s important to aim for a healthy weight, and what you can do to help meet your goals.

Why does weight change as we age?

As we age, metabolism — how the body gets energy from food — can change. This means that some older adults must become more active or eat fewer calories to maintain or achieve their ideal weight.

Other older adults may lose weight unintentionally. This can happen if you have less of an appetite, difficulty leaving the house to buy food, pain when chewing or swallowing, or forget to eat.

Why should older adults maintain a healthy weight?

Keeping your weight in the normal range is an important part of healthy aging. As in other stages of life, elevated body mass index (BMI) in older adults can increase the likelihood of developing health problems. These include heart disease, high blood pressure, stroke, and diabetes. Losing weight or maintaining a healthy weight can help decrease these risks.

Being underweight also increases your chance of developing health problems. If you have a low BMI, you may be more likely to develop medical problems such as osteoporosis and anemia, and it may be harder to recover from an illness or infection.

How are food, exercise, and calories connected?

Being active and choosing healthy foods can help you maintain or achieve a healthy weight, feel more energetic, and decrease your chances of having other health problems. It’s important to choose foods rich in nutrients and aim for at least 150 minutes of physical activity per week.

The energy your body gets from the foods and drinks you consume is measured in calories. Your body needs a certain number of calories each day, depending on your activity level and other factors, to maintain your current weight. Visit MyPlate Plan to determine how many calories a day you need based on your age, sex, height, weight, and physical activity level.

To lose weight, exercise more or eat fewer calories than is recommended. To gain weight, increase the number of calories you eat while maintaining a moderate activity level.

Read more about making smart food choices and find recommendations of how much to eat, organized by activity level.

What should I eat to lose or gain weight?

Whether you are trying to lose or gain weight, eating healthy foods matters. Try to follow a healthy eating pattern rich in vegetables, fruits, whole grains, low-fat dairy, and lean proteins. If you’re concerned about your weight and want to change it, there are things you can do. Talk with a health care professional about how to make changes in a healthy way that’s right for you.

Trying to lose weight?

• Limit portion size to control calorie intake.
• Be as physically active as you can be.
• Swap out your usual foods for healthier alternatives.
• Stay hydrated with water and avoid drinks with added sugar.
• Set specific, realistic goals, such as three 15-minute walks per week.
• If there’s a break in your healthy eating or exercise, try to get back on track as quickly as possible.
• Keep track of what you eat in a food diary.

Trying to gain weight?

• Eat more foods with healthy fats, such as avocados and peanut butter.
• If you get full quickly, eat frequent, smaller meals throughout the day.
• Add nutrient-dense snacks such as nuts, cheese, and dried fruit to your menu.
• Dine with friends and family to make the experience more enjoyable.
• Stay active to boost your appetite.

How much physical activity do I need?

Exercise and physical activity are good for just about everyone including older adults. Aim for at least 150 minutes of moderate-intensity aerobic activity — working hard enough to raise your heart rate and break a sweat — each week. You don’t have to accomplish this all at once, rather, you can break up your activity over the course of seven days. If you can’t meet the goal right away, try to be as physically active as you can. Doing something is better than doing nothing at all.

For adults at every weight, aging is associated with muscle loss, which makes certain activities difficult. Being active can help older adults maintain muscle mass and make it easier to conduct daily activities, participate in outings, drive, keep up with grandchildren, avoid falls, and stay as independent as possible.

You don’t need to spend a lot of money joining a gym or hiring a personal trainer to get fit. Think about the kinds of physical activities that you enjoy, for example, walking, running, bicycling, gardening, swimming, and dancing. Even everyday chores such as vacuuming can provide physical activity. While you’re getting started with exercise, try to stay motivated to move your body regularly. Then increase the length of time you exercise or add another fun activity. Talk with your doctor before starting a new or more vigorous exercise program.

To learn more, please visit https://www.nia.nih.gov/health/healthy-eating-nutrition-and-diet/maintaining-healthy-weight.

While many older adults value the independence of driving, changes that happen with age may alter a person’s ability to drive safely. You may notice driving becoming more difficult over time for yourself or for your loved ones. Changes in health, including medical conditions or injuries, also may impact a person’s driving skills. Learn more about the different factors that can affect driving as you age and signs of when it may be time to stop driving.

What can change driving ability with age?

Common health conditions and medication side effects may influence your driving skills.

• Stiff joints and muscles. As you age, your joints may get stiff, and your muscles may weaken. Arthritis, which is common among older adults, might affect your ability to drive. These changes can make it harder to turn your head to look back, turn the steering wheel quickly, or brake safely. If pain, stiffness, or arthritis seem to get in the way of your driving, talk with your doctor. Think about getting hand controls for both the gas and brake pedals if you have leg problems.
• Trouble seeing. Your eyesight can change as you get older. It might be harder to see people, things, and movement outside your direct line of sight. It may also take longer to read street or traffic signs or even recognize familiar places. At night, you may have trouble seeing things clearly. Glare from oncoming headlights or streetlights can be a problem. Depending on the time of day, the sun might be blinding. Eye diseases, such as glaucoma, cataracts, and macular degeneration, as well as some medicines, can also cause vision problems. If you are 60 or older, get a dilated eye exam from your eye doctor every one to two years. If you need glasses or contact lenses to see far away while driving, make sure your prescription is up to date and correct.
• Trouble hearing. As you grow older, your hearing can change, making it harder to notice horns, sirens, or even noises coming from your own car. These sounds warn you when you may need to pull over or get out of the way, or when there is a possible mechanical issue with your vehicle. Have your hearing checked at least every three years after age 50 or more frequently if you have had chronic exposure to loud noises or have other risk factors for hearing loss. Discuss your concerns with your doctor as there may be treatments that can help.
• Medications. Some medicines can make you feel drowsy, lightheaded, or less alert than usual, which can make driving unsafe. Some drugs include a warning about driving, but even those that do not might have a negative effect. Ask your doctor or pharmacist if any of your health problems or medications might make it unsafe for you to drive.
• Slower reaction time and reflexes. As you get older, your reflexes might get slower, and you might not react as quickly as you could in the past. Stiff joints or weak muscles also can make it harder to move quickly. Loss of feeling or tingling in your fingers and feet can make it difficult to steer or use the foot pedals.
• Some medical conditions make it unsafe to drive. The uncontrollable movements and loss of coordination and balance due to Parkinson’s disease make it unsafe to drive. Similarly, many of the loss of control of limbs or other movement limitations following a stroke can mean it is no longer safe to drive.

Tips for older adults to drive safely

Maybe you already know that driving at night or in rainy weather is a problem for you. Some older drivers also have problems with certain routes or driving on busy highways, for example. Consider these tips to help you make safe choices about driving:

• Talk with your doctor. If you have any concerns about your health and driving, see your doctor. Don’t risk hurting yourself or others.
• Be physically active. This will help you keep and even improve your strength and flexibility, which may help your driving abilities.
• Consider your car. If possible, drive a car with automatic transmission, power steering, power brakes, and large mirrors. Newer cars come equipped with backup cameras, which can make parking and backing up easier, as well as other sensors that can alert a driver to a nearby object or vehicle before an accident occurs.
• Take care of your eyes and ears. Always wear your glasses or contact lenses if you need them to see clearly. If you use hearing aids, be sure to wear them while driving.
• Avoid driving certain times of day. Cut back on or stop driving at night if you have trouble seeing in the dark. Try to avoid driving during sunrise and sunset, when the sun can be directly in your line of vision.
• Check in with yourself. Don’t drive if you feel lightheaded or drowsy. Be sure to check any warnings on your medications. Try to avoid driving when you are stressed or tired.
• Don’t crowd. Leave ample space between your car and the car in front of you and start braking early when you need to stop.
• Plan your timing. Avoid heavy traffic areas or rush-hour driving when you can.
• Plan your route. Drive on streets you know and find a way to go that requires few or no left turns. Choose a route that avoids highways or other high-speed roadways. If you must drive on a fast-moving highway, drive in the right-hand lane, where traffic moves more slowly.
• When in doubt, don’t go out. Bad weather, such as rain, ice, or snow, can make it hard for anyone to drive. Try to wait until the weather is better, or use buses, taxis, ridesharing services, or other alternatives.
• Wear seat belts. Always wear your seat belt and make sure your passengers wear theirs, too.
• Limit distractions. Eating, adjusting the radio, or chatting can all be distracting. If you use your cellphone while driving (for navigation, for example), use it hands-free and use voice activation when possible. Never type on your phone while driving.
• Use window defrosters. These will help keep windows and windshields clear.

How to check and improve your driving skills

Are you concerned that your driving skills are declining or could be improved? Consider the following:

• Have your driving skills checked by a driving rehabilitation specialist, occupational therapist, or other trained professional. The American Occupational Therapy Association maintains a national database of driving specialists, or you can ask your state’s Department of Motor Vehicles or your doctor to recommend someone who can test your driving skills. Note that there may be fees associated with these types of assessments.
• The American Automobile Association’s (AAA) RoadWise Driver Course is designed to help older adults adjust to age-related physical changes to extend their safe driving career.
• Try an online self-assessment, such as this one from the National Highway Traffic Safety Administration (NHTSA), to gauge your abilities.
• Ask your family and friends for feedback about your driving, including any concerns.
• Take a driver safety course. Some car insurance companies may even lower your bill when you complete this type of class. Organizations such as AARP or your car insurance company can help you find a nearby resource.

Signs your loved one should no longer be driving

Are you worried about an older family member or friend driving? It can be hard for some people to recognize or admit when it’s no longer safe to drive. You might want to observe the person’s driving skills or ask them to consider doing a self-assessment of their driving. If it’s not possible to directly observe the person’s driving, watch for these signs:

• Multiple vehicle crashes, near misses, or new dents or scrapes on the car
• Two or more traffic tickets or warnings within the last two years
• Increases in car insurance premiums because of driving issues
• Comments from neighbors or friends about erratic, unsafe, or aggressive driving
• Anxiety about driving at night
• Health issues that might affect driving, including problems with vision, hearing, and movement
• Complaints about the speed, sudden lane changes, or actions of other drivers
• Recommendations from a doctor to modify driving habits or quit driving entirely

Having “the talk” about driving

Talking with an older person about his or her driving is often difficult. For many older adults, “giving up the keys” means a loss of freedom of choice and movement. Many people are afraid of being dependent upon someone else for getting around. They worry about losing the ability to run errands, attend appointments, and participate in activities that they did on their own for decades. They may be concerned about becoming socially isolated and missing out.

Here are some tips that might help when talking with someone about no longer driving:

• Be prepared. Learn about local community services to help someone who can no longer drive before you have the conversation with them. Identify the person’s transportation needs.
• Avoid confrontation. Use “I” messages rather than “you” messages. For example, say, “I am concerned about your safety when you are driving,” rather than, “You’re no longer a safe driver.”
• Stick to the issue. Discuss the driver’s skills, not their age.
• Focus on safety and maintaining independence. Be clear that the goal is for the older driver to continue the activities they currently enjoy while staying safe. Offer to help the person stay independent. For example, you might say, “I’ll help you figure out how to get where you want to go if driving isn’t possible.”
• Be positive and supportive. Recognize the importance of a driver’s license to the older person. Realize they may become defensive, angry, hurt, or withdrawn during your conversation. You might say, “I understand that this may be upsetting,” or “Let’s work together to find a solution.”
• Consider broaching the topic gradually. Some experts suggest a gentle introduction of the driving conversation, and then revisiting it gradually over time.

The NHTSA has a helpful guide to help concerned families and friends better understand older drivers and suggestions on how to begin discussions.

Is it time to give up driving?

We all age differently, and for this reason, there is not one recommended age to quit driving. So how does one know when to stop? To help decide, ask yourself:

• Do other drivers often honk at me?
• Have I had some accidents even if just “fender benders”?
• Am I having trouble seeing road signs, exits, or lane lines?
• Am I still flexible enough to turn my head to check mirrors and blind spots comfortably?
• Have physical conditions or medications slowed my reaction time?
• Do I get lost frequently, even on familiar roads?
• Do cars or pedestrians seem to appear out of nowhere?
• Am I often distracted while driving?
• Have family, friends, or my doctor said they’re worried about my driving?
• Am I driving less these days because I’m not as sure about my driving as I used to be?
• Do I have trouble staying in my lane?
• Do I have trouble moving my foot between the gas and the brake pedals, or do I sometimes confuse the two?
• Have I been pulled over by a police officer about my driving?

If you answered “yes” to any of these questions, it may be time to talk with your doctor or family members about your driving, or to consider a driving assessment.

How will you get around?

Are you worried you won’t be able to do the things you want and need to do if you stop driving? Many people have this concern, but there may be more ways to get around than you think. For example, some areas provide free or low-cost bus, subway, rideshare, and taxi services for older people. Some communities offer a carpool service or scheduled trips to the grocery store, mall, or doctor’s offices. Religious and civic groups sometimes have volunteers who will drive you where you want to go.

If you have a smartphone or a computer, you could consider using mobile apps available for services like meal, grocery, or prescription deliveries. Most of these are paid services but may have free or lower-cost options for some older adults.

Your local Area Agency on Aging can help you find local services. Call 800-677-1116 or search the Eldercare Locator online. You also can try searching Rides In Sight or calling 855-607-4337, a service of the nonprofit ITN America that provides information about transportation options for older adults.

You can also think about using a car or ridesharing service. While these may sound pricey, remember that owning a car can be expensive. If you no longer need to make car payments or pay for insurance, maintenance, gas, oil, tolls, and other related expenses, then you may be able to afford other transportation or to buy gas for friends and family members who provide rides.

To learn more, please visit https://www.nia.nih.gov/health/safety/safe-driving-older-adults.

Doctor-patient communication is an essential, though sometimes challenging, aspect of the health care process. The following suggestions can help you work with older patients to optimize care and make the most of your time and resources.

Tips for communicating with older patients

Effective communication can help build satisfying relationships with older patients to best manage their care. It can strengthen the patient-provider relationship, lead to improved health outcomes, help prevent medical errors, and make the most of limited interaction time.

Interpersonal communication skills are considered so important that they are a core competency identified by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties.

These key communication tips can help facilitate successful interactions with all of your patients, including older adults:

• Speak to the patient as a fellow adult. Having physical, sensory, or cognitive impairments does not lessen the maturity of an adult patient. Those who are older might be used to more formal terms of address. Establish respect right away by using formal language as a default (such as Mr. or Ms.) and avoiding familiar terms, such as “dear,” which could be perceived as disrespectful. You or your staff can also ask patients how they prefer to be addressed.
• Make older patients comfortable. Ask staff to ensure patients have a comfortable seat in the waiting room and, if necessary, help with filling out forms. Staff should check on them often if they have a long wait before they are seen. Patients with impaired mobility may need to be escorted to and from exam rooms, offices, restrooms, and the waiting area. They may require assistance with climbing on to the exam table or removing clothing or shoes.
• Avoid hurrying older patients. Be mindful if you are feeling impatient with an older person’s pace. Some people may have trouble following rapid-fire questioning or torrents of information. Try speaking more slowly to give them time to process what is being asked or said, and don’t interrupt. Once interrupted, a patient is less likely to reveal all of their concerns. If time is an issue, you might suggest that your patients prepare a list of their health concerns in advance of appointments.
• Speak plainly. Do not assume that patients know medical terminology. Use simple, common language and ask if clarification is needed. Check to be sure your patient understands the health issue, what they need to do, and why it is important to act.
• Address the patient face-to-face. Don’t talk to patients with your back turned or while typing. Many people with hearing impairment understand better when they can read lips as well as listen. Watching a patient’s body language can also help you know whether they understand what you’re saying.
• Write down or print out takeaway points. It can often be difficult for patients to remember everything discussed during an appointment. Older adults with more than one medical condition or health concern benefit especially from having clear and specific written notes or printed handouts. That way, they have information to review later about their health conditions, treatments, and other major points from visits.
• Recognize that people from different backgrounds may have different expectations. Be sensitive to cultural differences that can affect communication with your patients. When needed, provide professional translation services and written materials in different languages.

Compensating for hearing deficits

Age-related hearing loss is common: About one-third of older adults have hearing loss, and the chance of developing hearing loss increases with age. Here are a few tips to make it easier to communicate with a person who may have difficulty hearing:

• Make sure your patient can hear you. Ask if the patient has a working hearing aid, look at the auditory canal for excess earwax, and be aware of background noises, such as whirring computers and office equipment.
• Talk clearly and in a normal tone. Shouting or speaking in a raised voice distorts language sounds and can give the impression of anger, and a high-pitched voice can be hard to hear.
• Face the person directly, at eye level, so that they can lip read or pick up visual clues.
• Indicate to your patient when you are changing the subject, such as by pausing briefly, speaking a bit louder, gesturing toward what will be discussed, gently touching the patient, or asking a question.
• Keep a notepad handy so you can write down important points, such as diagnoses, treatments, and important terms.
• Use amplification devices if they are available in your clinic or hospital.
• If your patient has difficulty hearing the difference between certain letters and numbers, give context for them. For instance, “m as in Mary” or “five, six” instead of “56.” Be especially careful with letters that sound alike.

Compensating for visual deficits

Visual disorders become more common as people age. Here are some things you can do to help manage the difficulties in communication that can result from visual deficits:

• Make sure there is adequate lighting, including sufficient light on your face. Try to minimize glare.
• Check that your patient has brought and is wearing eyeglasses or contact lenses, if needed.
• Make sure that handwritten instructions are clear. When using printed materials, make sure the type is large enough (at least 14-point font) and the typeface is easy to read.
• If your patient has trouble reading because of low vision, consider providing alternatives, such as audio instructions, large pictures or diagrams, and large pillboxes with raised markings.

Families and caregivers as part of the health care team

Family members and other informal caregivers play a significant role in the lives of their loved ones. They may provide transportation and accompany an older adult to medical appointments. In many cases, they act as facilitators to help the patient express concerns and can reinforce the information you give. But first, to protect and honor patient privacy, check with the patient by asking how they see the companion’s role in the appointment.

It is important to keep the patient involved in their own health care and conversation. Whenever possible, try to sit so that you can address both the patient and companion face-to-face. Be mindful not to direct your remarks only to the companion.

You might ask the companion to step out of the exam room during part of the visit so you can raise sensitive topics and provide the patient some private time if they wish to discuss personal matters. For example, if you’re conducting a test of a patient’s cognitive abilities, you might ask the companion to step out so they can’t answer questions or cover for the patient’s cognitive lapses.

Some patients may ask that you contact their long-distance caregivers to discuss conditions or treatment plans. Make sure these patients fill out any necessary paperwork giving permission for you to speak with specific family members or friends if they are not present at the appointment.

Families may want to make decisions for a loved one. Adult children especially may want to step in for a parent who has cognitive impairment. If a family member has been named the health care agent or proxy, under some circumstances they have the legal authority to make care decisions. However, without this authority, the patient is responsible for making their own choices. When necessary, set clear boundaries with family members and encourage others to respect them.

Obtaining a thorough history

Obtaining a complete medical history — including current and past concerns, lifestyle, and family history — is crucial to good health care.

You may need to be especially flexible when obtaining the medical history of older patients. When possible, have the patient tell their story only once, even if other health care professionals in the office or home would typically assist in gathering the information. The process of providing their history to another staff member and then again to you can be tiring for patients.

Open-ended questions encourage a more comprehensive response, but yes-or-no or simple-choice questions may be helpful if the patient has trouble responding. Also be sure to ask if anything in a person’s health, medications, or lifestyle has changed since their last visit. You may want to get a detailed life and medical history as an ongoing part of older patients’ office visits and use each visit to add to and update information.

Here are some strategies for obtaining a thorough history:

• Gather preliminary data. If feasible, request previous medical records or ask the patient or a family member to complete forms and worksheets at home or online prior to the appointment. Try to structure questionnaires for easy reading by using large type (at least 14-point font) and providing enough space between items for thorough responses. Keep any questionnaires meant to be filled out in the waiting room as brief as possible.
• Elicit current concerns. Older patients tend to have multiple chronic conditions. You might start the session by asking your patient to talk about their main concern. For example, “What brings you in today?” or “What is bothering you the most?”
• Ask prompting questions. The main concern may not be the first one mentioned, especially if it is a sensitive topic. Asking, for example, “Is there anything else?”, which you may have to ask more than once, helps to get all of the patient’s concerns on the table at the beginning of the visit. If there are too many concerns to address in one visit, plan with the patient to address some now and others next time. Encourage the patient (and their caregivers) to bring a written list of concerns and questions to a follow-up appointment.
• Discuss medications. Older people often take many medications prescribed by several different doctors and some drug interactions can lead to major complications. Suggest that patients bring a list of all of their prescription medications, over-the-counter drugs, vitamins, and dietary supplements, including the dosage and frequency of each. Or suggest that they bring everything with them in a bag. Check to ensure the patient is using each medication as directed.
• Ask about family history. The family history not only indicates the patient’s likelihood of developing some diseases but also provides information about the health of relatives who care for the patient or who might do so in the future. Knowing the family structure will help you evaluate what support may be available from family members.
• Ask about functional status. The ability to perform basic activities of daily living (ADLs) reflects and affects a patient’s health. There are standardized ADL assessments that can be done quickly in the office. Understanding an older patient’s usual level of functioning and learning about any recent significant changes are fundamental to providing appropriate health care.
• Consider a patient’s life and social history. Ask about where they live, who else lives in the home or nearby, neighborhood safety, their driving status, and access to transportation. Determine eating habits, assess their mood, and ask about tobacco, drug, and alcohol use. Factor in typical daily activities and work, education, and financial situations. Understanding a person’s life and daily routine can help you to understand how your patient’s lifestyle might affect their health care and to devise realistic, appropriate interventions.

Discussing medical conditions and treatments

Approximately 85% of older adults have at least one chronic health condition, and 60% have at least two chronic conditions. Clinicians can play an important role in educating patients and families about chronic health conditions and can connect them with appropriate community resources and services.

Most older patients want to understand their medical conditions and learn how to manage them. Likewise, family members and other caregivers can benefit from having this information. Physicians typically underestimate how much patients want to know and overestimate how long they spend giving information to patients. Devoting more attention to educating patients and their caregivers can improve patients’ adherence to treatment, increase patients’ well-being, and save you time in the long run.

Clear explanations of diagnoses are critical. Uncertainty about a health problem can be upsetting, and when patients do not understand their medical conditions, they are less likely to follow their treatment plans. It is helpful to begin by finding out what the patient understands about their condition, what they think will happen, and how much more they want to know. Based on the patient’s responses, you can correct any misconceptions and provide appropriate information.

Treatment plans need to involve patients’ input and consent. Ask about their goals and preferences for care and focus on what matters most to them. Check in with your patient about feasibility and acceptability throughout the process, thinking in terms of joint problem-solving and collaborative care. This approach can increase the patient’s satisfaction while reducing demands on your time.

Treatment might involve lifestyle changes, such as a more nutritious diet and regular exercise, as well as medication. Tailor the plan to the patient’s situation and lifestyle and try to reduce disruption to their routine. Keep medication plans as simple and straightforward as possible, indicating the purpose of each medication and when it should be taken. Tell the patient what to expect from the treatment.

These tips may help discussions about medical conditions and treatment plans:

• A doctor’s advice generally receives the greatest credence, so the doctor should introduce treatment plans. Other medical team members can help build on the doctor’s original instructions.
• Let your patients know that you welcome questions. Tell them how to follow up if they think of any additional questions later.
• Some patients won’t ask questions even if they want more information. Consider making information available even if it’s not explicitly requested.
• Offer information through more than one channel. In addition to talking with the patient, you can use fact sheets, drawings, models, or videos. In many cases, referrals to websites and support groups can be helpful.
• Encourage the patient or caregiver to take notes. It’s helpful to offer a pad and pencil. Active involvement in recording information may help your patient better retain information and adhere to the treatment plan.
• Repeat key points about the health problem and treatment plan at every office visit, providing oral and written instructions, and check that the patient and their caregiver understand the information.
• Provide encouragement and continued reinforcement for treatment or necessary lifestyle changes. Call attention to the patient’s strengths and offer ideas for improvement.
• Make it clear that a referral to another doctor, if needed, does not mean you are abandoning the patient.

Confusion and cognitive problems

A patient may still seem confused despite your best efforts to communicate clearly. In those instances, work to:

• Support and reassure the patient, acknowledging when responses are correct or understood.
• Make it clear that the conversation is not a “test” but rather a search for information to help the patient.
• Consider having someone from your staff call the patient to follow up on instructions.

Cognitive impairment, however, is more than general confusion or normal cognitive aging. If you observe changes in an older patient’s cognition or memory, follow up with screening and diagnostic testing, as appropriate.

There are a variety of possible causes of cognitive problems, such as side effects from medications, metabolic and/or endocrine changes, delirium, or untreated depression. Some of these causes can be temporary and reversed with proper treatment. Other causes of cognitive problems, such as Alzheimer’s disease, are chronic conditions but may be treated with medications or nondrug therapies. Having an accurate diagnosis also can help families wanting to improve the person’s quality of life and better prepare for the future.

Read more about Assessing Cognitive Impairment in Older Patients and Caring for Older Patients With Cognitive Impairment.

Sensitive topics

Caring for an older patient requires discussing sensitive topics related to safety, independence, and health. Older patients may be hesitant to bring up certain problems and other concerns such as:

• Advance care planning
• Driving
• Elder abuse
• End of life
• Health care costs
• Long-term care
• Mental health issues, such as depression
• Sexuality and sexual health
• Social isolation and loneliness
• Substance use/misuse, including alcohol
• Urinary incontinence

There are techniques for broaching sensitive subjects that can help you successfully start the conversation. Try to take a universal, nonthreatening approach that frames the subject as a common concern of many older patients (such as, “Many people experience …” or “Some people taking this medication have trouble with…”). You can also share anecdotes about patients in similar circumstances, though always clearly maintaining patient confidentiality, to ease your patient into the discussion.

Some patients will still avoid issues that they think are inappropriate to discuss with clinicians. One way to overcome this hesitation is to keep informative brochures and materials readily available in the exam room and waiting areas. To learn more, please visit https://www.nia.nih.gov/health/health-care-professionals-information/talking-your-older-patients

People with Alzheimer’s disease or a related dementia often have problems managing their money. Research shows that money problems may be one of the first noticeable signs of the disease.

Early on, a person with dementia may be able to perform basic tasks, such as paying bills, but they are likely to have problems with more complicated tasks, such as balancing a bank account. As the disease gets worse, the person may try to hide financial problems to protect their independence. Or the person may not realize that they are losing the ability to handle money matters.

Signs of money problems

Look for signs of money problems such as trouble counting change, paying for a purchase, calculating a tip, balancing a checkbook, or understanding a bank statement. The person may be afraid or worried when they talk about money. You may also find:

• Unopened and unpaid bills
• Lots of new purchases on a credit card bill
• Unexpected new merchandise in the home
• Money missing from the person’s bank account

A family member or legal representative should check bank statements and other financial records each month to see how the person with dementia is doing and step in if there are serious concerns. This can protect the person from becoming a victim of financial abuse or fraud.

Take steps early

Understandably, many older adults will resist allowing someone else to take over their financial affairs. To provide support while also respecting the person’s independence, a family member or trusted friend can do several things to help the person with dementia:

• Start a conversation about the importance of a monthly budget. Help the person develop a spending plan on paper. If the person is comfortable with computers or a smartphone, share information about secure online budgeting tools, many of which are free.
• Set up automated bill payments. Arrange for utilities, mortgage, rent, and other expenses to be paid through automatic deductions from a bank account. This will ensure that bills are paid correctly and on time.
• Discuss ways to help manage spending. Consider giving the person small amounts of cash to have on hand, reducing the spending limit on credit cards, and canceling unneeded credit and debit cards. Offer to go grocery shopping or have items delivered to reduce overspending and ensure the person has what they need at home.

To prevent serious money problems as the disease gets worse, you may have to take charge of the person’s financial affairs through legal arrangements. It’s important to handle the transfer of financial authority with respect and understanding.

You can arrange consent to manage the person’s finances via a durable power of attorney for finances, preferably while the person can still understand and approve the arrangement. To get started, consider taking steps to:

• Establish consent to manage finances. To prevent serious problems, consider naming a legal representative, called a proxy, to access and manage the person’s financial affairs. A lawyer may not be required to establish a legal proxy, but they can provide guidance and advice if needed. Learn more about finding legal resources.
• Plan for long-term care costs. Consider options for help at home, such as a personal care assistant or home health care aide. Find out how much they cost and whether Medicare, Medicaid, or long-term care insurance will cover any of the costs. If the person needs more care, they might move to a residential facility, such as an assisted living community or nursing home. Learn more about paying for long-term care.
• Gather important papers and discuss financial and estate planning. Gather the person’s important records and documents in one place. Basic papers include the person’s birth certificate, insurance information, and banking records. These papers should also include the person’s will and any health care or financial directives to ensure that their wishes are honored. Learn more about advance care planning and the process of getting your affairs in order.

Guard against financial abuse and fraud

People with dementia may be targets of financial abuse or fraud. Sometimes, the person behind it is a stranger. But financial abuse and fraud can also be carried out by a “friend” or family member. Telephone, email, or in-person scams can take many forms, such as:

• Identity theft
• Get-rich-quick offers
• Phony offers of prizes or home or auto repairs
• Insurance scams
• Government impersonator scams
• Health scams, such as ads for unproven memory aids
• Threats or intimidation

Look for signs that the person with dementia may be a victim of financial abuse or fraud. For example:

• Signatures on checks or other papers don’t look like the person’s signature.
• The person’s will has been changed without permission.
• The person’s home is sold, and they did not agree to sell it.
• The person signed legal papers (such as a will, power of attorney, or joint deed to a house) without knowing what the papers mean.
• Valuable belongings, such as jewelry or electronics, are missing from the home.

To lower the risk of telemarketing schemes, help place the person’s phone number on the National Do Not Call Registry. Consider registering the person for fraud alerts through their bank, credit card company, a national credit bureau, or other credit monitoring service.

One reason that scammers target older adults is that they are less likely to report suspected fraud. If you think that someone has been the target of a scam, contact the National Elder Fraud Hotline at 833–372–8311. You can also contact your local police department or the attorney general of your state or territory, and you can report the scam to the Federal Trade Commission. To learn more, please visit https://www.nia.nih.gov/health/legal-and-financial-planning/managing-money-problems-people-dementia.